PHM-Exch> Reform Agenda raises concerns, DG promises inclusive process

[Claudio Schuftan]

From: Sangeeta <ssangeeta at myjaring.net>
*From: *TWN News <news at twnnews.net>
*
*Third World Network
www.twnside.org.sg


*WHO: Reform Agenda raises concerns, DG promises inclusive process
Published in SUNS #7155 dated 23 May 2011 (updated 24th May 2011)
*
Geneva, 20 May (Sangeeta Shashikant) -- A number of Member States of the
World Health Organization (WHO), while recognising the need for the
organization to reform, have raised concerns over the reform plan that has
been proposed by the organization's Director-General Dr Margaret Chan.

These concerns were voiced at the sixty-fourth World Health Assembly (WHA)
taking place in Geneva from 16-24 May.

Although the reform plan that was discussed by the WHA is titled "The Future
of Financing for WHO" (A64/4), it however contains a broad, far-reaching
agenda that is likely to reshape the way in which the organization operates,
is governed, makes decisions and is financed.

The reform plan is also likely to redefine WHO's role in public health
issues at the international level.

The broad reform plan led to many Member States expressing their concerns.

In particular, concerns were raised over the lack of detail on the reforms
proposed, the stress on "donor-funding", especially funding from private
entities to resolve the financial difficulties of the WHO, as well as over
proposals such as the convening of the World Health Forum, which is likely
to increase the influence of the private sector and donors in setting the
health agenda in the WHO.

Thailand called the reforms "superficial", adding that they are likely to
fail.

Brazil stressed that the reform process must be funded through regular
budgetary funds, in response to WHO's proposal that the development of the
reform programme be partially funded by the Bill and Melinda Gates
Foundation (A64/4 Add.1). India queried how the WHO intended to achieve the
objective of making 40% of its funding flexible, when funding is
donor-driven.

Many Member States also emphasised that WHO’s reform process must be driven
by the Member States themselves, based on consensus, be incremental and
ensures that the decision-making power of the WHO remains with the Member
States.

These concerns were seemingly quelled by the Director-General (DG), with
promises to continue to consult with Member States until they are satisfied
with the reform. This led to the endorsement of a resolution (A64/54) on the
matter.

The resolution endorses the agenda for reform as set out in document A64/4
and urges Member States to support the implementation of the reform
programme. It also requests the Executive Board to establish an appropriate
process to examine the issues related to WHO's governance identified in
A64/4.

 The approved resolution further requests the DG:

--  to present a detailed concept paper for the November 2012 World Health
Forum, setting out objectives, numbers of participants, format and costs to
the Executive Board at its 130th session in January 2012;

--  in consultation with Member States to develop an approach to independent
evaluation, and to present a first report on the independent evaluation of
the work of WHO to the Sixty-fifth World Health Assembly in May 2012;

 The WHO reform plan, at its heart, is aimed at addressing the financing
challenges faced by WHO in achieving greater predictability and flexibility
in financing, to ensure that adequate financial resources are available to
meet the objectives set out by Member States. At present, Member States'
assessed contributions only constitute 18% of WHO's budget. Voluntary
contributions, most of it earmarked for specific projects, make up the rest.

Despite this scenario, the reform plan prescribes more of the same as a
solution, i.e. it proposes that WHO attracts donors and explores new sources
of funding, for example, "by drawing on Member States with emerging
economies, foundation[s] and the private and commercial sector". However, it
acknowledges that such funding is unlikely to be flexible.

A related document A64/INF.DOC/5 titled "Reforms for a Healthy Future:
Development Plan" states that the expected outcome of the reform process on
finance is to ensure that at least 40% of income will be fully flexible.

However, the document does not provide any details on how it will attain
this outcome. The same document lists the outputs of its financing proposal
as including a corporate mobilization strategy, a proposal for a
replenishment model, an expanded resource base including a mechanism to pool
funds from private entities, and a strategic communications strategy.

The reform plan also links financing of WHO to redefining WHO's role in
global health, as it anticipates flexible funding as a potential outcome, on
the assumption of greater confidence in WHO's policies and practices, and
the implementation of the reforms set out.

According to some critiques, this suggests that a critical component of the
reform plan is to redefine the role of WHO in global public health, to make
its role more palatable to donors in the hope of attracting more flexible
donor funds. The reform plan also lacks creativity on how to improve WHO's
financing, as it fails to emerge with any new workable strategy to improve
the predictability or sustainability of WHO's financial situation.

However, what has generated uproar among the Non-Governmental Organizations
(NGOs) is the proposal to hold a World Health Forum (WHF) in Geneva in the
last quarter of 2012, with its deliberations being reported to the Executive
Board. The concern among the NGOs is that the WHF will provide strategic
opportunities to the private sector to influence the health agenda of the
WHO.

The reform plan also envisages changes in the management and governance
structure of the WHO including focusing WHO in the core areas of business
and prioritizing its work;  redefining the role of the governing bodies of
the organization, that is, the Executive Board and the World Health
Assembly, as well as reviewing the relationships between different
governance meetings including the Programme, Budget and Administration
Committee of the Executive Board.

Director-General Dr. Chan, in introducing the reform plan on 17 May, said
that reform is not a reaction to the financial crisis, but rather a broader
opportunity for WHO to change and become more effective, efficient,
responsive, objective, transparent and accountable.

Dr. Chan also said that the assessed income had eroded through inflation and
currency exchange, adding that donors also faced constraints. She stressed
the need to look at new ways that it can be raised, and promised to consult
extensively with Member States at every stage of the process.

Following Dr. Chan's introduction, many Member States took the floor to
address the WHO's reform plan.

Responding to the numerous concerns raised, Director-General Dr. Chan said
that she would embark on a transparent and inclusive process with Member
States, civil society, global health initiatives and the private sector from
specific sectors.

Dr. Chan said that as the chief technical and administrative officer, she
will oversee the reform process with the Global Policy Group, made up of
herself, the Deputy Director-General and the six regional directors.

She further said that she will use a step-by-step and incremental approach,
beginning with managerial reform. On independent evaluation, she said that
WHO's core role in strengthening health systems in all countries is
important and that the evaluation is to determine if WHO has internal
capacity.

Dr. Chan also said that WHO was not going to dilute the technical support of
countries in implementing the health policy strategy plans. She added that
WHO was looking at taking a coordinated approach with other health actors.

Dr. Chan concluded by stating that she will "consult, consult and consult"
until Member States are "satisfied" with the reform process. +
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