PHM-Exch> WHO Members opt for modest reform and request more work

[Claudio Schuftan]

>From Sangeeta <ssangeeta at myjaring.net> wrote:

>
> TWN Info Service on  Intellectual Property Issues (Nov11/04)
> 14 November 2011
> Third World Network
> www.twnside.org.sg
>
>
> Please find below an article on the outcome of the discussion on WHO
> reform that took place during the Special Session of the Executive Board
> that met from 1-3 November 2011.
>
> ------------------------------
>
> *WHO: Members opt for modest reform and request more work
> Published in SUNS #7258 dated 11 November 2011   [excerpts]
> *
> Geneva, 10 Nov (K. M. Gopakumar and Sangeeta Shashikant) -- Governments at
> the World Health Organisation (WHO) have agreed on a modest reform package
> for the organisation, asked the Secretariat for more information and
> analysis to be done, and decided on an independent evaluation.
>
> The Special Session of the WHO Executive Board (EB), which met from 1-3
> November at the WHO headquarters in Geneva, declined to fully accept the
> reform proposals contained in the Director-General's Report (EBSS/2/2)
> titled "WHO Reform for a Healthy Future" (DG's report).
>
> The DG's report presented 18 recommendations covering reform proposals in
> three broad areas, i. e., programmes and priority-setting, governance and
> managerial reforms.
>
> However, Member States settled for a more modest outcome, and instead
> sought more information and analysis from the Secretariat on a number of
> issues related to these three areas. They have also decided to proceed with
> an independent evaluation to provide input into the reform process through
> a two-stage approach, the first of which will consist of a review of
> existing information with a focus on financing challenges for the
> organization, staffing issues and internal governance of WHO. The approach
> to stage two of the evaluation will be developed in consultation with
> Member States.
>
> Decisions on the three areas can be seen as an attempt by Member States to
> regain control of, and set brakes on, the reform process, which has been
> pushed at an unprecedented speed by Dr. Margaret Chan, Director-General of
> the WHO.
>
> The Special EB session considered the 18 recommendations in the DG's
> report that was prepared on the basis of feedback received on four initial
> concept papers on governance of WHO, independent formative evaluation, the
> World Health Forum and managerial reforms.
>
> Some observers have suggested privately that the push for reform is
> closely linked with Chan's re-election ambitions.
>
> PROGRAMMES AND PRIORITY-SETTING
>
> The decision on programmes and priority-setting establishes "a Member
> State-driven process to take place following the Executive Board at its
> 130th session in January 2012, with a view to providing recommendations on
> methods for programmes and priority setting, for the consideration of the
> Sixty-fifth World Health Assembly in May 2012".
>
> To support the process, the Secretariat is also requested to develop a
> background document for the 2012 EB session that will include: (a) a
> detailed description of current criteria and mechanisms for
> priority-setting, and the relationship between country-level, regional and
> global priorities, including elements of bottom-up and top-down
> prioritization; (b) a description of the current activities carried out at
> headquarters, regional and country level, including programmes as well as
> financial and human resources allocated to each level and cluster; (c) a
> description of the application of criteria and priorities to planning and
> the impact of criteria and priorities on resource allocation and results;
> (d) proposals for how criteria and priorities could be set and applied in
> the future; and (e) a detailed proposal, with a timeline, for the Member
> State-driven process established by this decision.
>
> The decision clearly rejects the DG's proposals, which proposed limiting
> WHO's programme activities to five areas, i. e., health development
> (determinants, risks, diseases and conditions); health security (public
> health and humanitarian emergencies); strengthening health systems and
> institutions; evidence on health trends and determinants; convening for
> better health; identifying limited flagship priorities as well as
> priorities within five core areas of work; and the Secretariat developing a
> detailed proposal for priority-setting to be submitted to the January 2012
> EB meeting through the Programme, Budget and Administration Committee.
>
> The decision clearly puts the issue of priority-setting in the hands of
> Member States. At Germany's insistence, the decision also includes a
> request for more information to guide the Member State priority-setting
> process.
>
> A delegate participating in the EB said privately that the background
> information requested will likely bring forth more information on
> allocation of resources provided to WHO's programmes.
>
> GOVERNANCE
>
> The decision on Governance, also drawn from the DG's report, contains
> three paragraphs. The first paragraph outlines five agreed principles. Four
> of these principles generally pertain to WHO's governance, while the fifth
> principle contains guiding principles for WHO's engagement with
> stakeholders. The four agreed general principles are: (a) Governance needs
> to be a fully inclusive process, respecting the principle of
> multilateralism; (b) WHO's governing bodies have a key role in
> priority-setting, with the Health Assembly to play a policy and strategic
> role and the Executive Board playing a strengthened advisory executive and
> oversight role; (c) WHO should seek to strengthen and make maximum use of
> existing mechanisms and structures; and (d) the General Programme of Work
> should guide the work of the governing bodies.
>
> The agreed guiding principles for WHO's engagement with other stakeholders
> are: (i) the intergovernmental nature of WHO's decision-making remains
> paramount; (ii) the development of norms, standards, policies and
> strategies, which lies at the heart of WHO's work, must continue to be
> based on the systematic use of evidence and protected from influence by any
> form of vested interest; (iii) any new initiative must have clear benefits
> and add value in terms of enriching policy or increasing national capacity
> from a public health perspective; and (iv) building on existing mechanisms
> should take precedence over creating new forums, meetings or structures,
> with a clear analysis provided of how any additional costs can lead to
> better outcomes.
>
> The second paragraph of the decision lists nine agreements on governance
> reform without spelling out details. Paragraphs (a) to (f) pertain to the
> function and role of the governing structures of WHO while paragraphs (g)
> to (i) pertain to WHO's role in coordination of international health and
> engagement with non-state actors.
>
> The third paragraph of the decision requests the DG to submit the
> following to the January 2012 EB session: (a) A proposal for revised terms
> of reference for the Programme, Budget and Administration Committee in
> order to strengthen its role as referred to above; (b) Further analysis on
> ways to increase linkages and alignment between Regional Committees, the
> Executive Board and the (World) Health Assembly as well as on proposals to
> harmonize the practices of Regional Committees; (c) Proposals for a
> revision of the annual timeline of the meetings of governing bodies in
> order to optimize their synergies and effectiveness; (d) Further analysis
> of proposals to promote engagement with other stakeholders; (e) Further
> analysis on modalities to improve Member State involvement with and
> oversight of partnerships including the possible expansion of the mandate
> of the Standing Committee on Non-governmental Organizations in this regard;
> and (f) Proposals on how to streamline national reporting in accordance
> with Articles 61 to 65 of the WHO Constitution while using modern tools.
>
> The decision adopted by the EB does contain most of the proposals put
> forward in the DG's report such as the EB filtering draft resolutions
> against criteria to limit the number of resolutions to be presented to the
> World Health Assembly; to rationalize intergovernmental working groups by
> entrusting certain negotiations to the Board; to prepare "omnibus"
> resolutions; to limit reporting on implementation of resolutions to a
> maximum of six instances; to hold an additional EB session etc.
>
> Many Member States spoke against these specific proposals.
>
> The issue of WHO's engagement in partnerships at the WHO was a
> particularly divisive issue. A draft decision included a paragraph (derived
> from the DG's report) on expanding the mandate of the Standing Committee on
> Non-governmental Organisations to provide guidance on WHO's work with
> partnerships.
>
> Several EB Members that preferred not to mix partnership issues with
> matters concerning NGOs vehemently objected to this proposal.
>
> The final outcome requests further analysis on this matter.
>
> Language on WHO's engagement with stakeholders also did not make it into
> the final decision. An initial draft text proposed: "Engagement with other
> stakeholders shall be conducted in line with the proposals contained in
> paragraphs 89 and 90 of the report of the Director General, as appropriate,
> while taking into account the importance of full engagement of Member
> States and of managing conflict of interest".
>
> Many countries preferred the proposal about the establishment of
> multi-stakeholder forums, as the latter would involve private sector and
> entities that are driven more by commercial rather than public health
> interests. However, some other countries such as the US insisted on the
> multi-stakeholder forum as a mode for engagement.
>
> None of the proposals of engagement suggested in the DG's report were
> explicitly endorsed by the EB. In fact, Chan revealed lack of support for
> the idea of convening a regular multi-stakeholder event also known as the
> "World Health Forum", that she had presented at the 2011 WHA. There has
> been significant concern that such a forum will increase the influence of
> the private sector and donors in setting the health agenda in the WHO.
>
> Chan informed Member States at the Special EB session that this idea had
> been abandoned.
>
> MANAGERIAL REFORMS
>
> The decision on managerial reforms contains six paragraphs.
>
> The first paragraph welcomes the DG's proposals in five areas while
> recognizing the need for complementary work, especially on the strategic
> allocation of resources: (a) organizational effectiveness, alignment and
> efficiency: strengthen country offices, promote alignment, synergy and
> collaboration, improve knowledge management; (b) financing of the
> Organization: improve financing of administration and management costs,
> strengthen financial controls, improve Organization-wide resource
> mobilization; (c) human resources policies and management: revise the
> workforce model and contract types, streamline recruitment and selection
> processes, improve performance management processes, implement a mobility
> and rotation framework, enhance staff development and learning; (d)
> Results-based planning, management and accountability: implement a new
> results chain, sequence planning to reflect country needs, prepare a
> realistic budget, create a new resource allocation mechanism, improve
> monitoring and reporting, strengthen the internal control framework,
> increase the capacity of audit and oversight, strengthen the
> conflict-of-interest policy, establish an information disclosure policy;
> (e) Strategic communications: build communications capacity, develop
> communications platforms, improve public and stakeholder understanding of
> the work of WHO.
>
> The second paragraph urges "caution and recognized that further analysis
> and consultation would be needed before action could be considered in
> several areas of reform, notably the proposals relating to strategic
> relocation of staff, resources, programmes and operations; and introduction
> of an annual ‘budget re-costing mechanism' to protect against currency".
>
> The third paragraph requests the DG to develop for the consideration of
> the 2012 January EB session: (a) a detailed proposal for mechanisms to
> increase predictability of financing and flexibility of income, which
> supports priorities set by Member States; (b) a detailed proposal to
> establish a contingency fund for public health emergencies; (c) a draft
> formal evaluation policy, including a mechanism for oversight of evaluation
> by the governing bodies informed by insights provided by the Independent
> Expert Oversight Advisory Committee (IEOAC).
>
> The same paragraph requests the DG to develop a proposal for a timeline
> for development of the programme budget and general programme of work,
> taking into consideration good experience of the medium-term strategic plan
> each for the period 2014 onwards, with an analysis of the advantages and
> disadvantages of changing the periodicity of the programme budget to three
> years and report to the
> 65th World Health Assembly in May 2012.
>
> It also asks for clarification on the proposals with respect to enhancing
> the networks and relationships between regional offices, and between groups
> of country offices within and across regions; and on enhancing capacity for
> effective resource mobilization, particularly at the country-level. It
> further requests the DG to develop a proposal for a new resource allocation
> mechanism, through the 16th meeting of the Programme, Budget and
> Administration Committee in May 2012.
>
> In the fourth paragraph, the decision decides to proceed with a two-stage
> independent evaluation to provide input into the reform. The first stage
> will consist of a review of existing information with a focus on financing
> challenges for the organization, staffing issues, and internal governance
> of WHO by Member States, following up where possible on questions forwarded
> from this EB for more information. This stage is expected to be completed
> for consideration of the 65th World Health Assembly.
>
> According to the decision, the first stage review will provide a roadmap
> for stage two of the evaluation, which is expected to be considered by the
> Assembly in 2013, as an input into the revised General Programme of Work.
>
> The decision adds that stage two of the evaluation will be built on the
> results of stage one and further consultations with Member States, focusing
> in particular on the coherence between and functioning of the
> organization's three levels. However, this evaluation would proceed in
> parallel with other aspects of the reform as an input.
>
> The decision also requests the DG to identify the appropriate entity for
> the first stage of the evaluation and to further develop in consultation
> with the UN Joint Inspection Unit, the External Auditor, and the IEOAC an
> approach to stage two of the evaluation in consultation with Member States.
> The DG is to present the outcome of the consultation to the EB's January
> 2012 session.
>
> The decision on independent evaluation is a significant shift from an
> earlier Secretariat proposal which proposed limiting the scope of the
> evaluation to only WHO's health system strengthening programme. However,
> many Member States particularly Germany have been pressing for the scope to
> be expanded to enable the evaluation to inform the reform process.
>
> Differences also emerged over the appropriate entity to carry out the
> independent evaluation. A draft text proposed that an "External Auditor"
> conduct the stage one evaluation. The US supported the idea of selecting an
> external auditor while many others such as Brazil, Ecuador and Germany were
> opposed to this. Some Member States instead proposed the UN Joint
> Inspection Unit (JIU).
>
> Since no consensus was achieved, the decision requests the DG to identify
> the appropriate entity for the first stage evaluation and to present it to
> the EB session in January.
>
> During discussion on managerial reforms, it also emerged that the
> Secretariat had taken certain steps to trim down its human resources. The
> statement of the Staff Association revealed that the restructuring of human
> resources had already resulted in a loss of jobs for nearly 150 staff.
>
>
>
>
>
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