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TWN Info Service on Health Issues (Jan12/06)
30 January 2012
Third World Network


Dear All,

Please 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.

Hope you find it to be useful.

Regards
Sangeeta Shashilant
Third World Network


WHO Reform debate to continue, February fixed for member-driven priority setting

Geneva, 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.[1]

Key reform 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.

In the 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, from Morocco.

[A member 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.[2]]

Deliberations 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.[3]

These 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].

Programme and Priority Setting

The decision on programme and priority setting sets the scope of work and terms of reference for the member state driven process.

According 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”.

The EB decision then outlines the four specific objectives of the process, which are:
(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";

(b) "to elaborate methodology, criteria and the timeline for the priority-setting process";

(c) "to 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 work";

(d) "to 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”;

The EB 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.

The EB 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 -2015.

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.

These 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.

The Secretariat 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.]

The Secretariat’s 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.

Governance

On the 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 Add.3]

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 adds.

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.[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 philanthropic organisations”.

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).

India 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.

Switzerland 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 sector.

Dr. Chan, 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.

Managerial Reforms

According 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 consideration.

[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 independent evaluation.

[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 (UN) systems.

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

Chair’s 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


[1] 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

[2] See http://www.twnside.org.sg/title2/intellectual_property/info.service/2011/ipr.info.111104.htm for a report on the EBSS took place in November 2011.

[3] See http://apps.who.int/gb/e/e_eb130.html for the WHO documents.

[4] See 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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