PHM-Exch> PHM letter to the members of the Executive Board of WHO Jan 2011

[Claudio Schuftan]

Issues for consideration at the WHO Executive Board

Distinguished members of the Executive Board of WHO,

On behalf of the People’s Health Movement and a number of affiliated
networks I submit the
comments and suggestions included below regarding some of the items
appearing on the agenda of the
WHO Executive Board. We hope that you may find time to read and consider
these comments before
the relevant discussions at the EB. We hope that you find them useful.
PHM is a global network of organizations working locally, nationally and
globally for ‘health for
all’. Our basic platform is articulated in the People’s Charter for Health
which was adopted at the first
People’s Health Assembly in December 2000.  More information about PHM can
be found at
www.phmovement.org.
PHM is committed to a stronger WHO, adequately funded, with appropriate
powers and playing
the leading role in global health governance. PHM follows closely the work
of WHO, through the
governing bodies and the secretariat. Across our networks we have technical
experts and grass roots
organizations with close interests in many of the issues coming before you
over the next week.
However, WHO does not make it easy for civil society NGOs to contribute to
its consideration of the
issues coming before it. It limits the number of organizations which have a
formal relationship with
WHO and has recently restricted access to spaces in the Palais de Nations
during the WHA.  It seems
that WHO is more welcoming of private sector organizations than people’s
organizations.  A different
model of consultation was evident during the work of the Commission on
Social Determinants and
Health.
Over the last week members of the PHM WHO liaison group have been working
through the EB
Agenda with the assistance of high level experts from a number of
collaborating networks and NGOs.
This workshop was part of our Global Health Governance Initiative which
involves both watching and
advocacy. In the course of these discussions we have prepared the following
comments on some of the
key issues coming before you.
Members of the PHM WHO liaison group will be following the discussion at the
EB over the next
week and would be keen to discuss these comments with you during this week.
2

4.1 Pandemic influenza preparedness: sharing of influenza viruses and
access to vaccines and other benefits.
*Secretariat note *
The Open-Ended Working Group of Member States on Pandemic Influenza
Preparedness: sharing of influenza
viruses and access to vaccines and other benefits will meet in December
2010. A report on this meeting and other
technical consultations undertaken to support the Group’s work will be made
to the Sixty-fourth World Health
Assembly, through the Executive Board, as decided in resolution WHA63.1.
*PHM Comment *
The provisions of the Convention on Biological Diversity provide for benefit
sharing where
biological samples such as viral material are transferred internationally.
Resolution WHA60/28 provides
a clear direction for managing this issue.
The H5N1 and H1N1 crises have shown the need for a equitable and transparent
mechanism for
pandemic preparedness that puts public health as a top priority over
industry’s profits.
A viable and sustainable system for pandemic preparedness must include
sustainable forms of
benefit sharing; ad hoc donations are unreliable solutions. This means that
recipients of influenza
biological materials must commit to benefit sharing on a mandatory basis.
This is important to achieve
public health objectives as well as to ensure compliance with international
obligations under the
Convention of Biological Diversity (CBD) to which almost all WHO member
states (except for the US) are
a party to. The CBD requires that those that receive and use genetic
resources must share benefit arising
from the use of those resources.
A Standard Material Transfer Agreement (SMTA), constructed as a formal
contractual agreement
between the provider of biological resource and the recipient of such
resource, is a practical way of
achieving concrete benefit sharing. MTAs have been used in the sharing of
influenza biological material
previously and there are no reasons why standardised MTAs should not now be
mandated for use in the
transfer of influenza biological materials. SMTA must have a contractual
binding effect, and contain
terms and conditions on the use of influenza biological material as well as
benefit sharing to be an
effective solution.
Claims of private intellectual property rights over the influenza biological
resources or over the
products/processes developed using such material should not be allowed by
WHO linked centres or by
third parties. If third parties are allowed to claim IPRs over the
products/processes developed using such
material then royalty free licenses must be made available to developing
countries.
The definition of PIP biological material in the Framework must include
parts of the biological
material in particular their genetic and other components and parts thereof,
including genes (RNA and
DNA), genes sequences and polynucleotides as well as the polypeptides they
encode. It further includes
sequence data.
The co-chairs of the OEWG should invite civil society organizations to make
written submissions as
many such organization may be unable to participate the inter-sessional
consultations in person due to
funding constraints.  3

4.3 Public health, innovation and intellectual property
*Secretariat note*:
The Consultative Expert Working Group on Research and Development:
Financing and Coordination
The Director-General will propose a composition of the Consultative Expert
Working Group to the Board for
approval, drawing on the roster of experts whose details, following
consultation with Regional Committees, have
been submitted to the Director-General through the respective Regional
Directors, and taking into account regional
representation according to the composition of the Executive Board, gender
balance and diversity of expertise, and
the Regional Committees’ recommendations.
*PHM Comment*
The Director-General proposes to recommend the composition of the
Consultative Expert
Working Group on Research and Development: Financing and Coordination to the
Board for approval.
The issues on which the CEWG will provide advice are of critical importance
in terms of finding
workable mechanisms for mobilizing funds for research and development in
relation to pharmaceuticals
and other medical products. The use of the patent system to raise (some of
the) money for research and
development has failed the tests of access and equity and appears to be
failing with respect to
innovation also. However, large pharmaceutical corporations are reluctant to
consider such a significant
change in their way of doing business and have opposed moving away from this
model.
The credibility of WHO will not be enhanced if non-transparent mechanisms
for assembling the
CEWG leave scope for concluding that conflict of interest conventions were
not followed in evaluating
the options before this group. In particular we are concerned to note that
an employee of a large
pharmaceutical corporation is recommended. It was our understanding that
WHO’s conflict of interest
policy would preclude such involvement in a norm setting forum, which
clearly this is. We recommend
that the appointment of Mr Paul Linus Herrling be disallowed on this basis.

We note that Resolution 62.28 4(c) requires the DG “to establish a roster of
experts comprising all
the nominations submitted by the regional directors”. We argue that all of
the names of the experts on
this roster should be provided to the EB, not just the proposed members of
the Group.
We note the lack of career detail provided regarding the proposed members.
 We believe that a
brief CV should have been provided with each name so that the nature of the
expertise that the
proposed members bring to the Group might be clear to the EB.
We recommend that EB approval of this list be deferred pending the provision
and consideration
of these additional data.
4.4 Health-related Millennium Development Goals
Secretariat note: WHO’s role in the follow-up to the high-level plenary
meeting of the sixtyfifth session of the United Nations General Assembly on
 the review of the Millennium
Development Goals (September 2010)
The report includes information on the progress made in the implementation
of resolutions WHA63.15 and
WHA63.24, the latter of which expanded the coverage of the annual report on
the monitoring of the achievement
of the health-related Millennium Development Goals to include an account of
progress towards achievement of 4
Millennium Development Goal 4 to reduce child mortality: prevention and
treatment of pneumonia. At the request
of a Member State, the report also presents an overview of WHO’s engagement
in the high-level plenary meeting
on the review of the Millennium Development Goals and the follow-up
activities, describing the key health
outcomes, implications for WHO and for countries, and required actions to
achieve the Goals in the next five years.
PHM Comment
In Document EB128/7 the Secretariat reports on progress towards achievement
of health related
Millennium Development Goals and particularly Goal 4 (to reduce child
mortality - through the
prevention and treatment of pneumonia).
This report is focused largely on the technical interventions which will
form part of any health
development program but is very thin with respect to the political and
economic context in which these
interventions might be mounted. Despite the mention of the Commission on
Social Determinants of
Health there is little in this report which reflects the focus on equity and
adressing upstream
determinants which were elaborated by the CSDH. There is no reference to the
constant pressure to
liberalise trade which in many settings has exacerbated hunger and
malnutrition.
The Secretariat is to be commended for its emphasis on the need for health
system strengthening
but we suggest that it could articulate more clearly the links between
privatization policies forced on
many L&MICs and the collapse of health systems;
These are issues which are not widely understood. The WHO’s leadership role
demands that it
takes the lead in researching, analyzing and developing appropriate policies
to address these issues.

4.5 Health system strengthening
*Secretariat note*
The review will include a summary of current debate on national and global
approaches to national health policies, strategies
and plans, and the role of such dialogue in the achievement of better health
outcomes and the mobilization and alignment of
resources behind country priorities. The report will cover the building
blocks for health systems including, at the request of a
Member State, a review of early progress made in the implementation of the
WHO Global Code of Practice on the International
Recruitment of Health Personnel.
PHM Comment
A report (Document EB128/8) is provided by the Secretariat pointing towards
strengthening the
role of WHO in supporting national work towards health system strengthening.

This is an inadequate report.
Notwithstanding the promise of the annotation on the EB agenda, there is
nothing in this report
about the implementation of the WHO Global Code of Practice on the
International Recruitment of
Health Personnel. Indeed there is nothing about the workforce crisis, no
reference to how brain drain in
health is to be managed; no reference to the policy question of compensation
of L&MICs whose
exported professionals are staffing the hospitals and clinics of richer
countries.
There is no mention in this report of the policies of the World Bank which
since 1993 have
promoted the horizontal stratification of health systems (private for the
rich, social insurance for the
middle and minimal safety net packages for the poor), nor is there any
explicit analysis of the
contribution of the disease specific funding bodies in promoting vertical
fragmentation and internal 5
brain drain. There is no mention of IMF restrictions on ‘fiscal space’ in
actually applying resources which
may be available.
The report acknowledges that health care reform is fundamentally a political
process but the
focus on the rational logic of ‘best practice’ does not offer any guidance
with respect to the politics of
health care reform. In particular there is no mention of the advocacy,
accountability and participatory
role of civil society in driving health system reform.
4.6 Global immunization vision and strategy
Secretariat note
Resolution WHA61.15 requests the Director-General to report on progress made
towards achievement of global
immunization goals. The report describes the implementation of the Global
Immunization Vision and Strategy
2006-2015 and gives an outline of efforts made by WHO, UNICEF, the Bill &
Melinda Gates Foundation and other
stakeholders to launch a 2011–2020 Decade of Vaccines and Immunization. The
Board is invited to consider
endorsement of the new initiative’s process and scope.
*PHM Commen*t
A ‘one-size-fits-all’ approach in the introduction of new vaccines should be
avoided. National
priorities are not everywhere the same. The introduction of new vaccines
should be subject to detailed
needs assessment studies, cost-benefit analyses and public health impact
assessments which recognize
the specific circumstances of each member state. WHO should assist member
states in undertaking such
studies where appropriate. An urgent focus is required on adequately
strengthening the vaccine delivery
system without disrupting existing health services.
It is recognized that effective and efficient vaccine delivery requires and
should be mediated
through well functioning health systems. It is less widely recognized that a
pre-occupation with
immunisation delivery can disrupt health care delivery with serious negative
consequences.
Sustainability is a key criterion in the financing of immunization programs.
While Global Alliance
on Vaccines and Immunizations (GAVI) may subsidize the cost of new vaccines
for a few years, the
capacity of member states to carry those costs in the longer term once the
new vaccines have become
part of their routine national health strategy needs to be considered. The
projected costs of a full course
of vaccination (para 25) underlines the importance of affordability.
Member states should be given technical assistance with respect to using the
flexibilities provided
under the Trade Related aspects of Intellectual Property Rights (TRIPS)
Agreement to ensure affordability
of vaccines.
The strategy should prioritise the provision of technical support and
technology transfer to
strengthen the capacity of member states to produce vaccines domestically.
We recommend a focus on
building research and manufacturing capacity in the public sector so
governments are not over-reliant
on the private vaccine industry and biotech industry.
The strategy mentions monitoring and surveillance of immunization but should
also include
reference to the monitoring of adverse events in the use of vaccines.
Likewise the strategy should 6
include the promotion of safe injection, proper storage of vaccines and
ensuring appropriate
compensation mechanisms for adverse events.

4.7 Draft WHO HIV/AIDS strategy 2011–2015
*Secretariat note *
Following the request to the Director-General in resolution WHA63.19 to
submit a WHO HIV/AIDS strategy for
2011–2015, a broad consultation process has informed a draft global health
sector strategy for HIV/AIDS structured
around four main goals: improving HIV outcomes; improving broader health
outcomes; strengthening health
systems; and creating supportive environments. The Board is invited to
consider the draft strategy.
*PHM Comment *
The progress report (EB128/10) does not discuss barriers to the
implementation of the “Three
Ones” principle (one agreed HIV/AIDS action framework, one national AIDS
coordinating authority, and
one agreed country-level monitoring and evaluation system) as provided for
in WHA59.12 which urges
for the identification of barriers and strengthening of institutional
capacity.
The Draft HIV/AIDS strategy should inform AIDS coordination and vice versa,
with clear links
established between the two. The two items should not be discussed in
isolation from one another.
Intellectual property rights, and the resulting unaffordability of diagnosis
and treatment, should
be acknowledged as a barrier to reaching the ultimate objective of
implementing the Three Ones
principles. The Draft HIV/AIDS Strategy mentions it, so it should be
reflected here as well so that
coordination efforts could be directed its way (with the UNDP, for
example).
According to WHA59.12, the DG is requested to prepare a plan of action for
the implementation
of the recommendations of the Global Task Team, and to provide effective
technical support at national
level. In the progress report (para. 92), there is mention of a UNAIDS
technical support strategy to which
the WHO has contributed, and is “elaborating a plan to outline WHO’s role
and contributions”. Member
States should ask for this plan of action (on WHO’s role and contributions)
to be developed and set a
deadline for this.
Under the revised UNAIDS division of labour, according to the progress
report (para 93), the WHO
continues to lead the health sector response to HIV. However, the report is
not clear as to how the
contribution of the WHO in these areas will see improved coordination among
multilateral and
international bodies, or, better, how such coordination of efforts could
strengthen such an exercise.
With regard to monitoring and evaluation, it is not clear whether using the
term “improving” the
performance of Joint UN Teams on AIDS (para. 94 of progress report), entails
some monitoring and
evaluation mechanism in place (in line with the Task Team recommendations
under Accountability and
Oversight). Developing the capacity of monitoring and evaluation at national
level should also be
covered by technical support activities (covered under para. 92), because it
is a crucial element for
sustainability of HIV response.
The close cooperation between WHO and the GF on technical support issues
should not be
confined to countries who succeed in receiving GF. There are developing
countries which are in need of7
technical support, but which often fail the GF “application process”. They
should not be deprived of such
support.
It has been recognised that access to affordable HIV-related medicines is
hampered by the failure
of countries to use safeguards available in the TRIPS agreement (with
reference to the Doha Declaration
in a footnote). However, there is no reference to the failure of the para 6
system of the Doha
Declaration in helping LDCs with no pharmaceutical manufacturing capacity
access medicines (CanadaRwanda case), and of its review process at the TRIPS
council. The WHO, as the UN organisation
mandated with health matters, should take the lead on this, rather than WTO
on its own.
There is no mention of TRIPS-plus provisions in bilateral trade agreements
through which
developing countries give away their TRIPS safeguards.
There is a need for technical assistance on health-related IP matters, which
should be specified
under the implementation section (Table 6, p. 52), where the WHO
collaborates with the UNDP. This is
being called for at other UN organisations such as WTO and WIPO, and
developing member states are
also questioning the content of existing technical assistance programmes
provided to developing
countries. The WHO should take the lead on such health-related discussions,
and there is also a need for
more information about specific ways in which the WHO will contribute.
Under Health financing (p. 27) the draft strategy calls for the adoption of
approaches to minimise
out-of-pocket expenditure, but places mobilisation of donations for adequate
funds as a first element,
further reinforcing a vertical donor-centred approach. The immediate
interpretation is that prices,
hence big pharma commercial interests, are not to be negotiated.
The vertical approach, which is criticised for being unsustainable, should
be addressed through
strengthening national capacity, namely health regulatory and legislative
capacities. Investing in local
pharmaceutical manufacturing capacity also provides a sustainable solution
away from the vertical
approach.

4.8 Substandard/spurious/falsely-labelled/falsified/counterfeit medical
products
*Secretariat note*
The Sixty-third World Health Assembly decided, inter alia, in WHA63(10) to
establish a time-limited and resultsoriented working group on
substandard/spurious/falsely-labelled/falsified/counterfeit medical
products. The
outcome of the working group’s meeting held in December will be reported.
*PHM Comment *
There is an urgent need to ensure disengagement of WHO from the activities
of IMPACT. Member
state should ensure that WHO’s activities in the medicine areas should focus
rational use of medicine
and strengthening the regulatory capacity of member states to ensure
quality, safety and efficacy of
medicines instead of IP enforcement.
We urge member states to expedite the process of convening the working group
prior to the
upcoming WHA. We urge attention to ensure that the appointments process is
transparent and free
from conflicts of interest.  8

4.14 Prevention and control of non-communicable diseases
*Secretariat note*:
WHO’s role in the preparation, implementation and follow-up to the highlevel
meeting of the United Nations General Assembly on the prevention and control
of noncommunicable diseases (September 2011)
The United Nations General Assembly decided, inter alia, in resolution
A/RES/64/265 to convene a high-level
meeting on non-communicable diseases in 2011. The resolution requires the
Assembly to hold consultations on the
scope, modalities, format and organization of the high-level meeting and
requests the Secretary General to submit
a report to the General Assembly at its Sixty-fifth session on the global
status of non-communicable diseases. The
report describes WHO’s plan for participation in and contribution to the
preparations for the high level meeting,
including the co-organization of an international ministerial conference on
non-communicable  diseases and
healthy lifestyles in Moscow, as well as other implementation activities.
Discussion of this topic by the Board also
forms part of the consultative preparations.
*PHM Comment *
This report (EB128/17) describes WHO’s preparations for the High Level
Meeting on NCDs in
September 2011.
In the Annex summarizing previous events leading up to this meeting there is
no reference to the
work of the Commission on Social Determinants and Health. The CSDH
emphasized the importance of
looking at the equity dimensions as well as the disease process. Clearly
there are important equity
dimension to the incidence and prevalence of NCDs and these variations are
closely linked to the social
and environmental factors; not just individual behaviours.
Clause 9 of the report notes that WHO has organized informal consultations
with representatives
of nongovernmental and civil society organizations and the private sector.
PHM is concerned that these
discussions should not be restricted to those NGOs and CSOs which advocate
for the prevention and
treatment of particular disease groups. Having regard to the breadth of
issues raised by the equity and
the social determinants dimensions of NCDs it would be appropriate to
consult with a broad range of
NGOs and CSOs whose work is focused on various aspects of equity and social
determinants also.
We urge that the materials produced for these consultation and the outcomes
documents are
posted on the WHO website. We urge that the regional consultation meetings
should be open to a full
range of NGOs and CSOs. We suggest the mounting of a web based consultation
after the release of the
foreshadowed WHO report.

4.15 Infant and young child nutrition: implementation plan
*Secretariat note *
The paper presents the outline of a comprehensive implementation plan on
infant and young child nutrition and
describes the process for developing the plan as a central component of a
global, multisectoral nutrition
framework, as requested in resolution WHA63.23.
*PHM Comment *
This is an important area and PHM will be following the development of the
implementation plan
closely. We suggest that EB members underline the importance of a
transparent consultation process 9
including the publication on the web of all submissions to the consultation
including particularly those
coming from private sector.

4.16 Child injury prevention
*Secretariat note*
The Board discussed the item at its 127th session, including the text of a
draft resolution, and agreed to defer
further consideration to its 128th session. The report and the draft
resolution are re-presented for consideration.
*PHM Comment*
There is no reference to the child injuries and death incurred during wars,
military conflict,
political instability and other forms of violence. WHO should recognize the
contribution of these factors
to child ill-health, injury and death.

4.17 United Nations Decade for Action for Road Safety: draft action plan
*Secretariat note*
In March 2010, in resolution A/64/255, the United Nations General Assembly
proclaimed the period 2011–2020 as
the Decade of Action for Road Safety, envisaging a significant role for WHO.
The Secretariat report describes the
main elements of a draft plan of action for the Decade. The Board is invited
to consider the draft plan.
*PHM Comment*
It is not clear that the reference to a draft plan in the Secretariat note
is correct. Document
EB128/20 states (para 17) that the Plan has been finalized.
The ‘finalised’ plan does not give due weight to appropriate urban planning
and the reduction in
the number of automobiles on the roads. This is closely linked to the
pressures and processes of
urbanization which were fully explored in the Report of the Commission on
Social Determinants of
Health (to which reference is not made in this draft plan).

5. The future of financing for WHO
*Secretariat note*
The Director-General undertook to report to the Board the views of Member
States on issues raised following the
informal consultation on the Future of Financing for WHO in January 2010.
The report will synthesize responses to
the web consultation conducted between April and October as well as
discussions held during the meetings of the
Regional Committees in 2010. The January consultation acknowledged that the
future of WHO’s financing has to be
based on an understanding of WHO’s changing role and the nature of its core
business. The report will therefore
highlight areas of consensus and divergence in relation to priority setting,
core business, and WHO’s governance
role in global health.
*PHM Comment*
The WHO faces a financial crisis and its legitimacy is under attack. This
paper (EB128/21) and the
process it foreshadows are to be welcomed.
Funding
The proportion of voluntary (extra-budgetary) funds relative to assessed
contributions (regular
budget) from Member States continues to increase, raising the concern that
priority setting by WHO 10
may be skewed by special interests and that WHO may be unable to fulfill its
constitutional mandate
and respond to the real health needs of populations.
An analysis of the 2012-2013 proposed budget (EB128/22)
1  reveals low allocations to areas of work relating to root causes of
avoidable disease and death
2  and a strong focus on medicines, diagnostics and other health
technologies.
In the area of communicable diseases, activities are almost exclusively
focused on
immunization/vaccination. This is despite the fact that the diseases of
poverty - as the name suggest and
public health history shows - require attention to the meeting of basic
needs for health such as food,
water, adequate sanitation and decent housing.
WHO’s work, as described in EB128/24
3   focuses overwhelmingly on treatment to the detriment of health
promotion, prevention and rehabilitation. Health promotion itself appears to
be restricted to individual behavior change while structural causes receive
inadequate attention.
We highlight the following statement by the DG in 128/21:
For this reason, Member States are urged to give serious consideration to
the issue of
increasing assessed contributions and, where appropriate, revisiting
national policies that
restrict their growth.
We suggest that the EB mandate the Secretariat to develop a sustainable
financing plan for the
WHO, to be placed at the next WHA. The plan should be premised on increased
assessed
contributions of member states, with a view to securing the independent role
of the WHO, its
continuing and expanded role in providing stewardship to global health
issues and to reverse the
present 20:80 division in WHO’s finances. Such a plan should also propose
mechanisms that ensure
that voluntary and donor contributions are not channeled for specified
programmes, but are free to
be used to promote the overall goals of the WHO that are collectively
decided upon by member
states. The plan should also propose a code of conduct on voluntary
donations, so as to prevent
conflict of interest between donor priorities and the member state driven
agenda of the WHO.

Core business
The discussion of core functions represents a significant step back from the
Core Functions
outlined in the WHO Constitution, Article 2. The proposition that WHO should
withdraw from its
responsibilities regarding health in development should be opposed. This
function is mandated in the
Constitution and must be properly addressed.
PHM believes that the WHO Constitution mandates WHO to take the leadership
role with respect
to the coordination of international decision making on health matters. This
should include holding the
large donors to account with respect to the effectiveness and coordination
of their technical and
funding roles. It is not consistent with WHO’s mandate to withhold
commentary on the large donors
because they also provide tied funds to WHO.

1 Medium Term Strategic Plan 2008-2013 and Proposed Programme Budget
2012-2013 (EB128/24).
2 Strategic Objectives 7, 8 and 9:  social and economic determinants of
health, healthier environment, and nutrition
and food safety, respectively.
3 Programme Budget 2008-2009: performance assessment (EB128/22)11
By way of illustration we cite WHO’s work on the rational use of medicines
which attracts virtually
no funds. In contrast the huge expenditures on pharmaceutical marketing
contribute in many ways to
the over-use and inappropriate use of medicines. WHO priorities should not
be shaped by the
availability of funds.
PHM is concerned about the repeated statements that WHO is a technical body
which we take as
code for the withdrawal from a range of contested issues. Health is
political as well as technical and
WHO must accept the responsibility of engaging in the politics of health as
well as advising on technical
issues. (Virchow reminds us that ‘medicine is a social science, and politics
is nothing else but medicine
on a large scale’.)

Mainstreaming cross cutting issues
PHM is concerned that the ‘mainstreaming’ of ‘cross-cutting issues’ will
lead to the neglect of such
issues, partly because there will be no internal champions of such issues.
The next step will be to implement a corporate approach to mainstreaming
cross-cutting issues, such as health
promotion, gender, human rights and social determinants. These activities
are part of core business of WHO, but will
be reflected in work across the Organization, rather than relying on
separate departments to champion their cause.
The neglect of the insights of the Commission on Social Determinants in many
of the papers
submitted to this EB meeting illustrates this. Likewise the paper on
integrating gender analysis and
actions into the work of WHO (resolution WHA60.25) focuses entirely on the
corporate policies of WHO
and does not consider the huge burden of disease globally which is rooted in
gender inequality.

Staffing
The discussion of staffing policies in this report is superficial and does
not appear to reflect a close
analysis of the kind of workforce required to carry the functions of WHO. We
are aware of widespread
concerns about the prevailing human resource management practices in the
secretariat and are
concerned that full endorsement of the remarks on staffing contained in this
report could further
damage the capability of WHO. In particular, with the financial crisis
facing WHO and the prospect of
widespread retrenchments we are apprehensive that WHO will increasingly take
its technical advice
from the private sector or through in-kind ‘donations’ from high income
countries.
Geographical representation
We note the geographical representation policy and the circulating concerns
that even while
achieving geographical representation there has been a practice of
recruiting graduates of a small
number of prestigious universities in a few high income countries. This
ensures that the perspectives of
those countries are fully represented even while appearing to meet the
geographical representation
policy. Further we are advised that the widespread use of short term casual
staff is in some cases a
device to avoid geographical representation.

10.1. Control of Leishmaniasis
*Secretariat not*e
Document number EB128/33 reports that the WHO Expert Committee on the
Control of Leishmaniases has
met and updated the two-decade old guidelines on the control of
Leishmaniasis.  12
*PHM Comment*
The Report by the Secretariat to the 60th World Health Assembly (A60/10
dated 22 March 2007)
makes three crucial points:
•  … the disease is not notifiable or is frequently undiagnosed, especially
where there is no access to
medication.
•  …for cultural reasons and lack of access to treatment, the case-fatality
rate is three times higher
in women than in men.
•  The number of cases is increasing, mostly because of gradually more
transmission in cities,
displacement of populations, exposure of people who are not immune,
deterioration of social
and economic conditions in outlying urban areas, malnutrition (with
consequent weakening of
the immune system), and coinfection with HIV.
Leishmaniasis cannot be controlled without addressing these bottlenecks. We
suggest that the
Expert Committee review these issues and give specific recommendations to
address the three key
issues highlighted above. We note that the WHO’s Commission on Social
Determinants of Health has
given many wide ranging recommendations which could adapted for addressing
these issues.
We request that an updated report be submitted in the upcoming World Health
Assembly.
The Report of the WHO Expert Committee on the Control of Leishmaniases (WHO
Technical
Report Series, No 949) should be publicly and freely available for
dissemination
4 10.2 Progress reports
10.2 L. Progress in the rational use of medicines (resolution WHA60.16)
>From 1986, there have been 14 resolutions related to rational use of
medicines
5  In spite of very clear policies being in place, majority of countries
have yet to tackle rational use of medicines in their
national plans and commit resources as recommended in the resolutions. The
WHO database on use of
medicines in primary care in developing countries and countries in
transition for the period 2004–2009,
reveals that only 50% of prescriptions issued in the public sector adhered
to clinical guidelines, whereas
in the private-for-profit sector during the same period prescription
adherence was only 30%.
In Resolution WHA60.16 the Director General is urged to strengthen the
leadership and evidencebased advocacy role of WHO in promoting rational use
of medicines. WHO is also urged to strengthen
WHO’s technical support to Member States in their efforts to establish or
strengthen, where
appropriate, multidisciplinary national bodies for monitoring medicine use,
and implementing national
programmes for the rational use of medicines. The resolution also recommends
the strengthening of the
coordination of international financial and technical support for rational
use of medicines and to
promote research for rational medicine use at all levels of the health
sector, both public and private.
It is evident from the progress report that the WHO has not invested
resources to follow through
these recommendations. Neglecting the implementation of the resolution will
have lasting negative

4  It is currently a paid publication. See WHO website at
http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=10&codcch=949
5  WHA39.27, WHA41.16, WHA41.17, WHA45.27, WHA45.30, WHA47.13, WHA47.16,
WHA43.20, WHA47.12,
WHA49.14, WHA52.19, WHA51.9, WHA54.11 and WHA60.16 13
repercussions on public health. For instance- the rational use of
antibiotics forms a significant part of the
effort to manage antimicrobial resistance.
It is not possible to address the rational use of medicines without
addressing the pressures for
irrational and over use of medicines through pharmaceutical marketing. WHO’s
inaction suggests that
dependence on assistance from the pharmaceutical industry in certain other
areas may have
discouraged proper attention to this field.
Likewise we note the continuing pressures from the international financial
institutions for the
privatization of health care and note the incentives in privatized health
care for over prescribing and
over servicing and the greater difficulty in regulating these distortions.
It is apparent that this field has been grossly neglected in terms of both
financing and staffing for
at least a decade. We suggest that the EB might ask the DG to prepare report
on the implementation of
WHA60.16 including separately for each item the expenditures, the number of
staff are working on the
item; and what has been achieved.
In closing I reiterate our warm anticipation of perhaps chatting with you
during the course of the
EB meeting.  A number of our members will be attending the EB meeting and
would be honoured to
chat through some of the above issues with you.

Yours sincerely
Hani Serag
Associate Global Coordinator, People’s Health Movement
globalsecretariat at phmovement.org
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