Role Of Industry, NGOs, Foundations At WHO Under Intense Debate

A proposal to increase the engagement of “non-state actors” – industry, nongovernmental organisations, foundations and academics – in the activities of the World Health Organization is under intense debate at the annual World Health Assembly this week.

The non-state actor issue is considered by a number of governments and stakeholders as a major item in the overall reform of the organisation. A draft framework on the engagement of those non-state actors was not approved when it was first raised in committee, and a drafting working group was tasked with improving it.

The drafting group met last night and is continuing work today.

According to sources inside the drafting group, progress began slowly last night despite efforts by some to move it rapidly, as the text is being analysed paragraph by paragraph.

Concerns raised by some developing countries relate to the influence of the private sector in WHO policymaking, and ways to prevent conflicts of interest.

The World Health Assembly is taking place from 19-24 May. One of the focuses of the Assembly is the ongoing reform of the WHO, begun three years ago. Part of this reform is expected to establish a framework governing the relationship of the global health agency with non-state actors interacting with it. These are defined as non-governmental organisations, private sector entities, philanthropic foundations and academic institutions.

The issue of non-state actors was addressed by the January session of the WHO Executive Board (IPW, WHO, 23 January 2014) with a proposed framework for engagement with non-state actors. A number of member states remarked on the difference between the different kinds of non-state actors and asked that this difference be reflected when assessing them.

On 27-28 March, a second informal consultation took place on the engagement with non-state actors. This followed a first informal consultation in October.

A new version of the proposed framework [pdf] was presented at this week’s WHA.

The framework was examined by the Programme, Budget and Administration Committee of the Executive Board, (PBAC) on 14-16 May.

According to the report of the PBAC to the WHA, during the March meeting, “several Member States indicated that they had additional comments and input to give on the current draft of the framework..:” Some other member states, the report notes, “wished to recommend to the World Health Assembly that it approve the draft framework in its current form:”

It was proposed that a working group be established, the report says.

This was reflected on 20 May as the WHA examined the report of the secretariat.

Some countries proposed to adopt the draft resolution on the framework, included in the report, such as Finland, Canada, the United States, and Australia, while others such as Pakistan and the UNASUR (Union of South American Nations) group, according to sources, considered that more discussions were needed on the framework. South Africa said different actors have different roles to play and measures should be put into place to manage conflicts of interests, but it did not wish to reopen the debate.

The majority of countries who took the floor agreed that WHO should not fall under undue influence.

Thailand said over the last decade the role of non-state actors has increased. They are now recognised as partners in global health mechanisms, the delegate said, adding that non-state actors should stand at the same level as member states as it was preferable to have non-state actors at the table than having them work behind the scene with member states. The country warned about the challenges of selection process and specified that member states should remain main actors of the WHO.

The US said the new framework represents a new era of engagement, and is an important piece in the reform of the organisation. Japan described the engagement of non-state actors as an “extremely sensitive issue.” He called for comprehensive monitoring, full transparency and strict compliance measures.

The EU said they are “convinced that interaction with non-state actors is a prerequisite for strengthening the role of WHO in the global health architecture, while at the same time maintaining the integrity and objectivity of the organisation.” They called to adopt the framework, whose functioning can be revisited “in two years’ time.”

Civil society insisted on the fact that the private sector carries out some activities that are incompatible with WHO work.

Medicus Mundi said the framework was a significant step forward but it may not be sufficient to address the problem of conflict of interest. “In a situation where managers at every level are competing for visibility and donor attention, it is not surprising that the risks of improper influence are seen as low priority,” he said, urging member states “to accept their responsibilities for this vital organisation, increase assessed contributions and curb the dominance of the donors.”

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) made reference to their “firm respect of the supremacy of WHO’s member states in normative work and the need to design a transparent and comprehensive set of rules that are symmetrically applicable to each actor with no discrimination.”

The IFPMA asked that practices of risk management and due diligence be “designed and enforced equally among all non-state actors.” This refers to the fact that the draft framework contains four separate WHO policies and operational procedures on engagement with the categories of non-state actors that have been described in the document.