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At the WHO Executive Board meeting 16-23rd January, I joined the IBFAN and Consumers International delegation, focussing WHOs Maternal, Infant and Young Child Nutrition Plan, the proposals for the Reform of WHO, and the strategy for controlling Non-Communicable Diseases. 

IBFAN intervention 

Nutrition: Maternal, Infant and young child Nutrition: draft comprehensive implementation plan. A draft Resolution was proposed by Chile, Peru, Ecuador and Poland proposing 7  targets, including one to "increase exclusive breastfeeding rates of infants under the age of six months to 50% at global level"  and requesting the WHO Director General to "develop  guidelines on the marketing of complementary foods."  Before proposing the Resolution for adoption at the WHA in May 2012,  Member States decided that the Plan should first be fine-tuned through a  web-based consultation.

In  our intervention we expressed several concerns about the Plan and the targets, including the emphasis on micronutrient deficiencies and public-private partnerships such as Scaling Up Nutrition (SUN) with no mention of safeguards to protect against conflicts of interest.  We proposed that the reference to SUN should be replaced with Paragraph 44 of the Global Strategy on Infant and Young Child feeding, and emphasis put on underlying factors, such as the inter-relation of nutrition with the right to sustainable livelihoods, adequate food, nutrition systems and economies, water and sanitation and maternity protection.

The EU made a fairly strong speech stating: "We know that breastfeeding is important and provides significant health benefits both for the mother and her baby. We are therefore very concerned with the fact that less than 40% of infants are exclusively breastfed in the first six months globally. This shows that our previous efforts were not sufficient and we need to take more determined, comprehensive  actions in this field." 

The US,  while highlighting and calling for partnerships went on to make a strong recommendation for enforcement of the International Code: "..... the implementation for the International Code is inconsistent across many Member States. The Code continues to be is a central pillar of improved  child nutrition  and needs to vigorously and universally supported, applied and enforced.  Lack of consistency across countries in Codex standards – and weak standardized international guidance on regulating the labeling of the use of  foods for older infants and young children may preclude Member States from implementing their own legislation. We suggest that the Implementation Plan provides standardized  guidance for the labeling and standards in order to provide Member States with a platform for institutionalization of legislative policies." The US also called for the addition of a  reference to WHO's  Recommendations on the Marketing of Foods and non-alcoholic beverages  to children. 

ISDI  (International Special Dietetic Foods Industries)  representing the baby food industry  made more or less the same speech in NCD and Nutrition - boasting about their research and products -  running down the quality of locally available complementary foods. ISDI claimed to respect the aims and principles of the International Code but also boasted about their counselling of  mothers - an activity that  contravenes it!

Prevention and control of noncommunicable diseases: follow-up to the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases (NCDs) 

Draft Resolution

During the debate on  NCDs a draft Resolution, was proposed by the  Australia, Barbados, Canada, Costa Rica, Kenya, Norway, Russia, Switzerland and the US. The US called for an inclusive  process involving partnerships and consultation with all stakeholders - albeit in a transparent manner.   East Timor followed  calling for public health to  be safeguarded 'from any potential  conflicts of interest' for "appropriate civil society engagement."   Switzerland appreciated their concern did not want amendments that used wording that was not already in the Political Declaration adopted at the General Assembly.  However France and Canada both supported the call for safeguards against conflicts of Interest as did Brazil and Thailand (who were not on the EB)  Thailand said that COI,  transparency and civil society were core aspects of the Declaration. Switzerland then backed down and recalled its objection.  The Draft Resolution put forward by the Executive Board  contains two mentions of conflicts of interest.

The resolution also contains an amendment by Estonia speaking for the EU: "building on and being consistent with existing WHO strategies and tools on tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity." 

WHO Reform

 The debate on the WHO reform was informed by 9 papers prepared by the Secretariat and covered three areas: priority-setting, governance and management issues.

See in particular the report by the Secretariat on Governance: Promoting engagement with other stakeholders and involvement with and oversight of partnerships  Our delegation focused on the engagement with other stakeholders and advocated for a review of the 1987 Principles that govern official relations of WHO with NGOs. In line with the recommendations of the 2002 Review Report of the WHO Civil Society Initiative, we called for a clear distinction between public-interest NGOs (PINGOs) and business-interest NGOs ( BINGOs).   We also called for a comprehensive conflicts of interest policy to ensure that WHO’s engagement with private sector, philanthropies and in public private partnerships does not result in undue influence of public health decision making by commercial actors. India, France, Chile, Barbados and other countries highlighted the need for guidelines to protect WHO against Conflicts of Interest. The Secretariat will prepare for the 2012 WHA a consolidated document, highlighting all elements discussed during the EB.

The Report by the Secretariat states (Para 12):  "No specific provisions exist in the Constitution that govern WHO’s relations with private for-profit organizations; not-for-profit philanthropies and public–private partnerships. The Sixty-third World Health Assembly endorsed the policy on WHO’s engagement with global health partnerships and hosting arrangements as a way to advance the global health agenda contained in the Eleventh General Programme of Work 2006–2015.1 Internal guidelines for staff interactions with private for-profit organizations have been developed by the Secretariat but they need extensive consultation and revision if they are to be transformed into a comprehensive framework that can be considered by the governing bodies."

Management: The discussion on management issues focused on issues of finance and evaluation. Member States raised concerns with regards to the proposed Pledging Conference, and how it is going to solve the financial problems of WHO and increase predictability. The Secretariat will prepare a new document on financing, and MS are invited to provide input before the 19th February.  As regards evaluation, our delegation raised concerns with relation to the first stage evaluation, whose scope has been narrowed as to significantly decrease its effective contribution to the reform process. Such contribution is diluted further by the inappropriate timeline of such evaluation that is happening at the same time as the report itself. Countries like Switzerland conveyed the opposite message by stating that “we have to be careful and do not postpone the reform while waiting for an independent evaluation”. The discussion focused much on the entity that will conduct such evaluation. Agreement was reached for the outgoing External auditor (India) to carry out the stage 1 and the results will be presented to the WHA with suggestions for the stage 2.

The Secretariat will now prepare a consolidated document that will contain all the aspects of WHO reform (programme and priority, governance and management).   

IBFAN/CI worked closely with the Democratising Global Health Coalition, the People's Health Movements and the Conflict of Interest Coalition.