PHM-Exch> The Future Financing and Reform of WHO

Fri May 13 07:50:54 PDT 2011

 Comments on ‘The future of financing for WHO’ 64th World Health Assembly
(WHA), May 2011

Distinguished delegate of the WHA,

People’s Health Movement (PHM) is a global network of organisations and
individuals working locally, nationally and globally in more than 80
countries for ‘health for all’. Our basic platform is articulated in
the People’s
Charter for Health<http://www.phmovement.org/en/resources/charters/peopleshealth?destination=home>which
was adopted at the first People’s Health Assembly in Dhaka, Bangladesh
in December 2000. More information about PHM can be found at
www.phmovement.org.

PHM is committed to a stronger World Health Organisation (WHO), adequately
funded, fully utilising the powers of the Constitution and playing the
leading role in global health governance. PHM follows closely the work of
WHO, through the governing bodies and the secretariat at all levels. Across
our networks we have technical experts and grass roots organisations with
close interests in many of the issues coming before you over the next few
days.

Over the last week, 30 members of the PHM WHO liaison group from over 20
countries have been working through the WHA 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 (a joint
project of PHM, Third World Network, Health Action International, Medicus
Mundi International and Medico International) which involves both watching
and advocacy. We are particularly concerned regarding the Director General’s
(DG) report “The Future of Financing for WHO: Reforms for a Healthy Future”
(Doc. A64/4).

The WHO is facing a financial crisis: programmes, projects and staffing face
the prospect of being disbanded; the dominance of tied donor funding is
having a terrible effect on administration. The WHO is also suffering from a
crisis of identity and legitimacy; its role and mandate have been diluted
and usurped by the proliferation of new actors in the field of global
health. Inefficiencies within the organisational processes remain
unresolved.

These crises have been building over several decades. They also reflect
questions about the role of the UN, the sovereignty of nation states and the
democratic deficit that exists at the global level of governance more
generally.

The driver of the reforms foreshadowed in the DG's report is the financial
crisis in which the WHO finds itself. In accordance with the demands of the
donors, the report simply addresses issues of effectiveness, efficiency,
responsiveness, objectivity, transparency and accountability *(A64/4, p.6)*.
However, while the report sets out broad directions for the WHO, it has few
concrete recommendations and inadequate analysis of the financial crisis.
Most worryingly, the key document – the “detailed development plan for the
programme of reform” *(A64/4, p.6, footnote 2) –* has not been posted even a
few days before the Assembly. Calling for endorsement of a general plan
without detail is asking member states to sign a blank cheque.

*Core business*

The focus on “core business” could well turn out to be a narrowing of the
mandate of the WHO. The DG has previously stated that certain key areas of
work of the WHO, including action on the social determinants of health,
human rights and gender, are to be ‘mainstreamed’. Mainstreaming is a
euphemism and will lead to reduced focus, analytic capacity and drive. There
are powerful interests that would like to see WHO restricted to a
technocratic role on communicable disease control and ‘health security’, and
distanced from issues such as economic development, justice and peace,
despite the fact that these are critical determinants of health and are
wholly encompassed in the WHO Constitution.

*Organizational effectiveness*

There is a need for greater coherence between the country, regional and
global levels of the WHO. But there is nothing in the report about the
concrete changes required. The issues of accountability, coordination and
management are complex and difficult. But it’s time to stop talking about
organizational effectiveness and to start drawing up an agenda and
implementing real reform.

*Management and accountability*

The WHO has not escaped from the new religion of performance-based funding.
Of course, the WHO should have clear plans and be capable of self-evaluation
and impact monitoring, but subjecting itself to a narrow form of performance
management could undermine its mandate, authority and independence. Much of
what the WHO does (convening, facilitating, leading, advocating,
coordinating and persuading) cannot be measured through simplistic
performance-related results and indicators. Management and accountability in
the WHO call for leadership and diverse methods of evaluation.

As the directing and co-ordinating authority on international health work,
the WHO should also take the lead in promoting accountability and
transparency in its functioning and the fulfilment of its mandate. This
should include transparent and participatory audit of its movement towards
achievement of the ‘highest attainable standard of health for every human
being’, including provision for the ‘right to information’ for its
constituents.

*Human Resources (HR)*

The goals of reform should precede changes to HR policies, planning and
management. However, the need to downsize is preceding and informing the
process of reform. It is a direct response to the WHO’s financial crisis,
and not to a rational and evidence-based determination of staffing needs for
the fulfilment of its mandate. Of course there are many improvements that
need to be made to the WHO’s systems of recruitment and HR management but
the evidence and logic to support reducing the number of core staff and
supplementing them with temporary staff and sub-contractees has not been
presented.

*Financing and communication*

To fulfil its mandate the WHO needs a budget that is adequate, predictable
and untied.  WHO’s state of financing is untenable; only 18% of WHO’s
funding comes from core, assessed contributions. The rest is cobbled
together from multiple streams of voluntary donations, grants and in-kind
support, much of which is conditional. A high proportion of voluntary
contributions by member states undermines the organisation’s independence
and results in huge inefficiencies. Increasing dependence on private
philanthropies and corporates carries serious risks of further distorting
WHO's priorities.

It is time that the assessed contributions formula for countries is reviewed
and revised; and it is time for a fair and adequate system of public
financing for the WHO. We propose that member states collectively commit to
increasing assessed funding so that it reaches 50% of the overall budget
over the next five years.

The report calls for the WHO to widen its resource base by drawing on the
private and commercial sector but it makes no mention of how its
independence will be protected, nor does it say anything about the
management of institutional conflicts of interest. WHO should set a cap on
the amount of tied funding received from the corporate sector. Independent
monitoring of public-corporate relationships are required to prevent or
deter unsafe or inappropriate relationships from forming. The funding of WHO
programmes by corporates and other donors should be explicitly identified on
the website. These safeguards to prevent the privatisation of the WHO and
the corporate capture of policy making should be spelled out before setting
off a revitalised programme of private and corporate fundraising.

*WHO’s effectiveness at country level*

Effectiveness at the country level should be “a key outcome of reform and an
immediate priority in the agenda for organisational alignment”. WHO does
have a role in promoting inter-agency cooperation but its unique role is
supporting access to evidence, information and best practice in the fields
of social determinants, intersectoral collaboration, primary health care,
health system strengthening, health care financing, rational use of medicine
and other critical areas. Whether this is carried out through country
representatives or regional offices, WHO should be accountable at the
global, regional and country level for the effectiveness of these functions
and for the protection of people’s health.

*Global health governance*

It is essential that the reform of the WHO be framed around the health needs
of people instead of being centred upon the financial crisis. Health policy
making over the last 30 years has been distorted by the pressure of odious
debt, the defence of intellectual property and the rationalisation of an
unjust global economy. The WHO should speak truth to power.

The proposed World Health Forum has the potential to promote the interest of
the private sector at the expense of a member states’ driven process. The
rationale and need for such a forum is not made clear; and there is no
discussion about how such a proposal would avoid undermining or duplicating
the role and mandate of the WHO. The WHO must not pursue public-private
partnerships without ensuring safeguards against corporate influence over
policy making and pernicious conflicts of interest. We urge you to consider
the risks of this proposal and hope you will not to endorse it in its
current form.

*Please refer to the WHO Watch <http://www.ghwatch.org/who-watch> section on
the Global Health Watch website <http://www.ghwatch.org/>.*

--
PHM Global Secretariat
People's Health Movement (PHM)
Email: globalsecretariat at phmovement.org
Web: www.phmovement.org
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