WHO Board Tackles Reform, Engagement With Non-State Actors

The World Health Organization Executive Board spent long hours this week discussing the progress of the reform of the organisation. Among items covered were the reform implementation plan, the engagement of WHO with non-state actors, and ways to improve decision-making by the organisation’s governing bodies.

On the third day of the WHO Executive Board (EB) meeting being held from 20-25 January, member states addressed in particular the report [pdf] of the WHO secretariat on the implementation of the reform decided upon by member states in 2011 and which covers programmatic, governance, and managerial reforms.

The chair of the Programme, Budget and Administration Committee of the Executive Board (PBAC) presented the report [pdf] of the PBAC, which met earlier in January, on the WHO reform, and called for member states “to expedite the implementation of the governance reforms in order to achieve strengthened oversight and strategic decision-making by WHO’s governing bodies.” He also noted concerns at the increasing number of agenda items in governing bodies meetings (IPW, WHO, 20 January 2014).

Board members took note of the secretariat’s report, as the secretariat remarked that there is a need to describe how different policies are translated into changes across the organisation.

Options to Improve Decision-Making

Another subject of the WHO reform on the agenda were options [pdf] for improved decision-making by the governing bodies, one of which [pdf] is the use of an electronic voting system for the appointment of the director-general. Also addressed under the topic of the WHO reform was an item [pdf] on streamlining national reporting and communication with member states.

Many countries, EB members and non-EB members alike, said the excessive and growing volume of agenda items in governing bodies should be addressed. The way to address the problem however did not meet immediate consensus. Delegates found it hard to agree on the methodology to determine the relevance/urgency of agenda items if the agenda reached the optimum number of items decided upon.

Executive Board Chair Jane Halton, secretary of the Australian Department of Health and Ageing and responsible for Australia’s national health system, said any decision would not be set in stone and the EB could decide on a trial period for a new management of agenda items.

The United States underlined the necessity to develop new resolutions only when “absolutely necessary” and proposed to have an online library of resolutions that can be searched by topic areas, to avoid duplicative work or that a new resolution be in conflict with past work. Some other delegations underlined the responsibility of member states to exercise self-restraint in the number of agenda items and resolutions, which would be more efficient than criteria for agenda items.

A draft resolution [pdf] on methods of work of the governing bodies was issued by the secretariat, but was not yet agreed. The draft resolution includes a proposal to introduce webcasting for future public sessions of the PBAC and the EB, and a proposed revision of the process for the agenda of the EB.

Non-State Actors and Protecting WHO Integrity

The issue of the engagement of the WHO with non-state actors was a prickly one. According to the report [pdf] by the secretariat, “the overall objective of WHO’s engagement with non-State actors is to work towards the fulfilment of the Organization’s mandate by making better use of non-State actors’ resources (including knowledge, expertise, commodities, personnel and finances).”

A large number of countries who took the floor remarked on the difference between non-state actors, whether they are industry or profit-oriented, or public interest non-governmental organisations (NGOs), and asked that this difference be reflected when assessing non-state actors, through different policies, for example. They also stressed the imperative protection of WHO from undue influence, conflicts of interest, and preservation of the organisation’s integrity. Some developed countries said they would prefer that all non-state actors be assessed in the same way.

A number of speakers, while supporting the “five over-arching principles” of the report, asked for further consultations between the EB and the upcoming WHA to address future engagement of WHO with non-state actors (IPW, WHO, 18 January 2014).

The report includes a section on next steps to reform WHO’s engagement with non-state actors, as well as a section on due diligence, risk assessment and risk management.

WHO Director General Margaret Chan said the WHO engagement with non-state actors in the 21^st century is to exercise the leading and coordinating role of public health. “We are not doing this for money” she said. Two red lines cannot be crossed by non-state actors, she stated: the policy space of states and the technical standards space of WHO.

No industry or business interest organisation should try to exert influence to their benefit, she insisted. She also asked that civil society organisations act as whistle-blowers. It is easier to distinguish industry from the others, as they are profit-makers, she said

She said she would analyse the different positions on whether civil society actors should be assessed in a different way than industry groups and would get back to member states on the issue, without specificity on when that would be.

Civil Society Concerned about Industry Participation

According to Nicoletta Dentico, co-director of Health Innovation in Practice (HIP) and affiliated with the Democratizing Global Health Coalition on the WHO Reform (DGH), created in May 2011 to study and accompany the reform initiative, “exactly three years from the beginning of the WHO reform, it is clear that we have come to the crucial knot of the process: how, and why, the organisation should interact with the external entities, including those that were created, or have acted to sideline its constitutional mandate, if not erode it.”

“Member states’ decision on WHO’s rules of engagement with external actors today will determine for a long time the role of the WHO in global governance for health, and will have a major impact on the realisation of the universal right to health for the future, in a complex world where structural inequalities are growing, and health makes no exception,” she told Intellectual Property Watch.

A positive step for civil society, she said, is the removal of the so-called “24 hour rule,” proposed in the draft decision. This procedure asked that NGOs’ interventions during meetings of the governing bodies be submitted 24 hours before the item discussion, so that “their statement could be scrutinized for censorship, which happened several times,” Dentico said. It was “a bad practice not to be found in other UN agencies, and which WHO member states were unaware of until recently,” she added.

The EB also discussed the financing dialogue [pdf], and the strategic resource allocation [pdf] and it was suggested that an extended PBAC meeting take place to accommodate further discussion on those topics. Also suggested was to constitute a group representing regions to work together with the PBAC chair and use experts as appropriate and necessary to help with the technical financial work.