Countries ‘Disappointed’ With WHO Reform Progress

The World Health Organization secretariat this week reported to its member states on progress made in implementing sweeping programmatic, governance, and management reforms. The report? WHO has made progress, but there is still a long way to go. Member states, meanwhile, used the opportunity to express concern about the way it is going.

The secretariat report is here [pdf].

Member states were also asked to approve a set of recommendations [pdf] and requested reforms drawn up by the Open-Ended Intergovernmental Meeting on Governance Reform.

These recommendations push for:

-Better agenda planning, including limiting the number of agenda items and requesting a 4-6 year advance planning schedule of agenda items;

-Improved transparency & accountability both within and outside the organisation, including clarifying lines of authority, standardising processes for nominating regional directors, and clarifying the selection process for assistant directors-general; and

-Increased alignment and coordination between all three levels of WHO and strengthening oversight of the regional and country offices

The draft decision was approved by consensus, consistent with WHO tradition. Nevertheless, more than a few member states from both the global North and South expressed their dissatisfaction with the document in relatively blunt terms.

Following the WHA opening plenary on the first day, work was divided into two committees, A and B. Committee B started today. The first order of business for Committee A on 23 May was an update on the WHO reform process, which has been ongoing since 2011. Work on the topic was concluded, except for the separate issue of how to handle WHO relations with non-state actors, which is the subject of a closed-door government-only drafting group this week (IPW, WHO, 24 May 2016).

Decentralisation Dissension

One of the major areas of disagreement seems to be WHO (de)centralization.

WHO has an organisational structure unique among international organisations: an international headquarters in Geneva; six regional offices, each with a regional director appointed by the region’s member states, rather than the director general; and 149 country offices.

Several European Union members, as well as the United States, expressed concern that too much decentralization is hamstringing the organisation. They advocated for increased efficiency, transparency and coherence across all three levels, including stronger management control at all levels and stronger monitoring and performance indicators. The delegate from Norway neatly summed up this position, proclaiming “we strongly believe in the concept of One WHO.”

For EU states, in particular, “disappointed” seemed to be the word of the day. Germany was unequivocal in its desire for WHO to remain the leading global health agency and is concerned by the widespread perception that the agency is losing ground to newer, more efficient global health organisations.

The German delegate continued: “This is why we were disappointed that there was no consensus on the central issue of accountability between the DG and the regional directors. Let us be very clear. We highly value the role of the regional directors. However, if it’s politically impossible for the chief technical and administrative officer of this highly decentralized organisation to hold her senior staff formally to account, then [WHO] will never be a truly effective global health organisation.”

The delegate from Monaco was even more direct: “My delegation is extremely disappointed by the results we’ve seen. We don’t think we’ve gone far enough. The consensus achieved was achieved on relatively marginal issues from which we don’t really see any improvements in the general governance of the organisation…We will accept the draft decision as is but we would like to once again state how disappointed we are and we would like to come back to this in the future.”

In contrast, countries like Somalia, Panama, Bangladesh, Iraq, Indonesia, and Mozambique (speaking on behalf of the African Union) argued that WHO’s primary focus should be strengthening health systems and country capacity. They fear that too much hierarchical accountability and centralization would weaken WHO’s ability to provide technical support at the regional and local level.

Somalia, in particular, stressed that WHO should do more to align its activities with country priorities and that agenda-setting should happen at the country level rather than in Geneva.

With respect to managerial reform, these states repeatedly called attention to the need for greater diversity and wider geographical representation at headquarters, in part because it would help build country capacity.

Somalia declared, “The success of WHO reform should ultimately be judged by WHO performance at country level.” This pointedly contrasts with Germany’s concern that “member states and regions seem to see their regional specificities as being incompatible with the concept of WHO as one. We are concerned that if we keep on arguing in favour of more decentralization and less alignment, WHO as a whole is at a crossroads and faces the risk of falling apart into seven separate entities.”

In short, the German delegate probably summed up the day best when in reference to the Inter-Governmental Meeting recommendation he said “we have to confess that we member states were unable to come forward and find a consensus.”

Mara Pillinger is a PhD candidate at George Washington University and a Junior Visiting Scholar at the Global Institution. She is a researcher at Intellectual Property Watch. She tweets @mplng.

 

Image Credits: Mara Pillinger