PHA-Exchange> Report to Peoples Health Movement and GEGA by david mccoy

[Claudio]

Report to Peoples Health Movement and GEGA

Collective action for health: the WHO 11th General Programme of Work
Special Session at the World Health Assembly


Moderator:  	Chris Powell 

Discussants: 	WHO Secretariat: Dr Roses, Regional Director, PAHO 
Member States: C.K. Ngilu, Minister of Health, Kenya
Partner Agency:  Julian Lob Levyt (GAVI)
Civil Society: David McCoy (People's Health Movement and Global Equity Gauge Alliance)

The session was attended by about 80 people, many from WHO.

For anyone wanting more information on the Global Programme of Work, please go to:
www.mayeticvillage.com/who-gpw
Username:  11thGPW
Password:  comment

My input in brief note form:

PHM is a loose network of activists, academics, NGOs, WHO officials and grassroots peoples' organisations.

GEGA is a collection of country-based initiatives in the South that were based on three sets of activities: measuring inequity; advocacy; and community empowerment. This is relevant because if the GPW is to address the challenge of widening health inequities, it must respond to political challenges, acknowledge the central importance of popular / social mobilisation and to find ways of popularising 'social solidarity'. This is vital if we are to accomplish the central task of redistribution and creating a level playing field for all to benefit. 

Unfortunately, the Equity Gauge model runs counter to the dominant development paradigm - one which focuses on the delivery of medical technologies and pre-determined packages of interventions without considering adequately the process of health development, and without considering how health interventions can simultaneously change the political and social landscape in which are constituted the fundamental social and economic determinants of health.

Worse still, we see too many health interventions and programmes - in spite of being explicitly pro-poor or centred on poverty reduction - which:
* reinforce dependency and disempowerment; 
* give to much publicity and credence to institutions and actors that do not share a commitment to equity or healthy for all - actors and institutions that may actually be part of the problem but which are positioning and portraying themselves as being part of the solution
* undermine government and undermine the mandate and capacity of the public sector within health care systems


So, our first point: the GPW must give attention to the process of health development, so that it incorporates and advocates health interventions that will also shift the imbalances in decision-making power; increase the transparency and accountability of governments, global initiatives and public-private partnerships; and shape global initiatives to fit in with the needs of health care systems, rather than shaping health care systems to fit in with the needs of global initiatives. We must not have the tail wagging the dog.

Following on from this, the second point is: we would like the GPW to discuss and respond to the environment within which WHO operates. PHM and GEGA want and hope for a revitalised and strengthened WHO, able to effectively discharge its mandate and mission as the lead multi-lateral agency on health. But the truth is that over the past years, WHO has had a diminishing influence on health. To reverse this, it would mean: 
* Looking at global governance and the effectiveness of the UN system as a whole; and challenging the capture of global institutions by the rich and powerful nations, and the undue influence on them by unaccountable private organisaitons
* Strengthening the ability of WHO to influence the form and rules of globalisation so as to be able to promote and protect public health - this would include increasing the relative power and influence of WHO vis a vis the key multilateral institutions influencing the global political economy such as the WB, WTO and IMF
* Improving the funding environment of WHO, and reducing the ability of donors to unduly control the WHO agenda through extra-budgetary support - both the quality and quantity of WHO funding needs to be improved; as well as the way in which funds are controlled and allocated.
* Limiting the undue influence of certain countries on the actions of WHO - for example, looking to see how the WHO can be protected from pressure to stop considering macro-economic and trade policies as being health issues
* Bring some sense of coordination and coherence to the proliferation of global initiatives and partnerships which results not just in Ministries of Health having to operate in an uncoordinated and disruptive circus of actors, being pulled in multiple directions at once, but which also results in undermining the authority and mandate of WHO.

We therefore hope that the General Programme of Work will pay attention to the operating environment of WHO, so that WHO can be made to be more effective. Ultimately, this will require the collective effort of civil society, Ministers of Health and the leadership of WHO to lobby and campaign to effect any real and positive changes.


Finally, the third point: we would like to see the GPW also reflect and comment on the internal environment of WHO. In two months, we and others, will be launching the production of an alternative world health report. One of the ideas behind this is to develop a mechanism for "writing a report on the people who normally write the reports". In other words, to find a mechanism by which we can scrutinise the work and actions of key global health institutions such as WHO (but not limited to WHO). 

Promoting such scrutiny, transparency and accountability is not only good for promoting effective bureaucracies, but is all the more important given the current environment of "global public-private partnerships".

WHO is a complex organisation, operating in a difficult environment. The system of formal governance through the WHA and Executive Board, and informal governance through behind-the-scenes lobbying, pressure and arm-twisting is far from ideal. 

But still, we believe more can be done, and needs to be done, to improve the organisational culture and management processes within WHO. We hope that the analysis and discussion of WHO in the forthcoming alternative world health report will be useful. A more effectively organised and managed WHO will only happen through actions from within WHO; but it will be helped through both support and constructive criticism from outside. 

On behalf of both PHM and GEGA, I thank you again for the opportunity to speak, and I wish WHO well in the further development of this important document.

Dr. David McCoy
 


I also brought up the following issues in response to questions and comments from the floor:

The whole discourse around public-private partnerships need to be examined with closely. Why is it that everyone is so keen on private sector partnerships? Why is it that we are so dependent on private sector financing - on their largesse and charity? Why are governments and UN agencies finding funding such a problem? How does this situation connect with the fact that more than $200 billion dollars is lost every year through corporate tax evasion? Globalisation now makes it increasingly difficult for national governments to capture legitimate tax revenue from economic activity, whilst making it ever easier for corporations to evade their social responsibilities and obligations. At the same time, corporate tax rates are declining. Wealth is being concentrated in fewer and fewer hands, and we are all now dependent on private sector voluntary contributions to sustain health programmes. The ILO and other agencies are now beginning to call for an international tax authority, and we hope to see WHO following suit.


A discussion on the inappropriate appointment of the new UNICEF Director is also reflected in the alternative world health report. In fact many people in developing countries, even in senior government positions, are not even aware of the appointment, let alone able to have had a say on who leads the UN agency mandated to protect children. This is the kind of issue that needs to discussed and debated more widely, and another reason for the alternative world health report.




-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20050524/492b9d4b/attachment-0001.html>