by Remco van de Pas, Wemos
This week, the 132nd Executive Board of the World Health
Organization (WHO) is taking place. An important board meeting because
it provides crucial directions for the leading institute on global
health which is currently re-defining its place in global health.
provides an overview of relevant global health topics, such as
non-communicable diseases, the social determinants of health, UHC,
health workforce & migration, pandemic-influenza-preparedness, etc.
The amount of documents that member states have to prepare is considerable.
It has become very difficult for one single member state to prepare all
topics alone and have a relevant input into the discussion. Following
the example of the EU, other countries also increasingly coordinate
their positions per region – for example for Latin America, the Middle
East and Africa. Over the years, non-state organizations, civil society
and academia have developed a greater interest in the field of global
health diplomacy. The People’s Health movement has developed WHO Watch, a critical civil society analysis and advocacy platform towards fairer and just policies by WHO. WHO Watch has made a comment on the EB documents and is providing daily reports from its proceedings. The Health diplomacy monitor also provides a guide to the EB discussions.
I focus hereby on WHO’s reform process. The Medicus Mundi International Network
has been involved in these deliberations over the last 3 years. To set
the tone, Director-General Margaret Chan provided in her opening speech a
good overview of the global health challenges that the world is facing.
The response she offered to deal with these challenges was rather
disappointing, though. Her opening speech provided references to many
medical and technical solutions for public health gains, without making
clear how these medical solutions contribute to solving the problems of
our time, such as climate change; an increasing world population,
growing inequalities and the food crisis. Her speech indicated exactly
why WHO’s role in global health is being questioned by many. Richard Horton,
the editor of the Lancet, has been similarly critical on Twitter this
week, arguing that many decisions of the WHO are motivated by a mere
survival reflex. He quite bluntly stated: “If
the Board of a FTSE100 company had a Board like WHO’s Executive Board,
it would have been convicted of failed governance long ago”.
Without going into details, some very relevant reform issues have been discussed at the board, such as a new financial mechanism to fund the organization; governance mechanisms on engagement with NGOs and the new 12th Global Program of Work,
the program strategy for the coming 6 years. Basically, WHO will open
its work towards more cooperation with (and funding by) NGOs,
philanthropy foundations and the private sector. While fully taking into
account potential ‘conflicts of interest’, the WHO will move forward
towards a wider engagement with non-state stakeholders. This is the
direction most member states, especially the US and the EU countries, favour to keep the organization relevant and funded. The program of
work will be more results oriented and focused on 6 defined categories
of work. Funding the organization will be facilitated via a ‘financing
dialogue’ that is somewhat resembling a replenishment fund, and in which
states and non-state funders come together. How remaining funding gaps
for less ‘sexy’ issues like environmental health or social determinants
of health will be covered remains unclear.
I see two overall trends. The first one is what Devi Shridhar has defined as Multi-bi financing. “Multi-bi
financing refers to the practice of donors choosing to route non-core
funding—earmarked for specific sectors, themes, countries, or
regions—through multilateral agencies such as the World Health
Organization (WHO) and the World Bank and to the emergence of new
multistakeholder initiatives. The shift to multi-bi financing likely
reflects a desire by participating governments, and others, to control
international agencies more tightly”.
Secondly, via these new financing mechanisms, there will be an institutionalization of the UN global compact
mode within WHO; further cooperation between businesses and the UN to
advance work on global health issues. Simon Peres made this principle very clear at the Davos club meeting, also known as the World Economic Forum, this week: “The world is becoming ungovernable, Governments
have found themselves unemployed because the economy has become global
while governments remain national. Global companies are replacing the
role of governments”.
What this all implies for global health remains to be seen, but it is
truly disappointing that the WEF gets so much attention, while WHO’s role in global health governance remains undiscussed, even by the member states of its organization.
First published as editorial in: IHP News 204, 25 January 2013