TWN Info Service on Intellectual Property Issues (Nov11/04)
14 November 2011
Third World Network

Dear All,

Please find below an article on the outcome of the discussion on WHO reform that took place during the Special Session of the Executive Board that met from 1-3 November 2011.

Regards
Sangeeta Shashikant
Third World Network

WHO: Members opt for modest reform and request more work
Published in SUNS #7258 dated 11 November 2011

Geneva, 10 Nov (K. M. Gopakumar and Sangeeta Shashikant) -- Governments at the World Health Organisation (WHO) have agreed on a modest reform package for the organisation, asked the Secretariat for more information and analysis to be done, and decided on an independent evaluation.

The Special Session of the WHO Executive Board (EB), which met from 1-3 November at the WHO headquarters in Geneva, declined to fully accept the reform proposals contained in the Director-General's Report (EBSS/2/2) titled "WHO Reform for a Healthy Future" (DG's report).

The DG's report presented 18 recommendations covering reform proposals in three broad areas, i. e., programmes and priority-setting, governance and managerial reforms.

However, Member States settled for a more modest outcome, and instead sought more information and analysis from the Secretariat on a number of issues related to these three areas. They have also decided to proceed with an independent evaluation to provide input into the reform process through a two-stage approach, the first of which will consist of a review of existing information with a focus on financing challenges for the organization, staffing issues and internal governance of WHO. The approach to stage two of the evaluation will be developed in consultation with Member States.

Decisions on the three areas can be seen as an attempt by Member States to regain control of, and set brakes on, the reform process, which has been pushed at an unprecedented speed by Dr. Margaret Chan, Director-General of the WHO.

WHO's Reform Agenda was formally initiated at the January 2011 EB session. While it was endorsed at the 64th World Health Assembly (WHA), the reform agenda was not implemented due to concerns raised by a vast number of developed and developing countries at the EB session in May 2011, leading to a decision to hold a Special Session in November to discuss the reform agenda (see SUNS #7077 dated 31 January 2011, SUNS #7155 dated 23 May 2011, and SUNS #7163 dated 6 June 2011).

The Special EB session considered the 18 recommendations in the DG's report that was prepared on the basis of feedback received on four initial concept papers on governance of WHO, independent formative evaluation, the World Health Forum and managerial reforms.

The wide-ranging proposals put to the EB left many delegates and civil society observers wondering as to the actual motivation for the DG's reform plan. The reform agenda was initiated to secure a predictable, flexible and sustainable financing for WHO, and yet after many papers and meetings, there is little clarity on the issue of finance and no agreement as to how this will be achieved. At the same time, the reform plan has metamorphosed into a broad range of issues, many of which involve basic management and procedural issues.

Some observers have suggested privately that the push for reform is closely linked with Chan's re-election ambitions.

Deliberations at the Special Session of the EB raised a number of pertinent points on programmes and priority-setting, governance and managerial reforms, with decisions taken on each of these matters.

PROGRAMMES AND PRIORITY-SETTING

The decision on programmes and priority-setting establishes "a Member State-driven process to take place following the Executive Board at its 130th session in January 2012, with a view to providing recommendations on methods for programmes and priority setting, for the consideration of the Sixty-fifth World Health Assembly in May 2012".

To support the process, the Secretariat is also requested to develop a background document for the 2012 EB session that will include: (a) a detailed description of current criteria and mechanisms for priority-setting, and the relationship between country-level, regional and global priorities, including elements of bottom-up and top-down prioritization; (b) a description of the current activities carried out at headquarters, regional and country level, including programmes as well as financial and human resources allocated to each level and cluster; (c) a description of the application of criteria and priorities to planning and the impact of criteria and priorities on resource allocation and results; (d) proposals for how criteria and priorities could be set and applied in the future; and (e) a detailed proposal, with a timeline, for the Member State-driven process established by this decision.

This decision is the outcome of an informal consultation among Member States undertaken during the Special Session (see SUNS #7253 dated 3 November 2011).

It clearly rejects the DG's proposals, which proposed limiting WHO's programme activities to five 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; identifying limited flagship priorities as well as priorities within five core areas of work; and the Secretariat developing a detailed proposal for priority-setting to be submitted to the January 2012 EB meeting through the Programme, Budget and Administration Committee.

The decision clearly puts the issue of priority-setting in the hands of Member States. At Germany's insistence, the decision also includes a request for more information to guide the Member State priority-setting process.

A delegate participating in the EB said privately that the background information requested will likely bring forth more information on allocation of resources provided to WHO's programmes.

GOVERNANCE

The decision on Governance, also drawn from the DG's report, contains three paragraphs. The first paragraph outlines five agreed principles. Four of these principles generally pertain to WHO's governance, while the fifth principle contains guiding principles for WHO's engagement with stakeholders. The four agreed general principles are: (a) Governance needs to be a fully inclusive process, respecting the principle of multilateralism; (b) WHO's governing bodies have a key role in priority-setting, with the Health Assembly to play a policy and strategic role and the Executive Board playing a strengthened advisory executive and oversight role; (c) WHO should seek to strengthen and make maximum use of existing mechanisms and structures; and (d) the General Programme of Work should guide the work of the governing bodies.

The agreed guiding principles for WHO's engagement with other stakeholders are: (i) the intergovernmental nature of WHO's decision-making remains paramount; (ii) the development of norms, standards, policies and strategies, which lies at the heart of WHO's work, must continue to be based on the systematic use of evidence and protected from influence by any form of vested interest; (iii) any new initiative must have clear benefits and add value in terms of enriching policy or increasing national capacity from a public health perspective; and (iv) building on existing mechanisms should take precedence over creating new forums, meetings or structures, with a clear analysis provided of how any additional costs can lead to better outcomes.

The second paragraph of the decision lists nine agreements on governance reform without spelling out details. Paragraphs (a) to (f) pertain to the function and role of the governing structures of WHO while paragraphs (g) to (i) pertain to WHO's role in coordination of international health and engagement with non-state actors.

The third paragraph of the decision requests the DG to submit the following to the January 2012 EB session: (a) A proposal for revised terms of reference for the Programme, Budget and Administration Committee in order to strengthen its role as referred to above; (b) Further analysis on ways to increase linkages and alignment between Regional Committees, the Executive Board and the (World) Health Assembly as well as on proposals to harmonize the practices of Regional Committees; (c) Proposals for a revision of the annual timeline of the meetings of governing bodies in order to optimize their synergies and effectiveness; (d) Further analysis of proposals to promote engagement with other stakeholders; (e) Further analysis on modalities to improve Member State involvement with and oversight of partnerships including the possible expansion of the mandate of the Standing Committee on Non-governmental Organizations in this regard; and (f) Proposals on how to streamline national reporting in accordance with Articles 61 to 65 of the WHO Constitution while using modern tools.

The decision adopted by the EB does contain most of the proposals put forward in the DG's report such as the EB filtering draft resolutions against criteria to limit the number of resolutions to be presented to the World Health Assembly; to rationalize intergovernmental working groups by entrusting certain negotiations to the Board; to prepare "omnibus" resolutions; to limit reporting on implementation of resolutions to a maximum of six instances; to hold an additional EB session etc.

Many Member States spoke against these specific proposals.

Syria, on behalf of members of the Eastern Mediterranean Regional Office (EMRO), stressed that an additional EB session would incur additional costs, and suggested extending the existing sessions instead.

Ecuador, speaking on behalf of UNASUR (Union of South American Nations), noted that intergovernmental working groups should not be abolished, because they are the "most representative" of Member States, and are "very strategic" and thus should be retained.

The issue of WHO's engagement in partnerships at the WHO was a particularly divisive issue. A draft decision included a paragraph (derived from the DG's report) on expanding the mandate of the Standing Committee on Non-governmental Organisations to provide guidance on WHO's work with partnerships.

Several EB Members that preferred not to mix partnership issues with matters concerning NGOs vehemently objected to this proposal.

Papua New Guinea expressed its concern that the proposal would be "counterproductive", while India considered it "premature", preferring to deal with them individually. Brazil, a non-EB Member, also added its voice to the opposition, saying that the two issues should not be mixed. The United States, on the other hand, was keen to expand the NGO Standing Committee to include partnerships.

The final outcome requests further analysis on this matter.

Language on WHO's engagement with stakeholders also did not make it into the final decision. An initial draft text proposed: "Engagement with other stakeholders shall be conducted in line with the proposals contained in paragraphs 89 and 90 of the report of the Director General, as appropriate, while taking into account the importance of full engagement of Member States and of managing conflict of interest".

[Paragraph 89 of the DG's report proposes "multi-stakeholder forums", while paragraph 90 proposes "separate consultations with different groups of stakeholders to provide input on specific issues".]

Many countries preferred the proposal in paragraph 90, to the establishment of multi-stakeholder forums, as the latter would involve private sector and entities that are driven more by commercial rather than public health interests. However, some other countries such as the US insisted on the multi-stakeholder forum as a mode for engagement.

Divergence of views resulted in only an agreement recognizing the need to strengthen engagement with stakeholders, taking into account conflicts of interests and that in the longer term options for a framework to guide interaction between all stakeholders active in health should be explored. The DG was also requested to conduct further analysis of proposals to promote engagement with other stakeholders.

None of the proposals of engagement suggested in the DG's report were explicitly endorsed by the EB. In fact, Chan revealed lack of support for the idea of convening a regular multi-stakeholder event also known as the "World Health Forum", that she had presented at the 2011 WHA. There has been significant concern that such a forum will increase the influence of the private sector and donors in setting the health agenda in the WHO.

Chan informed Member States at the Special EB session that this idea had been abandoned.

MANAGERIAL REFORMS

The decision on managerial reforms contains six paragraphs.

The first paragraph welcomes the DG's proposals in five areas while recognizing the need for complementary work, especially on the strategic allocation of resources: (a) organizational effectiveness, alignment and efficiency: strengthen country offices, promote alignment, synergy and collaboration, improve knowledge management; (b) financing of the Organization: improve financing of administration and management costs, strengthen financial controls, improve Organization-wide resource mobilization; (c) human resources policies and management: revise the workforce model and contract types, streamline recruitment and selection processes, improve performance management processes, implement a mobility and rotation framework, enhance staff development and learning; (d) Results-based planning, management and accountability: implement a new results chain, sequence planning to reflect country needs, prepare a realistic budget, create a new resource allocation mechanism, improve monitoring and reporting, strengthen the internal control framework, increase the capacity of audit and oversight, strengthen the conflict-of-interest policy, establish an information disclosure policy; (e) Strategic communications: build communications capacity, develop communications platforms, improve public and stakeholder understanding of the work of WHO.

The second paragraph urges "caution and recognized that further analysis and consultation would be needed before action could be considered in several areas of reform, notably the proposals relating to strategic relocation of staff, resources, programmes and operations; and introduction of an annual ‘budget re-costing mechanism' to protect against currency".

The third paragraph requests the DG to develop for the consideration of the 2012 January EB session: (a) a detailed proposal for mechanisms to increase predictability of financing and flexibility of income, which supports priorities set by Member States; (b) a detailed proposal to establish a contingency fund for public health emergencies; (c) a draft formal evaluation policy, including a mechanism for oversight of evaluation by the governing bodies informed by insights provided by the Independent Expert Oversight Advisory Committee (IEOAC).

The same paragraph requests the DG to develop a proposal for a timeline for development of the programme budget and general programme of work, taking into consideration good experience of the medium-term strategic plan each for the period 2014 onwards, with an analysis of the advantages and disadvantages of changing the periodicity of the programme budget to three years and report to the
65th World Health Assembly in May 2012.

It also asks for clarification on the proposals with respect to enhancing the networks and relationships between regional offices, and between groups of country offices within and across regions; and on enhancing capacity for effective resource mobilization, particularly at the country-level. It further requests the DG to develop a proposal for a new resource allocation mechanism, through the 16th meeting of the Programme, Budget and Administration Committee in May 2012.

In the fourth paragraph, the decision decides to proceed with a two-stage independent evaluation to provide input into the reform. The first stage will consist of a review of existing information with a focus on financing challenges for the organization, staffing issues, and internal governance of WHO by Member States, following up where possible on questions forwarded from this EB for more information. This stage is expected to be completed for consideration of the 65th World Health Assembly.

According to the decision, the first stage review will provide a roadmap for stage two of the evaluation, which is expected to be considered by the Assembly in 2013, as an input into the revised General Programme of Work.

The decision adds that stage two of the evaluation will be built on the results of stage one and further consultations with Member States, focusing in particular on the coherence between and functioning of the organization's three levels. However, this evaluation would proceed in parallel with other aspects of the reform as an input.

The decision also requests the DG to identify the appropriate entity for the first stage of the evaluation and to further develop in consultation with the UN Joint Inspection Unit, the External Auditor, and the IEOAC an approach to stage two of the evaluation in consultation with Member States. The DG is to present the outcome of the consultation to the EB's January 2012 session.

The decision on independent evaluation is a significant shift from an earlier Secretariat proposal which proposed limiting the scope of the evaluation to only WHO's health system strengthening programme. However, many Member States particularly Germany have been pressing for the scope to be expanded to enable the evaluation to inform the reform process.

Differences also emerged over the appropriate entity to carry out the independent evaluation. A draft text proposed that an "External Auditor" conduct the stage one evaluation. The US supported the idea of selecting an external auditor while many others such as Brazil, Ecuador and Germany were opposed to this. Some Member States instead proposed the UN Joint Inspection Unit (JIU).

Since no consensus was achieved, the decision requests the DG to identify the appropriate entity for the first stage evaluation and to present it to the EB session in January.

During discussion on managerial reforms, it also emerged that the Secretariat had taken certain steps to trim down its human resources. The statement of the Staff Association revealed that the restructuring of human resources had already resulted in a loss of jobs for nearly 150 staff.

The lack of information over measures taken with regard to human resources prompted Brazil to request that the DG stop taking further measures until further instructions were received from the governing bodies. Canada demanded a report on this matter from the Secretariat in the upcoming EB.

The decision also requests the UN JIU to update their reports on: (a) Decentralization of Organizations within the United Nations System - Part III: the World Health Organization (JIU/REP/93/2), and (b) Review of Management and Administration in the World Health Organization (WHO) (JIU/REP/2001/5).