PHM-Exch> WHO Reform debate to continue, February fixed for member-driven priority setting

[Claudio Schuftan]

From: Sangeeta <ssangeeta at myjaring.net>

Third World Network
www.twnside.org.sg <http://www.twnside.org.sg>

WHO Reform debate to continue, February fixed for member-driven priority
setting.  (excerpts)

Geneva, 23 January (K. M. Gopakumar & Sangeeta Shashikant**): The reform
debate formally set in motion in January 2011 will continue during the
World Health Assembly and the Executive Board meeting following the
Assembly according to the outcomes of the 130th session of the EB that took
place on 16-23 January 2012.

Key reform issues remained unresolved and outstanding, as Member States
(MS) demanded more information and time for discussion. To satisfy these
demands, the EB outcomes sets out a detailed timeline for the Secretariat
to provide more information, for member states¹ feedback on Secretariat¹s
proposals and for further debate.

In the meantime the EB has fixed 27-28 February 2012 for the first
intergovernmental working group meeting on programmes and priority
setting.   [A member state driven process on programmes and priority
setting was agreed to at the Special session of the EB (EBSS) held in
November 2011 after the Secretariat¹s proposals to limit WHO's programme
activities to five core 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 as
well as identifying limited flagship priorities and priorities within five
core areas of work was rejected by MS.

Deliberations at the EB on the 9 documents on WHO reform prepared by the
Secretariat were structured under three broad themes i.e. programmes and
priority setting, governance and managerial reforms.

These deliberations led to a Decision on Programmes and Priority Setting
and a Chairman¹s Summary  (Chair¹s Summary). The Decision sets out the
scope of work and time lines for the intergovernmental process on
programmes and priority setting that will take place in February. The
Chair¹s Summary touches more on issues of governance, managerial reforms
and preparations for reform discussion during the WHO governing bodies¹
meetings in May.

Programme and Priority Setting

According to the EB decision, the scope of work of the member state driven
process is to make recommendations to the up-coming WHA on ³the categories,
methodology, criteria and timeline for programmes and priority setting in
order to serve as a guidance for the development of the next and future
general programmes of work, recognizing the important linkages to other
elements of the WHO reform process².

The EB decision then outlines the four specific objectives of the process,
which are: (a)  ³to review and consider proposals  on priority setting
taking as a basis  for priority setting: country needs, the relevance of
WHO for all countries, its specific comparative advantage and its leading
role in global health";

(b) "to elaborate methodology, criteria and the timeline for the
priority-setting process";

(c)  "to consider possible ways of grouping WHO¹s work into categories",

(d) "to identify additional analytical work by the Secretariat emerging from
these discussions, which will continue to the development of the next  and
future general programmes of work²;

The EB decision notes that the member state meeting on programmes and
priority setting to be held in Geneva in February can be followed up with
any number of meetings or discussions, as necessary, to be agreed at the
February meeting in order to finalise the work before WHA in May.

NGOs in official relations with WHO will be allowed to observe the
presentation but will not be allowed to participate in the member state
process. However the EB decision notes that a web based consultation will
be organized for such NGOs to present their views according to the agreed
scope of work.

The Secretariat also classifies countries into 5 groups i.e. countdown
countries; small island developing states; countries in fragile
circumstances; newly industrialised and middle-income countries; and OECD
countries. [Countdown countries refers to 68 States that bear the highest
burden of child and maternal mortality and whose progress in MDG
achievement is monitored by a UN group through the countdown process.]

The Secretariat¹s categorization of WHO¹s functions and classification of
countries did not receive approval during the EB deliberations.

In fact during the deliberations, Member states said that information in
EB130/5 Add 1 was insufficient and thus decisions cannot be taken. Member
States also pointed to the lack of information on the criteria used to
categorise WHO¹s activities.

[Dr. Chan clarified that the categorization and classification was an
attempt to systematize the available information as well as the current
activities of the Organization].

Most member states noted that priority setting should be based on
individual country needs. However the US disagreed, preferring instead a
top-down approach i.e. of global objectives guiding regional and local
objectives.

Governance

On the topic of ³Governance², the Chair¹s summary states that MS are
invited to submit comments on two of the Secretariat¹s proposals.
The Chair¹s summary further states that MS can submit their comments
through the password protected website open to all MS before 29th February.
Based on the feedback the Secretariat will prepare revised proposals for
submission to the 131st session of EB.

The Chair¹s Summary further notes that the Secretariat will revise the
proposed options for the schedule of the governing bodies, incorporating
the proposal for a revised schedule of meetings of the Regional Committees,
Executive Board, PBAC and WHA. Further the Secretariat will also take
forward the work on streamlining national reporting as well as further
develop proposals for management of resolutions, the Summary notes.

In relation to governance, the EB also considered Secretariat¹s proposals
on engagement with NGOs and private-for-profit sector as well as
not-for-profit philanthropic organisations.

On this the Chair¹s Summary notes that ³Further consultations with Member
States will be required on ³WHO¹s engagement with other stakeholders,
including  nongovernmental organisations and industry, and  the proposals
to review and update principles governing  WHO  relations with
nongovernmental organisations and to develop comprehensive policy
frameworks to guide interaction with the private-for- profit sector , as
well as not-for-profit philanthropic organisations².

Regarding partnerships the Chair Summary states ³We have agreed on the
importance of partnerships and on the need for better management and
greater oversight by the governing bodies, in particular the Executive
Board. Members of the board have proposed a review of WHO hosting
arrangements, along with further efforts to harmonize work with hosted
partnerships².

THe Secretariat proposed handing over oversight of WHO¹s
partnerships to the EB after concluding that the Standing Committee on
Nongovernmental Organizations was unsuitable for this purpose.

Of all the governance related issues, the topic of WHO¹s engagement with
other stakeholders was the most controversial as 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).

Dr. Chan, in her response to the issue of conflicts of interest played down
the issue, stating that ³Everybody has an interest², and calling for all
actors to be transparent and accountable.

Managerial Reforms

[WHO¹s document EB 130/5 Add 5 contained a road map for increasing
predictability of WHO finance from the current level of 50% to 70%.  The
main strategy proposed was the holding of a pledging conference in 2013 to
secure pledges for the programme budget that will begin in 2014.]

On the issue of financing, the majority of MS sought clarification as to
whether assessed contributions are allocated to cover WHO¹s core functions
or to fill up the gaps remaining after the allocation of voluntary
contributions. The US stressed that assessed contributions should not
subsidize costs associated with voluntary contributions.

Concerns were also expressed over the pledging conference particularly over
how it would increase financial predictability. Secretariat was asked to
explore other possible solutions. On contingency fund for outbreaks
delegates sought clarification on how the fund would be managed in
harmonization with regional funds for emergencies.

In response, Dr. Chan clarified that assessed contributions were used to
support core-functions and governing bodies meetings and that Secretariat
³will not accept any money that do not go with priorities². She also
expressed hopes that the mechanism will increase transparency and prevent
civil society organisations from saying that WHO ³is in bed with industry².

The Chair¹s Summary further invites MS to submit comments on the draft
evaluation policy through the password protected web site open to all
Member States before 29th  February. Based on these comments
the Secretariat will prepare a revised draft of the evaluation policy for
the consideration of the EB in May through the PBAC.

On the matter of stage one of the independent evaluation of WHO, the
Chair¹s Summary states that  ³..the Executive board has welcomed the offer
of the External Auditor to carry out this step , and  expects  that the
report of stage one will be presented to the Sixty fifth World Health
Assembly, and will include the proposed road map for stage two of the
independent evaluation.

[A two stages process of independent evaluation of WHO to guide the reform
was agreed to at the EBSS.]

The Chair¹s Summary also notes that the EB welcomed the agreement of the
Joint Inspection Unit to update their reports of 1997 on decentralisation
within WHO and of 2003 on management and administration of WHO.

Preparations for upcoming meetings of the Governing Bodies

The WHA will have an opportunity to review and discuss all proposals on
reform. The Secretariat¹s report will cover programmes and priorities,
governance and managerial reforms incorporating the outcome of the Member
State driven process on priority setting, showing linkages and indicating
areas where consensus has been reached and those
areas where further discussion is required.  The report will also include
the elements of reform agreed in the Special EB session in November 2011
and the further elaboration of the proposals where the EB has requested
additional work. The report will also include a draft implementation plan,
with a budget and monitoring framework for consideration by the WHA.


**This report has been prepared with some input drawn from the reports
produced by the WHO Watchers linked to the Peoples¹ Health Movement. Their
reports are available at http://www.ghwatch.org/node/448


[1] <#_ftnref1>  See
http://www.twnside.org.sg/title2/intellectual_property/info.service/2011/ipr
.info.110101.htm for more information on the beginnings of WHO reform
discussion

[2] <#_ftnref2>  See
http://www.twnside.org.sg/title2/intellectual_property/info.service/2011/ipr
.info.111104.htm for a report on the EBSS took place in November 2011.

[3] <#_ftnref3>  See http://apps.who.int/gb/e/e_eb130.html for the WHO
documents.

[4] <#_ftnref4>  See Overhaul needed on rules on NGOs' relationship at
http://www.twnside.org.sg/title2/intellectual_property/info.service/2012/ipr
.info.120103.htm



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