TWN Info Service on Health Issues (Jan12/06)
30 January 2012
Third World Network
find below an attempt to present succinctly the outcomes as well as
some of the discussion that took place on WHO Reform during the WHO
Executive Board that met from 16-23 January 2012.
find it to be useful.
Third World Network
Reform debate to continue, February fixed for member-driven priority
23 January (K. M. Gopakumar & Sangeeta Shashikant**): The reform
debate formally set in motion in January 2011 will continue during the
World Health Assembly and the Executive Board meeting following the
Assembly according to the outcomes of the 130th session of the EB that
took place on 16-23 January 2012.
issues remained unresolved and outstanding, as Member States (MS) demanded
more information and time for discussion. To satisfy these demands,
the EB outcomes sets out a detailed timeline for the Secretariat to
provide more information, for member states’ feedback on Secretariat’s
proposals and for further debate.
meantime the EB has fixed 27-28 February 2012 for the first intergovernmental
working group meeting on programmes and priority setting. This meeting
will chaired by the current Chairman of the EB Mr. Rahhal El Makkaoui,
state driven process on programmes and priority setting was agreed to
at the Special session of the EB (EBSS) held in November 2011 after
the Secretariat’s proposals to limit WHO's programme activities to five
core areas, i. e., health development (determinants, risks, diseases
and conditions); health security (public health and humanitarian emergencies);
strengthening health systems and institutions; evidence on health trends
and determinants; convening for better health as well as identifying
limited flagship priorities and priorities within five core areas of
work was rejected by MS.]
at the EB on the 9 documents on WHO reform prepared by the Secretariat
were structured under three broad themes i.e. programmes and priority
setting, governance and managerial reforms.
deliberations led to a Decision on Programmes and Priority Setting and
a Chairman’s Summary (Chair’s Summary). The Decision sets out the scope
of work and time lines for the intergovernmental process on programmes
and priority setting that will take place in February. The Chair’s Summary
touches more on issues of governance, managerial reforms and preparations
for reform discussion during the WHO governing bodies’ meetings in May.
[Chair’s Summary while commonly used in other international organization
is not usually seen in the WHO decision-making context. According to
sources, this method was opted for to avoid MS negotiation. Dr. Margaret
Chan, the Director General of WHO and the EB Chairman, both requested
that no negotiations take place on the Summary. Certain member states
were uncomfortable with this approach. China sought clarification from
the Legal Advisor as to whether the Chair’s Summary should be in the
form of a decision or a resolution. Legal Advisor clarified that there
was no need for a formal decision unless Member States requested].
and Priority Setting
on programme and priority setting sets the scope of work and terms of
reference for the member state driven process.
to the EB decision, the scope of work of the member state driven process
is to make recommendations to the up-coming WHA on “the categories,
methodology, criteria and timeline for programmes and priority setting
in order to serve as a guidance for the development of the next and
future general programmes of work, recognizing the important linkages
to other elements of the WHO reform process”.
decision then outlines the four specific objectives of the process,
(a) “to review and consider proposals on priority setting contained
in the background paper EB1 30/ 5 Add.1 taking as a basis for priority
setting: country needs, the relevance of WHO for all countries, its
specific comparative advantage and its leading role in global health";
elaborate methodology, criteria and the timeline for the priority-setting
consider possible ways of grouping WHO’s work into categories, including
but not limited to the seven categories contained in Documents EB 130/5
Add.1 as proposed for the framework for the next general programme of
identify additional analytical work by the Secretariat emerging from
these discussions, which will continue to the development of the next
and future general programmes of work”;
decision notes that the member state meeting on programmes and priority
setting to be held in Geneva in February can be followed up with any
number of meetings or discussions, as necessary, to be agreed at the
February meeting in order to finalise the work before WHA in May.
decision also requests the Secretariat to hold a presentation on the
afternoon of 26th February on current priority-setting practices, the
strength and weakness of those practices and the relationship between
the country cooperation strategies, the general programme of work formulation
process and the programme and budgeting process.
NGOs in official relations with WHO will be allowed to observe the presentation
but will not be allowed to participate in the member state process.
However the EB decision notes that a web based consultation will be
organized for such NGOs to present their views according to the agreed
scope of work.
The EB decision also states that presentations to be made on the 26th
February will be circulated three days in advance of the meeting, while
the other documents will be made available at least 7 days prior to
the February meeting. These documents are: (a) a three page summary
paper of the 26th February presentations; (b) mapping of the functions
of the organization (Article 2, WHO Constitution) in relation to the
categories proposed in document EB 130/5 Add.1 including cross cutting
global needs and areas of work; (c) an analyses of country cooperation
strategies that identifies the needs of countries in a way that allows
a determination of what WHO should focus its work on and where WHO is
best placed to add value; (d) a roadmap and timeline for the preparation
of the next general programme of work and the programme budget 2014
The EB decision also calls for the following documents to be made available
for the meeting: the Eleventh General Programme of Work, 2006-2015;
Medium-term Strategic Plan 2008-13 (amended); Documents EB130/5 Add.1
and Add.2; Documents EBSS2(1); Documents EB 118/7 on Strategic Resource
Allocation and World Health Statistics 2011.
[WHO document EB130/5 Add.1 was prepared on the request of the EBSS
for a background document. However in this document, the Secretariat
divides WHO’s functions in Article 2 of WHO constitution into seven
categories are: (1) Supporting the achievement of the health-related
Millennium Development Goals (primarily Goals 4, 5 and 6) will bring
together HIV/AIDS, tuberculosis, malaria, and maternal and child health,
with a focus on integrated service delivery; (2) Promoting risk reduction,
prevention, treatment and monitoring of non-communicable diseases, mental
health, disability and injuries; (3) Strengthening the structure, organization
and financing of health systems with a particular focus on achieving
universal coverage, strengthening human resources for health and increasing
access to medical technologies including medicines; (4) Surveillance
of, and response to, disease outbreaks and acute public health emergencies,
and the effective management of humanitarian disasters; (5) Work on
health information, information systems, evidence for health policy-making,
innovation, and research and monitoring of trends, to include analysis
and strategies to address the social, economic and environmental determinants
of health; (6) Convening governments and other stakeholders and facilitating
partnerships in line with WHO’s role as the coordinating and directing
authority on international health work, with a particular focus at country
level on the development of national policies and strategies; (7) Establishing
effective corporate services that enable the efficient functioning of
the whole Organization.
also classifies countries into 5 groups i.e. countdown countries; small
island developing states; countries in fragile circumstances; newly
industrialised and middle-income countries; and OECD countries. [Countdown
countries refers to 68 States that bear the highest burden of child
and maternal mortality and whose progress in MDG achievement is monitored
by a UN group through the countdown process.]
categorization of WHO’s functions and classification of countries did
not receive approval during the EB deliberations.
In fact during the deliberations, Member states said that information
in EB130/5 Add 1 was insufficient and thus decisions cannot be taken.
Member States also pointed to the lack of information on the criteria
used to categorise WHO’s activities.
Senegal on behalf of the members of the African Regional office called
for an in-depth study on resource allocation and staff at the three
levels of the WHO. It also sought clarification on Secretariat’s classification
of countries in EB130/5 Add. 1. Senegal also stressed the role of WHA
in the programme and priority setting.
Ecuador on behalf of UNASUR said that time was required to reflect on
the details provided in EB130/5 Add.1, adding that at least two WHO
documents were provided just two days before the EB meeting. However
it also noted the lack of information particularly on the Secretariat’s
categorisation of functions and classification of countries. It also
stressed on a member driven process on programmes and priority setting.
China said that that it did not support the classification of countries
mentioned in EB 130/5 Add.1 stressing that this approach did not make
sense and it was against the UN language.
India noted that the Secretariat’s country classification was on the
basis of development indicators rather than disease burden. India also
sought more information on further break down of the financial and human
resource allocation of assessed and voluntary contributions.
[Dr. Chan clarified that the categorization and classification was an
attempt to systematize the available information as well as the current
activities of the Organization].
Estonia on behalf EU said that even though time was limited it was important
to reach a clear decision on priority setting. It stressed on the need
to carefully look at the categorisation of countries and asked the Secretariat
to investigate experiences of UNDP, World Bank etc. Lastly it also observed
that the Secretariat’s suggestion to spend 50% of the resources at the
country level is premature at this stage.
Most member states noted that priority setting should be based on individual
country needs. However the US disagreed, preferring instead a top-down
approach i.e. of global objectives guiding regional and local objectives.
topic of “Governance”, the Chair’s summary states that MS are invited
to submit comments on two of the Secretariat’s proposals i.e. (i) the
draft revised terms of reference for the Programme Budget and Administration
Committee (PBAC) and (ii) proposals for increasing linkages between
Regional Committees and the global governing bodies and harmonisation
of the Regional Committees. [These proposals are contained in EB 130/5
The Chair’s summary further states that MS can submit their comments
through the password protected website open to all MS before 29th February
and that MS which do not have access to that website are invited to
contact the Secretariat for details on how to register for the site.
Based on the feedback the Secretariat will prepare revised proposals
for submission to the 131st session of EB, through the PBAC, the Summary
The Chair’s Summary further notes that the Secretariat will revise the
proposed options for the schedule of the governing bodies, incorporating
the proposal for a revised schedule of meetings of the Regional Committees,
Executive Board, PBAC and WHA. This document will also include a detailed
analysis of the advantages and disadvantages, feasibility and cost of
different options, the Summary adds. Further the Secretariat will also
take forward the work on streamlining national reporting as well as
further develop proposals for management of resolutions, the Summary
notes. [The Secretariat’s proposals on the aspects mentioned are in
EB 130/5 Add.3]
In relation to governance, the EB also considered Secretariat’s proposals
on engagement with NGOs and private-for-profit sector as well as not-for-profit
philanthropic organisations contained in EB 130/5 Add.4.
On this the Chair’s Summary notes that “Further consultations with Member
States will be required on “WHO’s engagement with other stakeholders,
including nongovernmental organisations and industry, and the proposals
to review and update principles governing WHO relations with nongovernmental
organisations and to develop comprehensive policy frameworks to guide
interaction with the private-for- profit sector , as well as not-for-profit
Regarding partnerships the Chair Summary states “We have agreed on the
importance of partnerships and on the need for better management and
greater oversight by the governing bodies, in particular the Executive
Board. Members of the board have proposed a review of WHO hosting arrangements,
along with further efforts to harmonize work with hosted partnerships”.
[In EB 130/5 Add. 4 the Secretariat proposed handing over oversight
of WHO’s partnerships to the EB after concluding that the Standing Committee
on Nongovernmental Organizations was unsuitable for this purpose.]
Of all the governance related issues, the topic of WHO’s engagement
with other stakeholders was the most controversial as the discussion
focused on the criteria for the inclusion of non-state entities and
on the need to differentiate between PINGOs (Public Interest NGOs) and
BINGOs (Business Interest NGOs).
proposed a greater participation of civil society. Barbados, Chile and
some others highlighted the need for setting out clear guidelines to
protect against potential conflicts of interest. France asked for procedures
to ensure the independence of public health experts, adding that while
dialogue with other actors should happen, decision making process should
remain with Member States. Norway called for an evaluation of WHO engagement
in partnerships and their added value.
and US said it was not necessary to go too far in differentiating between
types of NGOs since divisions are arbitrary and all stakeholders come
to the WHO with their specific agendas. Switzerland welcomed the proposal
of increasing stakeholders involvement, both of NGOs and the private
in her response to the issue of conflicts of interest played down the
issue, stating that “Everybody has an interest”, and calling for all
actors to be transparent and accountable.
to Chair’s Summary the Secretariat will further elaborate the proposals
for the predictable financing mechanism, and the contingency fund, based
on the feedback received and present it to the next EB in May 2012 for
[WHO’s document EB 130/5 Add 5 contained a road map for increasing predictability
of WHO finance from the current level of 50% to 70%. The main strategy
proposed was the holding of a pledging conference in 2013 to secure
pledges for the programme budget that will begin in 2014.]
On the issue of financing, the majority of MS sought clarification as
to whether assessed contributions are allocated to cover WHO’s core
functions or to fill up the gaps remaining after the allocation of voluntary
contributions. The US stressed that assessed contributions should not
subsidize costs associated with voluntary contributions.
Concerns were also expressed over the pledging conference particularly
over how it would increase financial predictability. Secretariat was
asked to explore other possible solutions. On contingency fund for outbreaks
delegates sought clarification on how the fund would be managed in harmonization
with regional funds for emergencies.
In response, Dr. Chan clarified that assessed contributions were used
to support core-functions and governing bodies meetings and that Secretariat
“will not accept any money that do not go with priorities”. She also
expressed hopes that the mechanism will increase transparency and prevent
civil society organisations from saying that WHO “is in bed with industry”.
The Chair’s Summary further invites MS to submit comments on the draft
evaluation policy through the password protected web site open to all
Member States before 29th February. Based on these comments the Secretariat
will prepare a revised draft of the evaluation policy for the consideration
of the EB in May through the PBAC.
[In document EB 130/5 Add.8 WHO proposes a “WHO evaluation policy”.
This policy sets the basic rules for both internal and external evaluation
of the different WHO levels].
On the matter of stage one of the independent evaluation of WHO, the
Chair’s Summary states that “..the Executive board has welcomed the
offer of the External Auditor to carry out this step , and expects that
the report of stage one will be presented to the Sixty fifth World Health
Assembly, and will include the proposed road map for stage two of the
[A two stages process of independent evaluation of WHO to guide the
reform was agreed to at the EBSS. The EB decision provides more clarity
on the evaluation process]
Further it also states that the Secretariat will update the Terms of
Reference for stage one of the independent evaluation based on the written
comments submitted by the Joint Inspection Unit of the United Nations
The Chair’s Summary also notes that the EB welcomed the agreement of
the Joint Inspection Unit to update their reports of 1997 on decentralisation
within WHO and of 2003 on management and administration of WHO.
Preparations for upcoming meetings of the Governing Bodies
Summary states that the Secretariat will prepare a consolidated report
covering all aspects of WHO reform for submission to the upcoming WHA
in May 2012 adding that the WHA will have an opportunity to review and
discuss all proposals on reform. The Secretariat’s report will cover
programmes and priorities, governance and managerial reforms incorporating
the outcome of the Member State driven process on priority setting,
showing linkages and indicating areas where consensus has been reached
and those areas where further discussion is required. The report will
also include the elements of reform agreed in the Special EB session
in November 2011 and the further elaboration of the proposals where
the EB has requested additional work. The report will also include a
draft implementation plan, with a budget and monitoring framework for
consideration by the WHA.
Further, the Chair’s Summary proposed the extending the one-day PBAC
meeting in May to three days and 131st session of the EB from one day
to two days to ensure sufficient time for considering the Reform proposals.
**This report has been prepared with some input drawn from the reports
produced by the WHO Watchers linked to the Peoples’ Health Movement.
Their reports are available at http://www.ghwatch.org/node/448
 See http://www.twnside.org.sg/title2/intellectual_property/info.service/2011/ipr.info.110101.htm
for more information on the beginnings of WHO reform discussion
for a report on the EBSS took place in November 2011.
http://apps.who.int/gb/e/e_eb130.html for the WHO documents.
Overhaul needed on rules on NGOs' relationship at http://www.twnside.org.sg/title2/intellectual_property/info.service/2012/ipr.info.120103.htm
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