WHO Board Debates Framework On Engagement With Non-State Actors

The World Health Organization routinely works with a number of outside actors, such as non-governmental groups, philanthropic organisations, industry and academics. Member states have been trying to establish a framework to regulate such engagement and are still working to produce a consensus document. This week they are trying to extend the mandate of an intergovernmental meeting in the hope that an ultimate meeting in April can solve remaining issues.

The 138^th WHO Executive Board (EB) meeting is taking place from 25-30 January. An Open-ended Intergovernmental Meeting on the draft framework of engagement with non-state actors has been seeking to reach a consensus text. The framework is intended to prevent potential conflicts of interest and preserve the independence of the WHO, while allowing the organisation to engage with a range of non-state actors.

The text as it stands in the annex of the meeting document [pdf], is colour-coded, with text highlighted in green for agreed text, and yellow for non-consensual text. The chair of the intergovernmental meeting, Julio Mercado of Argentina, said yesterday that 161 paragraphs in the text are now green and 15 still open, some of which should be easy to agree on, and others requiring compromise.

The intergovernmental meeting had requested that its mandate be extended so that a meeting could be convened between this week’s EB and the next World Health Assembly (WHA) in May.

The Programme, Budget and Administration Committee (PBAC) of the EB considered the request and addressed two recommendations to the EB in its report [pdf]. Kathryn Tyson of the United Kingdom, a member of the PBAC, yesterday said the recommendations were:

• To “endorse the request of the Open-ended Intergovernmental Meeting to extend its mandate, so that it may resume its work for a final session from 25 to 27 April 2016, in order to submit a consensus text of the draft framework and a draft resolution to the Sixty-ninth World Health Assembly through the Programme, Budget and Administration Committee; and”
• To “request the Secretariat to present an objective and balanced report on the implications for WHO of the implementation of the framework, well in advance of the final session.”

Agreement on April Meeting, Split on “Implications” Report

All countries taking the floor appeared to agree with the PBAC recommendation to hold a final session in April so that a consensus may be reached in time for the WHA. But a number of developing countries did not agree with having a report on implications be provided in advance of the final session.

Egypt for WHO Regional Office for the Eastern Mediterranean (EMRO) said one particularly important outstanding issue for the region is the paragraph referring to the engagement with non-state actors in the context of emergencies. Egypt also said secondment, in which an employee from a non-state actor would be able to work within WHO, is one of the most controversial issues in the draft text. The EMRO representative said it has already been agreed that the framework be evaluated, which entails the possibility of revisions.

Malta, speaking for the European Union, said it is crucial that WHO engage actively with all relevant actors. The EU supported the April meeting, and said that WHO’s work with non-state actors in emergency situations was a complicated issue.

However, the EU is concerned that if the Framework of Engagement of Non-State Actors (FENSA) is fully implemented as it currently stands, “it may place limitations on WHO’s flexibility to react effectively to an emergency with health consequences,” the representative said.

The EU is concerned about the “broader impact of the implementation of the FENSA on the organisation” he said, and added that the EU support a paper including assessments from all regional offices on the implications of FENSA before the April meeting.

Gambia for the Regional Office for Africa (AFRO), said the region does not support the PBAC recommendation for the secretariat to present an implications paper before the final session, as it would “disturb discussions and delay the process,” the delegate said.

This was shared by India, which said the implications report may unnecessarily complicate the process of negotiations in the April meeting, and would be likely to prolong discussions and reopen issues that have been already agreed upon.

China, and the United States both supported the implications document. The US said it would help to get the fullest possible understanding of the implications of FENSA for the organisation, and it should not be forgotten that the framework is about the need to enhance WHO’s ability to engage with a range of non-state actors.

Norway mentioned a non-paper [pdf] provided in October by the WHO Pan American Sanitary Bureau/Regional Office for the Americas (PAHO) on the implications of the implementation of FENSA. The paper presents some unintended consequences, such as the fact that the high number of engagements could lead to an overload of the clearance system and transparency to a certain level could lead to the reluctance of some actors to engage with WHO. Zambia remarked that the non-paper delayed discussion of the intergovernmental meeting in October.

Germany underlined the need to seek the view of regional offices, such as PAHO, on the implementation of FENSA. The representative underlined five issues: FENSA should be implementable, should not lead to WHO stopping work with non-state actors because the process is too complex, should allow the WHO to go on with its day-to-day work, should not impede WHO’s work in emergencies, and should be implemented in all six regions in the same way, with no double standard.

Today, with what she characterised as “overwhelming support to expend the mandate,” EB Chair Precious Matsoso, director-general of the National Department of Health of South Africa, said the implications paper raised issues, in particular on its timing. She thus left the issue open so that member states can work on a way to proceed.

Non-State Actors Give their Take

A number of NGOs took the floor today, such as the International Baby Food Action Network (IBFAN), the International Federation of Medical Students’ Associations (IFMSA), the International Pharmaceutical Federation (FIP), and Medicus Mundi International.

IBFAN lauded the fact that WHO staff secondments by the private sector was excluded from the draft framework. However, according to its statement [pdf], some principles, such as the principle of inclusiveness in the FENSA draft, “risks to open further channels for undue influences by the corporate and venture philanthropic sector, fundamentally undermining the agency’s capacity to set norms, standards and regulations.”

IFMSA called for more involvement of young people in global health issues, nationally and internationally, and said non-state actors include a diverse group with potentially contradicting interests. According to its statement [pdf], direct involvement of the industry in trade negotiations such as the Trans-Pacific Partnership, and the Transatlantic Trade and Investment Partnership “has proven not to be in the best interest of the populations,” so the group called for a cautious approach.

The FIP voiced concerns, according to its statement [pdf] on accreditation criteria. It warned against a “burdensome workload to asses systematically conflicts of interest” for all members of organisations, which may lead them to exclude large numbers of members, may it be active employees, researchers, or academics with some links with the private sector. “… it would make more sense that such conflict of interest management is applied at NGO board level and to individuals interacting with WHO.”

Medicus Mundi International found that the draft framework as it stands “constitutes a Trojan horse, which will legitimise the influence of private sector interests on the decision-making processes of the WHO.” In their statement [pdf], they said WHO’s independence is compromised by its financial crisis “and crippling dependency on tightly earmarked voluntary contributions.” This situation has led to “gross misalignments between the priorities identified in the Assembly and the expenditures underwritten by donors,” it said.

 

Image Credits: Catherine Saez