WHO Members Note Reform Progress, Ask For Speedy Implementation

World Health Organization members this week examined progress made in the ongoing reform of the UN agency. Members speaking in committee made firm requests for speedy implementation of reforms, and commended WHO’s efforts toward financial sustainability, with some cautions.

Member states in committee addressed programmes, management and governance. The reform is now three years into the process. There was praise but some remarked on the slow progress of the governance reform.

The WHO budget appears to show more predictability than during the preceding biennium, with some 85 percent of the budget covered.

The 67th World Health Assembly (WHA) is meeting from 19-24 May.

The committee adopted a number of reports and draft decisions related to reform. The only remaining item is the engagement of WHO with the private sector, non-governmental organisations, foundations and academics. This was addressed on the second day of the WHA and was discussed without success in a small drafting group. Member countries could not agree on the language of a framework that would establish rules of engagement for non-state actors (IPW, WHO, 22 May 2014).

‘From Tango to Quick Step’

First to be discussed yesterday was a progress report [pdf] by the WHO director general on the implementation of the reform, and a report [pdf] of the Programme, Budget and Administration Committee of the Executive Board (PBAC). The committee noted the report.

The reform is three-pronged and deals with programmes and priority-setting, governance, and management. A number of countries remarked on the slow pace of the reform.

Namibia, representing the African region, said the governance reform is moving slowest, warning, “If governance reform is not sorted out and implemented, little progress will be achieved in the two other areas.” WHO country offices should be the centrepiece of the reform, and should be equipped with staff and resources, he said. The African region called for acceleration of the reform process, and for a faster transition from policy analysis to implementation, he said.

The European Union also said it was concerned with slow progress on human resources and governance, and said they would like “to go from tango to quick step.” Germany agreed on slow progress.

Namibia for the African region also voiced concern on the “disproportionately unfavourable” representation of African experts in leadership, managerial and technical positions in WHO headquarters. Ongoing reform should address issues of rotation mobility and diversity, he said.

The secretariat said it had heard the clear message that the reform needs to move at a quicker pace from upstream policy analysis to more downstream implementation. “The secretariat is keen to move in that direction,” the WHO official said.

The reform is an open-ended process, he said, and the secretariat is trying to create an organisation that is flexible and able to adapt to changes. “There is no turning back but we have to deliver on the results,” he concluded.

Follow-up on Financing Dialogue

The committee also adopted the draft decision proposed by the PBAC about the financing dialogue on the financing of the programme budget. The financing dialogue, which aims to “ensure a match between WHO’s results and deliverables,” was launched in June 2013, according to the report of the secretariat [pdf].

According to the report, as a direct result of the financing dialogue, “18 Member States and other contributors shared firm funding projections totalling US$ 935 million, which will assist in programme planning, deepen the understanding of where the residual shortfalls will be and help in the allocation of flexible resources,” Available and projected funds total 85 percent of the WHO programme budget for the 2014-2015 biennium, according to the report.

“The overall level of funding of the Programme budget 2014-2015, as at 31 October 2013,is better than at the same time in the previous biennium, with 61% of required funding available compared with 51% as at 31 October 2011,” the report states.

The report notes that expected voluntary contributions from several member states and other contributors were not yet included in the projections, and that the WHO, through continued dialogue with these partners, expects to reach the full funding of the programme budget.

The reports also remarks on the vulnerability of the WHO funding, where the organisation relies on 20 contributors for 80 percent of all voluntary contributions, 11 of which are non-member state contributors.

The WHA also was also expected to consider an independent evaluation [pdf] of the financing dialogue by an external consultant.

Switzerland said the financing dialogue was a “courageous step forward” and Mexico underlined the added value of the financing dialogue. The United States commented on the level of detail as being important to understand how contributions are put to work. Sweden and Germany expressed concern about the gap between the 85 percent available and projected funds and the full funding of the budget.

The budget of the WHO appears to show more predictability than during the preceding biennium, with some 85 percent of the budget covered. This is an improvement over the situation three years ago that put the organisation in jeopardy and was the primary reason for its reform.

In 2011, WHO Director General Margaret Chan announced to the Executive Board that “the best-case scenario presents a US$ 200 million difference between projected income and expenditure, a worst-case scenario presents an equally possible shortfall of up to US$ 600 million” (IPW, WHO, 25 January 2011). A main theme of the 2011 World Health Assembly was making cuts in staff and expenses (IPW, WHO, 23 May 2014).

London-based Chatham House think tank this week circulated a report containing an analysis of WHO, with many suggestions for improvement. The report found that in the year 2013, the Bill and Melinda Gates Foundation became the top funder of the WHO, surpassing the United States government.

Strategic Resource Allocation

The committee also noted the report of the PBAC on the strategic resource allocation. The PBAC, which met from 14-16 May, considered the report of the Working Group on Strategic Resource Allocation. The Working Group report stated that “the development of a new strategic resource allocation methodology in WHO is quite complex and interdependent with many other WHO reform initiatives that are currently under way…”

The PBAC “agreed that more analysis and in-depth discussion are needed in order to propose a new strategic resource allocation methodology for consideration by the Executive Board in January 2015.”

The January 2014 Executive Board endorsed a proposal by the WHO director general to establish a working group on strategic resource allocation to provide guidance to the secretariat, according to the WHO report.

The working group includes six members of the PBAC (Belgium, Cameroon, Egypt, Malaysia, Maldives and Mexico).

Financing of Administrative and Management Costs

The committee also noted a report on the financing of administrative and management costs. According to the report by the WHO secretariat [pdf], following an external review, a number of recommendations were made to improve budgeting, cost containment and financing. Proposed next steps were subsequently outlined by the January Board meeting, which the report details.

Improved Decision-Making

The committee further approved the draft resolution of the PBAC on the improved decision-making by the governing bodies of the organisation. The issue was discussed at the January Executive Board meeting (IPW, WHO, 24 January 2014), which adopted four resolutions to be adopted by the WHA, in document A97/5 [pdf]. The first one was about the webcasting of the sessions of the WHA and the Executive Board.

The second proposed to introduce an electronic voting system for the appointment of the WHO Director General. The third suggested to amend the rules of procedure of the WHA to set clear timeline for the introduction of proposals for resolutions or decisions and proposals and amendments related to items on the agenda. The last one proposed that progress reports be only considered by the WHA and no longer by the Executive Board.

The WHA is also considering a report [pdf] on financial and administrative implications for the secretariat of those resolutions.

A number of delegations remarked on the importance of reducing the number of agenda items to be dealt with by the WHA and the EB.

Thailand raised concerns about the security and confidentiality of the electronic voting system, which were answered by the secretariat representative who said that the WHO would rent the electronic voting system from the World Meteorological Organization (WMO), and assured that the votes would remain secret. The WMO and the International Labour Organization are already using this system without complaints on security and confidentiality, the secretariat said.

At the WHA, the members review WHO’s work and set goals for the organisation. They also consider draft decisions taken by the WHO Executive Board. Two committees note reports and approve draft resolutions, which are then submitted to the plenary meeting. The committee that handled the reform issues, Committee A, is usually tasked with technical and health matters.