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WHO: Members' pressure leads to more inclusive reform process

SUNS #7163 Monday 6 June 2011

Geneva, 1 Jun (K. M. Gopakumar and Sangeeta Shashikant) –

Dissatisfaction brewing among many Member States over the Secretariat's reform plan culminated with Members reasserting their control over the reform process of the World Health Organisation.

This took place at the 129th session of the WHO Executive Board on 25 May. Earlier, the World Health Assembly (WHA) that met in Geneva on 16-24 May had considered the WHO Director General's report titled "The Future of Financing for WHO" (A64/4) that contains a broad, far-reaching reform agenda that is likely to reshape the way in which the organization operates, is governed, makes decisions and is financed.

The broad reform plan led to many Member States expressing their concerns particularly over the lack of detail on the reforms proposed, the stress on "donor-funding" to resolve the financial difficulties of the WHO, as well as proposals such as the convening of the World Health Forum, which is aimed at increasing the influence of the private sector and donors in setting the health agenda in the WHO. They also emphasized that the WHO's reform process must be driven by Members States themselves. However, these concerns were skilfully side-stepped by Dr. Margaret Chan, WHO's Director-General with promises of inclusiveness leading to the rapid adoption of the Secretariat's resolution on the reform process which did not measure up to Member States' expectations (See SUNS #7155 dated 23 May 2011).

Member States' discontent with Dr. Chan's approach to reform continued to brew, forcing the matter onto the agenda of the Executive Board (EB) that met on 25 May after the conclusion of the WHA.

The Executive Board is composed of 34 members technically qualified in the field of health and meets twice a year. The main functions of the Board are to give effect to the decisions and policies of the World Health Assembly, to advise it and generally to facilitate its work.]

Discussion at the EB saw a push by developed and developing countries for a more transparent and Member State-driven process, resulting in the adoption of a new decision EB 129(8) on WHO's reform for a healthy future. This new decision sets out a more transparent and inclusive consultative process for the finalisation of a reform plan in the next 6 months for consideration of a special EB session that will be convened in November 2011.

The decision taken is as follows:

"The Executive Board,

"1. DECIDES to establish a transparent, Member State-driven and inclusive consultative process, on WHO reforms, based on existing mechanisms, comprising of the following steps:

"2. REQUESTS the Director-General to prepare by the end of June 2011, three concept papers which will be further revised on an ongoing basis through the consultative process, on the following issues: governance of WHO, independent evaluation of WHO, and the World Health Forum, as outlined in resolution WHA64.2;

"3. REQUESTS the Director-General to hold consultations of Member States at WHO Headquarters, on these papers, and to create a platform for web-based consultations by the end of July 2011;

"4. REQUESTS Regional Committees, based on the updated concept papers, to engage in strategic discussions regarding the WHO reform process and report on these discussions to the meeting outlined below;

"5. DECIDES to hold a special session of the Executive Board open to all Member States in November 2011, following the Regional Committee meetings, to discuss outcomes of the consultative process on the three papers, and draft proposals prepared by the Secretariat or proposed by Member States on other aspects of the reforms outlined in document A64/4.;

"6. URGES Member States to support, with possible funding, and actively engage in the reform process;

"7. REQUESTS the Director-General to support the aforementioned elements of the consultative process."

This decision is significant in that Member States pushed to regain control of WHO's critical reforms which has hitherto been driven by the Secretariat. It is also a major improvement over the Secretariat's resolution WHA 64.2 adopted during the WHA. The EB decision sets out a detailed process for Member States' involvement including at the regional level, in driving all aspects of WHO's reform. According to the decision, the special session of the EB (open to all Member States) in November will discuss the entire reform package.

On the other hand, the WHA 64.2 envisaged limited participation of Member States including the EB in the reform process.

[WHA 64.2 endorses the Director-General's report (A64/4) and requests the EB to establish an appropriate process to examine specific issues related to WHO's governance identified in the Report. The resolution also further requests the Director-General to present a concept paper for the World Health Forum proposed to be held in November 2012, to the 130th session of the Executive Board in January 2012; to develop an approach to independent evaluation in consultation with Member States, and to present a first report on the evaluation of the work of WHO to the 65th WHA in 2012; and to update the 65th WHA on the progress through the 130th Executive Board meeting.

[An Annex to A64/4 briefly outlines the time-line for the reform process. WHO will develop elements of the reform programme, based on expert guidance, and consultations with Member States, partners and staff between June and October 2011. WHO will also undertake an independent formative evaluation of the work of WHO between July 2011 and December 2011. Further in January 2012 the 130th Executive Board meeting will discuss the report on the programme of reform followed by consideration of the programme of reform by the 2012 WHA.]

The EB decision adopted on 25 May is based on a draft text proposed by Ecuador.

Switzerland and the US preferred to work on the basis of the Secretariat's text, however, Brazil insisted that Ecuador's text be the basis as it would be a perfect example of a Member State-driven process. The Secretariat used the Ecuadorian draft text to further propose a new text for consideration by EB members. Member States finally adopted this as the EB decision following changes proposed.

Despite the EB decision, certain uncertainties over the reform plans continue to linger. The reform process began with the aim of addressing the poor financial health of WHO. However, the Director-General's report fails to incorporate any new dynamic strategy to address the issue leading some to question the Director-General's intent. Confusion over the true intent has been further compounded as the Director-General stressed during the EB meeting that reform is an attempt to respond to a changing architecture of global health.

Interestingly, the three concept papers to be prepared under the EB decision do not mention the financing of WHO.

During EB meeting, Germany raised this issue and proposed the addition of "including strengthening of financing and resource mobilisation" to the title of the first concept paper on Governance of WHO. Germany reiterated that the whole reform agenda discussed at the WHA was under the title of "Future financing of WHO".

In response, Dr. Chan said that there was insufficient time to include the issue of financing in the concept paper, but agreed to conduct consultations beginning July and to address the issue in the concept paper. Dr. Chan also said that the issue of finance and resource mobilisation is part of the governance mechanism. Following this explanation, Germany withdrew its amendment. As such the extent to which Dr. Chan will seek to address the financial difficulties of WHO as part of the reform process is unclear. The EB decision also lacks clarity on the utility of the independent evaluation to the reform process as the independent evaluation will be undertaken in parallel with other aspects of WHO's reform.

Several Member States raised this concern. Norway suggested a different time-line for the independent evaluation so the findings of the independent evaluation can feed into the reform process. However, the decision fails to address this issue. There is also little clarity as to the scope and content of the independent evaluation, whether it covers all WHO's activities or only a select few.

The EB decision also does not go as far as to incorporate the call for intergovernmental consultation on the reform as suggested by Mozambique and supported by India and Brazil. While the EB meeting is open to all WHO Member States, the participation of non-EB members is restricted to the level of observers without any voting rights. Several Member States also raised again concerns over the private financing of the reform as WHO proposed that the development of the reform programme be partially funded by the Bill and Melinda Gates Foundation (A64/4 Add. 1). The EB decision attempts to address the issue by urging Member States to support the reform process including possible funding. Countries such as Germany and Brazil offered financial support for the reform process.

The EB also considered other agenda items that were relevant to the reform of WHO. It considered proposals to reduce reporting requirements for future resolutions to a maximum of 3 biennium (6 years) and a nominated session for review due to the current heavy burden of reporting requirements on the Secretariat. It also considered a proposal to introduce a new agenda item in the Programme, Budget and Administration Committee of the EB to consider the financial and administrative implications of resolutions that have been recommended by the EB in its January sessions before the resolutions are considered by the WHA.

The EB also considered a proposal on the rules of procedure of the EB that "Formal proposals relating to items of the agenda shall be introduced within 48 hours after the adoption of the agenda, unless the Board decides otherwise". Member States deferred consideration of these items, rather preferring to address all these proposals as part of the reform process. As a result, the Secretariat's proposals were not adopted.

The WHO staff association representative said that while they supported the reform, they sought clarification on the purpose and direction of reform, adding that the staff was under severe stress. The staff association also protested outside the EB meeting room, holding placards with slogans questioning the accountability of WHO's top management. Some slogans were: " WHO on Fire 800 staffs gone what is the vision and the implications for WHO mandate" and "350 staffs to be fired where is the management accountability".

Concerns raised at the WHA were also raised by several civil society organizations in a letter to the EB members, prior to the EB meeting. In particular, the letter expressed concern with the WHO's reform and the potential conflict of interest involved in the reform process. The letter requested "the Executive Board to provide guidance and design a process by which the WHO secretariat might manage conflicts of interest as part of the governance review process.

"This process should include a definition of individual and institutional conflicts of interests as well as specific guidelines on how to appropriately manage them; it should also require that WHO's institutional policies for interaction with the commercial sector are clarified and widely publicised. "Finally, we believe that in order to have a credible reform, there is need for a broader discussion with Member States on the reform process and objectives and the financing of the WHO, where these matters are duly addressed, as are Member States contributions to, and their engagement with, the WHO".