WHO reform for a healthy future. WHO EURO meeting, third day

The third day of the Regional Committee meeting had on its agenda the item most relevant for the Democratizing Global Health (DGH) coalition to which Wemos and the Medicus Mundi International Network belong: the WHO reform for a healthy future. The DGH coalition is following the reform intensively, as we believe that WHO needs to remain the unique mandated global authority to coordinate international health with the aim to reach and safeguard the right to health for all. We have concerns that some elements of the WHO reform might actually weaken the organisation, rather than re-enforce its leadership.

We expressed our concerns to the member states in a letter that is available on the WHO Euro website. So I was excited to follow the panel that is well covered on the WHO Euro website in the highlights of Regional Committee day 3.

The discussion was prepared the day before during a technical briefing; and part of the discussion was held in three working groups that covered the items of governance, core business, and managerial reforms. NGOs were invited as observers to the working groups, a much appreciated practice that is not common during working groups at the World Health Assembly.

WHO DG Margaret Chan briefed the Committee about the discussion at other regional committees, in the AFRO and SEARO regions. The African countries like WHO to reform, but are cautious that it proceeds too fast, or that it would lead to a reduced presence by WHO at country level. There was little discussion in the SEARO region on the reform.

In the EURO region key elements emerging during the panels and working groups are:

• The reform is at this stage focused on the internal reform of the WHO and less so on its relation with external actors.
• The Governance part focused on the functioning and alignment between the Executive Board (EB) and the World Health Assembly (WHA), setting priority for resolutions, preparation and engagement by member states (MS), alignment between the global, regional and country level. There were crucial questions how legitimate the EB functions within the mandate of the constitution, and if there should actually be adaptations to the 60 year old constitution within a changing global health context. Everybody agrees that the constitution remain the basis on which the organisation functions.
• Legaly, The WHO constitution is actually set up as treaty, that must be seen as a living document and can be improved over time.
• NGOs and private actors are currently not involved in the WHO reform. For the moment it is an exclusive MS driven process.
• There is little willingness to elaborate further on a new World Health Forum. It was suggested that in the future public hearings or a model based on the Pandemic-Influenza-Preparedness (PIP) consultation could be used instead.
• The core functions discussion made clear that WHO should stay away from business, guarantee democracy and legitimacy in its proceedings and that currently WHO uses its leadership position more limited then the constitution would allow. There is no need to expand the five core functions. What is important is that MS speak with one face when working with WHO. Now ministries of health represent a MS during the WHA, but funding to WHO departments or WHO supported partnerships are often provided via ministry of foreign affairs or development cooperation. Priorities and funding by these two departments are not always aligned. This demonstrates the need for policy coherence at national level.
• Regarding managerial reforms, the most important is a need for more full and flexible income for the organisation that is not tied to program activities. A suggestion arose to split the WHO budget in a core and project part, and hence to guarantee that the organisation has about 40% of its total funds available for flexible use. MS are hesitant to install a “replenishment financing model”, like the Global Fund. This can destabilise long-term available funding levels.

The direction of the reform envisaged by the member states of WHO Europe provided me with more trust in the outcome of the reform process. However; the other regions still have to come with their deliberations and the debate will continue further with the Geneva based missions and during an extraordinary EB meeting in November. The process can still lead to several directions. For us it is now important to monitor and work with MS regarding their position within the WHO, WHA and EB. Some states simply are not prepared or do not respect or know the procedures of the organisation. Often states agree on WHA resolutions, without providing financial resources or take responsibility for its implementation. In this regard, let me refer to chapter XIV, art, 61-65 of the WHO constitution: MS should annually report to the organisation how it improved the health of their citizens. It is therefore important to monitor and promote MS discipline regarding constitution, WHA and RC resolutions as well as showing one face to the organisation.

After the discussion, we were able to present our statement on the reform to the secretariat and member states.

Lastly, a remark about the European Non-Communicable Diseases (NCD) action plan that was discussed in the afternoon. This concerns the following excerpt: “The Netherlands was particularly opposed to the emphasis on population measures rather than personal choice in the promotion of healthy lifestyles. A resolution endorsing the action plan as amended to reflect some of these concerns would be considered on Thursday." The Netherlands amended the resolution on 10 points and the resolution was eventually adopted on the fourth day. These amendments reflects a changing national view on health promotion and prevention and it also precedes a position ahead of the UNGA highlevel meeting and political declaration on NCDs coming week. Frankly, and especially as a citizen of the Netherlands, my hart sinks to see that a national political position can influence in such a way the resolution of an important multilateral established health strategy that all countries have been waiting for.

For an visual impression of the Regional Committee meeting have a look here.

Remco van de Pas, Wemos