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TWN
Info Service on Health Issues (Feb24/02) New Delhi/Geneva, 5 February (K M Gopakumar and Nithin Ramakrishnan) – The continued push of the Bureau of the Working Group on the Amendments of the International Health Regulations 2005 (WGIHR) for the creation of two additional institutions at the national level to implement the regulations raises concerns of institutional and financial fragmentation. The latest version of the Bureau’s text on amending Article 4, which sets out the details of responsible authorities for the implementation of IHR, proposes the creation of a National IHR Authority and a National IHR Competent Authority. [This proposal will be discussed at the 7th meeting of WGIHR which is taking place on 5-9 February at WHO Head Quarters, Geneva. The idea for two more new institutions was first tabled in October and again in December, by the Co-Chairs and Bureau respectively.] Paragraph 2 of the Bureau’s text sets out the function of the proposed National IHR Authority as follows: “The National IHR Authority shall coordinate the implementation of these Regulations within the territory of the State Party, including Article 54 and those provisions that do not explicitly refer to the National IHR Focal Point or the National IHR Competent Authority”. Functions of the proposed National Competent Authority are set out in Paragraph 4 of the Bureau’s text as follows: “… (a) guide and oversee the implementation of provisions of these Regulations that are related to points of entry and/or conveyance operators and/or travellers; and (b) identify the competent authorities at points of entry in its territory.” According to the current Article 4 of the IHR each State Party shall “designate or establish a National IHR Focal Point and the authorities responsible” for the implementation of health measures. It is left to the State Parties to determine the nature of the authorities, even though Article 4 sets out the functions of National IHR Focal Points as follows: “… (a) sending to WHO IHR Contact Points, on behalf of the State Party concerned, urgent communications concerning the implementation of these Regulations, in particular under Articles 6 to 12; and (b) disseminating information to, and consolidating input from, relevant sectors of the administration of the State Party concerned, including those responsible for surveillance and reporting, points of entry, public health services, clinics and hospitals and other government departments.” Thus, National IHR Focal Points of State Parties are envisaged as the only entity to be in communication with WHO on IHR implementation especially in relation to Articles 6 to 12. The current proposal seeks to create two more institutions, which will not only fragment the institutional arrangement for domestic implementation but also create fragmentation of finance and technical resources. Institutional Fragmentation To avoid the criticism of institutional fragmentation the proposed obligation to create another two institutions at the national level is spelled out with two qualifications. Paragraph 1 of the Bureau’s text reads: “Each
State Party shall, in accordance with its national law and context,
designate or establish the following responsible authorities:
a National IHR Authority, a National IHR Focal Point and a
National IHR Competent Authority. The aforementioned responsible authorities
Thus, it is clear that State Parties have no choice in terms of creation of the two new authorities in addition to the existing National IHR Focal Point. However there is a choice in designing the work and structure of these authorities, i.e. whether they have to act in close coordination within a single entity or as three separate entities. Through the proposal for the creation of these authorities is qualified by the words “in accordance with its national law and context” the subsequent paragraphs setting out the functions clearly show that there is little policy space for State Parties in this regard. Though several countries have a national IHR authority there are no national IHR competent authority. Further, proposed amendments to Paragraph 4 (renumbered as 7 in the Bureau’s text) states:
Although it appears as an innocent and neutral proposal to share contacts between authorities for administrative ease, the proposal implies that there will be a network of national authorities established in the near future. Furthermore, the Bureau’s text spells out functions of these institutions in such a way as to make it clear that State Parties do not have the choice but to create two more institutions at the national level. For some larger countries and federal form of governments, these institutions will be in addition to similar institutions set up the provincial or sub-national governments. However, the rationale of the Bureau for this proposal is: “In light of the experience gained with the implementation of the Regulations until now, the proposed allocation of responsibilities across three authorities would seem more adequate than maintaining only a National IHR Focal Point (which has appeared to be insufficient to comply with all IHR provisions in several States Parties). The overall rationale is to facilitate the attribution of responsibilities at the domestic level for the implementation of all the provisions of the Regulations – spanning from obligation with a more political connotation to obligations of a more operational nature –, thereby enhancing accountability. By outlining in more granular terms each of the three authorities’ responsibilities, this Article ultimately intends to facilitate the allocation of responsibilities at the hierarchically most appropriate domestic level. This will help to support full implementation and ensure National IHR Focal Points are not assumed to be the ‘default’ implementing entity for provisions that they have neither the mandate nor resources for.” This institutional fragmentation would create a risk of resource diversion to support the new institutions. This lack of financial resources in developing countries would help developed countries and the WHO Secretariat to attempt creating a network of these institutions and effectively bypass the authority of the Ministry of Health of developing countries. Furthermore, it will create confusion of authority and in the line of communication since all the three entities are national level authorities. This can in fact cause further delays in communications about health emergencies, and thus has the potential to worsen the problem which States Parties are seeking to address. It is understood that the WHO Secretariat explained the need to the WGIHR delegations, and that they would recommend creation of National IHR Authority outside the Ministry of Health at the country level. Financial Fragmentation To address the concerns on the additional financial and technical resources required for the creation/designation of two more institutions a new paragraph 5 is proposed, which states: “States Parties shall take measures to implement paragraphs 1 to 4 of this Article, including by allocating human and financial resources, and adjusting its national law in accordance with paragraph 3 of Article 59, as necessary”. Though this clause creates an optics of relating the legal obligations on technical and financial assistance this paragraph does not specify the differentiated responsibility of actors to provide such assistance. Since it is a general obligation on State Parties it gives an easy way out for developed countries, who are have the financial and technical means at their disposal to assist developing countries. Further, it also allows WHO to abdicate its responsibility. This proposal to amend Article 4 initially came from Switzerland and Russia. Switzerland wanted to obligate States parties “to inform WHO about the establishment of its National Competent Authority responsible for overall implementation of the IHR that will be recognized and held accountable for the NFP’s (national focal points) functionality and the delivery of other IHR obligations”. It also wanted States Parties to share contacts of such National IHR competent Authority to WHO. Russia on the other hand wanted to amend Article 4 such that National IHR focal point will then be an “entity” (institution), rather than a single person office as is the case for many resource-poor countries. It also wanted to obligate States Parties to amend or adapt national legislation so as to provide National IHR Focal Point with authority and resources. Therefore, it is clear that what has been proposed by the WGIHR Bureau is much more than what was asked by the initial proponents. Proposals receive mixed response The proposals received mixed response during the first day of the WGIHR7 on 5 February. Several countries including the United States, the European Union. Botswana, Bangladesh and Malaysia questioned the need for three national entities. TWN learnt that a few developing countries proposed to delete the proposed paragraph that imposes an obligation to adjust national laws. Also, the E.U., the U.S. and Bangladesh questioned the creation of a National IHR competent Authority, just to coordinate other competent entities functioning at the ground level. In addition, the delegations have explained how the national institutions work and why WHO cannot intervene in national administrative structures. On another note, Bangladesh proposed to expand the obligation of National IHR Focal Points and WHO Contact point to communicate not only on disease detection and information sharing, but also to communicate on the needs for coordinating any public health response measure, including request for support and assistance. The Bureau Co-chair, however, tried to downplay this proposal citing it as a new proposal. The proposal is surprisingly under “reservation” from Bureau.+
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