PHM-Exch> Recent WHO Executive Board meeting

[Claudio Schuftan]

Last week the Executive Board (EB) of the World Health Organisation
conducted its 130th session. This board, consisting of 34 member states,
governs the organisation on behalf of the World Health Assembly, the
overall governing body of the WHO that consists of 194 member states. Last
week the EB had to provide guidance for and decide on several elements of
reform that the organisation requires. Over the last 20 years WHO has
become “outpaced” by other actors in the growing global health arena,
including global health initiatives like the Global Fund on AIDS,
Tuberculosis and Malaria, the World Bank, philanthropists like the Bill and
Melinda Gates foundation, but also other UN Agencies as UNAIDS, UNFPA and
UNICEF.

The reform, that has become somewhat a process in its own, was during the
EB discussed in the sub-themes “priority setting for the Organisation”,
“internal governance and the relation with external stakeholders like
companies and NGOs”, and “financing, management and evaluation”. I will not
go into detail on the reason and background of the reform, the precise
content of the last EB discussions and its outcomes, as these have already
been extensively covered by others such as WHO Watch, Medicus Mundi
International, the Centre for Global Health Policy and Innovation and the
Global Health Diplomacy Network.

I take a step backward and look to the process. The WHO functioning,
necessary reforms and more precisely its lack of available and predictable
financing for core tasks have been already discussed since two years. What
can be observed is that after a formal reform process, a special session of
the EB in November 2011, discussions at the regional committees of the WHO
and numerous consultations and background papers further …so little
progress is made: The 130th EB only decided that an intergovernmental
working group will develop further criteria for priority setting in
February 2012; that a new consolidated document for the World Health
Assembly 2012 will be prepared with a more detailed proposal for
stakeholder engagement; and thirdly that a new financing mechanism (a
financing dialogue and pledging conference) will be further elaborated. One
could assess this process from two sides; either you see it that the member
states taken it very serious and cautious; hence moving on a step-by-step
approach to strengthen the constitutional mandated leader in global health;
or that WHO currently lacks real relevance in global geo-politics.

Will WHO remain relevant? That’s hard to say. Last week Margaret Chan was
re-elected for her second five-year term as Director General of the WHO.
She was the only candidate for the post. This indicates that member states
choose for a technocratic option for the WHO in this time of reform, rather
than to play a political power play over leadership.

The question is whether the UN system in itself is still considered as
relevant. In a multi-polar world order much pressing global issues are
discussed under the G20 umbrella and directly between regional blocks (like
EU, UNASUR and ASEAN). Ban-Ki-Moon, the UN Secretary General also recently
elected for a second five year term, highlights the challenges coming ahead
for the UN system, with its 15-member security council remaining
deadlocked. The current financial austerity will affect considerably the
voluntary contributions from member states and donors to several UN
agencies. While the health focus on WHO has broadened to areas like health
systems strengthening, the social determinants of health and NCDs, its
traditional focus on infectious disease control, elimination and
eradication (e.g. smallpox, malaria, polio) in “developing” countries has
proportionally reduced. WHOs current focus is less on health security and
more on health development, where equity and human rights are important
values. States tend to act in terms of (their own) security and it takes
true courage for statesmen to bridge this paradigm and propagate a global
good.
Remco van de Pas, Wemos,  Medicus Mundi International
remco.van.de.pas at wemos.nl
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