Info Service on Health Issues (Apr14/01)
3 April 2014
Third World Network
No consensus on draft policy on non-State actors
Published in SUNS #7777 dated 3 April 2014
Geneva, 2 Apr (K. M. Gopakumar) -- Member States of the World Health
Organisation (WHO) are unable to agree on a draft framework and policy
on the organisation's engagement with "non-State" actors.
A two-day informal consultation that took place in Geneva on 27-28
March 2014 concluded with an understanding to entrust the WHO Secretariat
to submit a new version of the policy, taking into consideration the
comments from Member States, to the World Health Assembly (WHA) through
the Program Budget and Administrative Committee.
The WHA is to decide on the future process regarding the draft framework
and policy on NSAs (non-State actors).
A developing country delegate told Third World Network (TWN) that
the WHA is to decide on the next steps with regard to the finalisation
of a draft framework and policy and would not take any decision with
regard to the adoption of the draft framework and policy.
The draft framework for engagement with NSAs is part of WHO's reform
agenda which was kick-started in 2011. It was prepared after two face-to-face
consultations and two web-based consultations. The last informal consultation,
which was open to both NGOs and Member States, took place in Geneva
on 17-18 October 2013.
According to the WHO draft, NSAs include non-governmental organisations,
private sector entities, philanthropic foundations and academic institutions.
WHO is currently collaborating with all these NSAs without a comprehensive
policy for such engagement.
Some of the NSAs, especially philanthropic foundations and private
sector entities, provide financial and in-kind resources to WHO and
are thus in a position to influence the public health agenda at times
to further business interests.
For instance, WHO in 2012 received US$264,167,357 as voluntary specified
funds from Bill and Melinda Gates Foundation which is more than the
US Government's voluntary specified contribution of US$208,109,268.
Interestingly, the Bill and Melinda Gates Foundation does not provide
any core voluntary funding. Core voluntary funding provides spending
flexibility to the Secretariat.
In the absence of a policy, the last WHA put on hold the implementation
of certain elements of a global strategy for the control and prevention
of non-communicable diseases, which is to be implemented through partnerships
TWN learned that many Member States are concerned over the draft framework
and policy with regard to the proposal on secondment, a lack of effective
safeguards to protect WHO from undue influence of private and philanthropic
organisations, and the silence of the framework with regard to engagement
with philanthropic and academic institutions.
Many Member States also said that there is not sufficient time to
study the draft framework and policy and to take a decision with regard
to its adoption at the upcoming WHA. Further, Member Sates also pointed
out that the Secretariat has not provided existing documents relevant
for a comprehensive understanding of the framework and policy for
NSA engagements such as a conflict-of-interest policy.
A diplomat who attended the consultation said that the United States
and the United Kingdom complained that the draft policy sets a high
degree of scrutiny for the private sector compared to other NSAs.
The Secretariat's document contains the following parts:
Overarching Framework for Engagement with Non-State Actors;
Policy and Operational Procedures on Engagement with Non-governmental
Organisations (Draft NGO Policy);
WHO Policy and Operational Procedure on Engagement with Private
Sector Entities (Draft Private Sector Policy);
WHO Policy and Operational Procedures on Management of Engagement
with Non-State Actors (Draft Management Policy) defining the common
policies and processes applied in the management of WHO's engagement
with all non-State actors; and
of a glossary on definition of terms.
International Baby Food Action Network (IBFAN) has strongly criticised
the WHO's draft framework and policy on NSAs.
IBFAN stated that: "Despite the many statements of WHO's Director
General, Margaret Chan, that WHO's policies, norms and standards setting
processes should be protected from commercial influence, if the new
proposals were to be adopted, the corporate influence would increase.
IBFAN fears that this would compromise WHO's integrity, independence
and its ability to fulfill its mandate".
The proposed overarching framework sets the basic principles, boundaries
and types of interaction for all NSAs.
The principles for interaction with NSAs are: Demonstrate a clear
benefit to public health; Respect the intergovernmental nature of
WHO; support and enhance the scientific and evidence-based approach
that underpins WHO's work; be actively managed so as to reduce any
form of risk to WHO (including conflicts of interest); be conducted
on the basis of transparency, openness and inclusiveness.
The boundaries are: Decision-making by the governing bodies is the
exclusive prerogative of Member States; WHO's processes in setting
norms and standards must be protected from any undue influence; WHO
does not engage with industries making products that directly harm
human health, such as tobacco or arms; engagement with non-State actors
must not compromise WHO's reputation.
The boundaries clearly exclude any engagement with the tobacco and
arms industry. However, it is not very clear whether the policy excludes
engagement with pharmaceutical firms that work against WHO, which
has established policies such as the use of flexibilities in the World
Trade Organisation's intellectual property rights agreement.
Often, pharmaceutical multinational companies work against the use
of these flexibilities. Recently, a set of emails leaked to the public
showed that Pharmaceutical Research and Manufacturers of America (PhRMA)
had planned a campaign against the proposed pro-public health changes
in the South African patent law.
The WHO document identifies five types of interaction viz. participation,
resources, evidence, advocacy and technical collaboration.
Both draft policies viz. draft NGO policy and draft private sector
entities policy spell out policy and operational procedures that relate
to interactions with NGOs and the private sector. It sets the norms
for all five types of interaction.
Both the policies set the same level of treatment for NGOs and the
private sector and thus completely ignore the inherent risk of engagement
with the private sector, which works primarily for profit. There are
no new safeguards against engagement with the private sector, including
business associations and business interested NGOs.
[Currently, public interest NGOs and business interest NGOs and business
associations are categorised as NGOs. All the three entities have
official relations with the WHO. Often, many "NGOs" are
believed to be the front organisations for pursuing business interests.
Many patient organisations, for instance, in official relations with
the WHO, receive substantial funding from pharmaceutical companies
and often speak in support of pharmaceutical companies during WHO
governing body meetings.]
The most worrying part of the draft NGO and private sector policies
is with regard to the acceptance of resources and deployment of NGO
and private sector staff in the WHO on the basis of secondment.
The draft NGO policy allows the acceptance of resources from NGOs
and also provision of resources to NGOs from the WHO. Similarly, the
draft policy on private sector entities states:
15: "Funds may be accepted from private sector entities whose
business is unrelated to that of WHO, provided they are not engaged
in any activity that is incompatible with WHO's work."
16: "Funds may not be sought or accepted from private sector
entities that have themselves or through their affiliated companies
have a direct commercial interest in the outcome of the project
toward which they would be contributing, unless approved in conformity
with the provisions on clinical trials or product development, set
17: "Caution should be exercised in accepting financing from
private sector entities that have even an indirect interest in the
outcome of the project (i. e. the activity is related to the entities'
field of interest, without there being a conflict as referred to
above). In such event, other commercial enterprises having a similar
indirect interest should be invited to contribute, and the reason
clearly described if this does not prove possible. The larger the
proportion of the donation from any one source, the greater the
care that should be taken to avoid the possibility of a conflict
of interest or appearance of an inappropriate association with one
18: "Unspecified financial and in-kind contributions from private
sector entities to WHO programmes are only acceptable under the
following conditions: (a) the contribution is not used for normative
work; (b) if a contribution is used for activities other than normative
work in which the private sector entity could have a commercial
interest, the public health benefit of the engagement needs to clearly
outweigh its potential risks; (c) the proportion of funding of any
activity coming from the private sector cannot be such that the
programme's continuation would become dependent on this support."
19: "The acceptance of donations (whether in cash or in kind)
should be made subject to the following conditions: (a) The acceptance
of the donation does not constitute an endorsement by WHO of the
private sector entity, its activities, products or services; (b)
The donor may not use the results of WHO's work for commercial purposes
or seek promotion of its donation; (c) The acceptance of the donation
does not award the donor with any privilege or advantage; (d) The
acceptance of the donation does not offer the donor any possibility
for advising, influencing, participating in, or being in command
of the management or implementation of operational activities. WHO
keeps its discretionary right to decline a donation, without any
proposed policy thus does not provide any effective safeguard against
the dangers of accepting finance and in-kind resources from non-State
actors like private sector entities and NGOs. These draft policies
thus institutionalise the danger of funder-driven agenda setting in
The draft policies also completely ignore the suggestion to address
the crucial issue of conditional funding or voluntary contributions
tied to specific programs, which set the funder-driven program priority
setting. One of the prominent suggestions was the creation of a pool
in which donors are free to contribute and the Secretariat would have
the flexibility to spend on underfunded but important public health
priorities. The draft policies do not put any restrictions on receiving
financial contributions from NSAs especially from private sector entities
to specific programs in the form of tied funds.
The language in paragraph 20 of the draft private sector policy gives
the discretion to the WHO Director-General without setting a clear
policy direction. It states: "The Director-General can set up
mechanisms of pooled donations from multiple sources, if the mechanisms
are designed in such a manner as to avoid any perceived influence
from the donors on WHO's work; the mechanism is open to all interested
donors; and is subject to the conditions in paragraph (19) above".
Alternatively, there should have been a ceiling on the specified financial
and in-kind resources from the private sector in the absence of pool
The draft private sector policy also does not bar the Secretariat
from accepting resources from the private sector for the salary of
WHO staff. Paragraph 37 states: "Funds designated to support
the salary of specific staff or posts (including short-term consultants)
may not be accepted from private sector entities if they could give
rise to a real or perceived conflict of interest in relation to WHO's
Paragraph 38 states: "The acceptability of contributions from
private sector entities to projects that have a staffing element should
be reviewed in the light of other relevant guidance provided in this
Further, the draft policy does not increase the level of transparency
with regard to NSAs. It reiterates the existing practice of disclosing
through financial reports and audited financial statements. These
reports do not disclose the details of donations. The draft policy
is silent regarding the disclosure of details of donations from NSAs
especially the purpose of their use and the agreement between WHO
and the private sector donors.
Another major concern is related to the secondment of personnel to
WHO. Under this scheme, the salary of the person would be paid by
the agency, which deploys the person to WHO. The policy clearly states
that secondment is possible from NGOs and private sector. Even though
the secondment opportunities are open to NGOs, the most frequent user
would be the private sector considering the financial resources available
with the private sector. The NSAs are likely to use the secondment
of personnel to leverage the commercial interest. Further, the secondment
person may compromise the neutrality of the international civil service.
The draft policy also rejects the demand of many public interest groups
to be allowed to participate in WHO governing body meetings as observers.
However, the draft policy restricts the participation to NGOs which
are only in official relations with the WHO. Further, there is no
clarity whether NGOs would be differentiated from the business associations
for the participation in WHO governing body meetings. Currently, all
non-State actors who are in official relations with WHO including
business associations like the International Federation of Pharmaceutical
Manufacturers & Associations participate in the meetings as NGOs.
Even through the draft policy refers to philanthropic organisations,
it ignores the original decision to have a separate policy for not-for-profit
The Chair's summary of the 130th Session of the WHO Executive Board
clearly states that: "Further discussion will be required on
WHO's engagement with other stakeholders, including different categories
of non-governmental organisations and industry, and the proposals
to review and update principles governing WHO relations with non-governmental
organisations, and to develop comprehensive policy frameworks to guide
interaction with the private-for-profit sector, as well as not-for-profit
According to IBFAN: "If these new policy proposals are adopted,
IBFAN fears that WHO will be unable to lead and support Member States
in taking the bold decisions necessary to tackle global health challenges."
There is concern therefore that the draft framework and policies could
legitimize the status quo and further the corporate capture of WHO