PHM-Exch> WHO Exec Bd 130 Report Day 4

[Claudio Schuftan]

From: Alice Fabbri <alealifab at gmail.com>

Just uploaded is the report the WHO watchers prepared on the fourth day of
the 130th Executive Board.
The report is available at:http://www.ghwatch.org/who-watch/eb130

 *Highlights from the fourth day of the 130**th* *Executive Board*

*Geneva, 19.01.12*

*WHO REFORM: Governance*

*Governance and engagement with other stakeholders. (EB Documents 130/5
Add.3 and Add.4)*

The discussion on WHO Reform continued with comments on  “Promoting
engagement with other stakeholders and involvement with and oversight of
partnerships”.

The discussion initially focused on the *revised timeline for meetings of
the governing bodies*.

  Norway pointed out that having the EB at the end of February would not
leave enough time to get ready for the World Health Assembly.  Despite the
long discussion, no agreement was reached on the timeline.

The proposal of extending the session of the Board in May from one to three
days was also discussed but not all the countries agreed with this
suggestion and Mexico raised also the issue of the significant cost
implications.

Concerning the *revised Terms of Reference (ToR) for prog, budg + admin
Comm (PBAC),* Member States seemed quite satisfied and they didn’t propose
any substantial changes.

*Internal governance* was another issue addressed; some Member States (i.e.
Iran) asked for more clarification on the proposal of increasing the
linkages between Regional Committees and the global governing bodies, as
well as the harmonization of the practices of Regional Committees. On
linkages between global and regional governing bodies, US stressed once
again (see also the discussion on priority setting) the importance for
Regions to adapt to global policies rather than the opposite, highlighting
a clear will to adopt a top-down approach.

Mexico, commenting on participation of various groups of stakeholders in
Regional Committee meetings, noted that the external observers should not
have any conflicts of interest.

The *engagement with other stakeholders* was one of the thorniest issue;
the discussion focused on the criteria for the inclusion of non-state
entities and on the need to differentiate between PINGOs (Public Interest
NGOs) and BINGOs (Business Interest NGOs).

India was the only country who proposed a greater participation of civil
society, and along with Barbados and Chile, among others, highlighted the
need for setting out clear guidelines to protect the Organisation against
potential conflicts of interest. On the same issue, France explicitly asked
to establish procedures that will ensure the independence of public health
experts and stated that the dialogue with other actors should happen in a
consultative process, but the decision making process should remain in
Member States hands. Following this observation, Norway suggested to
conduct an evaluation of WHO engagement in partnerships with an evaluation
of their added value.

There were obvious divergences regarding the differentiation between the
different types of nongovernmental organizations that interact with WHO.
Switzerland and US strongly affirmed that it is not necessary to go too far
down the road in terms of differentiating between diverse types of NGOs
since divisions are arbitrary and all stakeholders come to the WHO with
their specific agendas. Switzerland also welcomed the proposal of
increasing stakeholders involvement, both NGOs and the private sector.

After Member States interventions and NGOs statements, DG summarized the
discussion and accordingly proposed a way forward.

Since no agreement was reached on most of the items, she suggested the
Secretariat to prepare a new consolidated document for the next World
Health Assembly in which all elements discussed during the EB will be
interlinked together. In this consolidated document Dr Chan will bring
together proposals coming from Member States and suggestions from the
Secretariat. Concerning the ToR for PBAC, DG proposed that any Member
States who have ideas and suggestions, should send them to the Secretariat
by the end of February in order to be included. Concerning the timeline for
meetings of the governing bodies, since no agreement was reached, Dr. Chan
proposed the Secretariat to prepare some proposals to be further discussed.
Finally, on the WHO engagement with other stakeholders, she raised the
point of conflicts of interest saying: “*I've never seen an organization
coming to WHO without an interest. Everybody has an interest. Also Member
States have interests. The interest of private sector is not so clear as
well as the interest of some Civil Society Organisations. In the light of
transparency, we need to improve that transparency and hold each partner
accountable”*. Recognizing that further discussion is needed on this knotty
issue, she promised that the Secretariat will provide some proposal to
stimulate the process taking into account Member States will to take
oversight of the partnerships.

 *WHO REFORM: Financing and evaluation*
*

Managerial reform: making WHO’s financing more predictable , Managerial
reform: contingency fund for outbreaks , WHO evaluation policy , Managerial
reform: evaluation
*

Once the discussion on governance came to an end, the Chair requested
delegates to present their comments on both financing and evaluation.

The majority of Member States raised the point of *the use of assessed
contributions* asking whether they are allocated to cover WHO
core-functions or to fill up the gaps remained after the allocation of
voluntary contributions. US went further pointing out that assessed
contributions should not subsidize costs associated with voluntary
contributions.

Addressing the issue of predictability of funding, Member States expressed
their concerns about the core of the new financing mechanism presented in
Secretariat document: the *pledging conference*. In general, the issue
raised deep concerns among Member States, that showed reservations about
this proposal expressing their need for clarifications. Particularly
Estonia, on behalf of EU, asked how the pledging conference would increase
the predictability and along with Canada, requested the Secretariat to
explore other possible solutions.

On the *contingency fund for outbreaks*, many delegates (i.e. Senegal)
supported the idea but asked for clarification on how the fund would be
managed in harmonization with the Regional funds for emergencies.

Concerning the *evaluation process*, Member States expressed themselves on
both the internal evaluation and the external one. US welcomed the proposed
evaluation policy  and suggested to build a stronger culture of evaluation
within WHO by adopting norms and standards of the UN evaluation group.
While agreeing on creating a culture of evaluation - a position shared
among many countries - UK stressed the need to move from the general idea
to practical actions.

On the external evaluation, Senegal and Mexico stated that an independent
evaluation is utmost important in order to promote the transparency and
credibility of the reform process. Regarding the nature of the entity that
should carry out the first stage of the evaluation, some countries proposed
the External Auditor while others the Office of Internal Oversight Service.
Talking about the timeline, Switzerland expressed an arguable position
affirming that “*we have to be careful and do not postpone the reform while
waiting for an independent evaluation”*. At this point in time, it is
unavoidable to ask whether the external evaluation is meant to inform the
reform process or to be just an academic exercise.

The floor was then opened to NGOs: Oxfam and Medicus Mundi International
(MMI) with People’s Health Movement (PHM) presented their statements
recalling the importance of the predictability of funds and transparency
and sustainability of the proposed financial mechanism. MMI and PHM also
called upon Member States to await the recommendations of the independent
evaluation, before agreeing on the precise trajectory of reforms.

Dr Chan opened her summary by ambiguously saying “*I didn't pay the NGOs to
ask my Member States to increase their assessed contributions”*.

Directly addressing the questions on the use of contributions, she
clarified that it was not her intention to cross-subsidize voluntary
contributions with assessed contributions and stated that  the assessed
ones are used for core-functions and to support governing bodies meetings.

Afterwards, she tried to cope with Member States request for clarification
on the pledging conference. Firstly, she apologized for being unable to
come up with the right language and proposed to call the new mechanism
“financial dialogue”. Then she explained how the new mechanism would work:
firstly, the priorities and subsequent activities will be defined by Member
States. Dr. Chan reassured the delegates saying that “*We will not accept
any money that do not go with these priorities”.* The second phase will be
the financing one whose main event is the pledging conference that will be
open to Member States together with all other non-State funders. According
to DG words, today non-state donors provide up to 40% of the WHO budget
and, at the same time, Member States seem not to be able to fill this gap.
That is why the financing dialogue will be opened up to UN agencies and
philanthropies. Addressing this issue she made a subtle distinction between
philanthropies and industries precising that the latter, along with civil
society organisations, will be allowed only to come and listen to. Despite
the clever analysis she proposed, a question arises: does a clear
distinction between philanthropies and industries really exist considering
the potential conflicts of interest both of them might have in health
affairs? Moreover in her opinion, an open conference might have an
additional incentive: everybody would know what the others give since
pledges will be made publicly. This mechanism will increase the
transparency and, in DG’s hopes, it will prevent civil society
organisations from saying that WHO “*is in bed with industry”*.

Concerning the external evaluation, she recalled the EB Special Session
decision to consult three entities: the United Nations Joint Inspection
Unit, the External Auditor and the Independent Expert Oversight Advisory
Committee. Recognizing Member States will to have an independent entity to
carry out the evaluation, Dr Chan stated that the External Auditor would be
the best option for the first stage that will be then the roadmap for the
second one.


 *Prevention and Control of Noncommunicable Diseases ***

Member States highlighted the importance of the UN High-Level Meeting on
the prevention and control of noncommunicable diseases (HLM) and stated the
momentum should not be lost. USA introduced the draft resolution
co-sponsored by Australia, Barbados, Canada, Costa Rica, Kenya, Norway and
Switzerland. The resolution attempts to set out a clear process of active
participation by Member States through the critical year of 2012 on three
areas, reflecting the tasks given to WHO by the UNGA at the HL Mtg (to
develop a comprehensive global monitoring framework with targets and
indicators; to strengthen multisectoral action through partnerships; and to
develop a new Action Plan for 2013-2020).
The USA, Mexico, South-Africa, Brazil, Thailand, France and Estonia on
behalf of the EU emphasized the importance of linking future NCD action
with action addressing the SDH and the Rio Declaration. The need for
multisectoral action was highlighted by several countries. Canada looked
forward to working with “funds, programs, Member States and WHO”. Brunei
Darrusalam mentioned the need to engage with the food and beverage
industries. France however, stressed that health should remain at the heart
of a multisectoral approach. The commitment of all stakeholders is
essential, but any involvement in this very lucrative sector should be very
transparent. Safeguards should be in place to prevent conflict of interest.
Switzerland recognized that the work of the framework and the targets
should be protected from conflict of interest, but urged that all
stakeholders should be involved in the *implementation* of the Action Plan.
India on the other hand, recalled that the Political Declaration of the HLM
specifically recognizes the fundamental conflict of interest between the
tobacco industry and public health [par 38] and urged for similar action to
minimize the use of alcohol. They requested WHO to initiate action on a
framework convention on alcohol, similar to the one on tobacco. As for the
development of the comprehensive monitoring framework and the setting of
targets, they urged for the process to be as inclusive as possible,
involving CSOs and international organizations.
Access to medicines was taken up in the draft resolution and its importance
was stressed by India, Brazil, Mexico, South Africa, Côte d’Ivoire and the
US. Mozambique on behalf of the AfR, Brazil and Algeria specifically asked
for the implementation of TRIPS flexibilities. Several developing countries
stressed the importance of continuous technical support tailored to country
needs, data collection and working both on lifestyle changes
*and*strengthening health systems, including training of primary
health care
workers. The need for health system strengthening was emphasized by India,
Mexico and France, calling for universal health coverage.
The need to increase funding was touched upon by Myanmar, India, South
Africa and Mozambique on behalf of the AfR. Algeria mentioned that
additional expenditure on health was being backed up by innovative methods
deriving from taxing tobacco.
There were many CSO statements, from Alzheimer’s Disease
International, Consumers
International, International Special Dietary Food Industries, World Dental
Federation, Union of International Cancer Control, Thalassemia Association,
World Health Professional Association, Patient Protection NGO,
International Federation of Medical Students’ Associations and off course,
Medicus Mundi International on behalf of the People’s Health Movement
(click *here<http://www.ghwatch.org/sites/www.ghwatch.org/files/WHO%20EB%20130-MMI%20PHM%20statement%20on%20NCDs.pdf>
* for our statement).
Some very positive amendments were made to the resolution (click
*here<http://www.ghwatch.org/sites/www.ghwatch.org/files/EB130%20--%20Res%20on%20NCDs%20-%20follow%20up%20of%20the%20UN%20HLM%20--%20amendments.pdf>
* for the final resolutions with the amendments in track changes).
Timor-Leste and France added language on civil-society engagement and the
need for transparency and safeguards for conflict of interest when engaging
in partnerships. Interestingly, the original draft contained the following
sentence regarding access to essential medicines: *to facilitate engagement
by governments and the private sector*. Timor-Leste requested to add “as
appropriate civil society and” before the “the private sector”. Several
countries supported, but Canada explicitly rejected the amendment as they
believe the word “civil society” is not clear. They asked whether the
Secretariat could provide a definition of the term to clarify whether it
does or does not include the private sector. The Secretariat did not
respond.
Also noteworthy is the amendment by Timor-Leste of language that was
adopted from the Political Declaration of the HLM. In the declaration WHO
is asked to develop “options for strengthening and facilitating
multisectoral action *through effective partnerships*”. Timor-Leste amended
this to “through effective *and transparent* partnerships, *while
safeguarding public health from any potential conflict of interest”. *The
point raised by Switzerland that language coming from the Political
Declaration should not be amended was neglected and Timor-Leste’s request
was supported by several other countries.
The resolution on “Strengthening noncommunicable disease policies to
promote active ageing” was also adopted after some amendments. The EU
introduced language on health promotions, social services etc; India
introduced access to medicines and Mexico stressed a life-course approach.
To see the amendments in track changes in the final resolution, click
*here<http://www.ghwatch.org/sites/www.ghwatch.org/files/EB130%20--%20Res%20on%20NCDs%20and%20health%20ageing%20-%20amendments.pdf>
*.
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