PHM-Exch> Donors tighten their grip on WHO's agenda. Report from PHM's WHO Watch

[Claudio Schuftan]

From: David G Legge <dglegge01 at gmail.com>

PHM-EXCHANGE ASKS FOR AN EXCUSE FOR THE HIGH VOLUME OF WHA-WATCH POSTINGS.
THESE HAVE TO BE TIMELY FOR READERS TO UNDERSTAND THE ISSUES BEFORE THE
WORLD HEALTH ASSEMBLY.


As Member States of the World Health Organisation prepare to commence the
65th World Health Assembly on 21st May 2012, PHM has again called on the
member states of WHO to mandate an increase in untied assessed
contributions to the Organisation.  The donor states (and philanthropies)
are tightening their grip on WHO’s agenda with disabling effects on the
WHO.  ****

** **

Under pressure from the donors WHO is presently going through a program of
reform.  For a commentary on WHO Reform at this week’s World Health
Assembly and further links see http://www.ghwatch.org/who-watch/wha65****

** **

PHM is at the WHA, reporting through WHO Watch.  Follow @WHOWatch on Twitter
****
12. WHO Reform ****The issues before the Assembly****

The DG presents a Consolidated
Report<http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_5-en.pdf>(
http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_5-en.pdf) on decision
making and progress with respect to WHO Reform (A65/5).  The CR is
structured around 16 ‘decision points’ for decision by the Assembly.  ****

   1. Endorse EB Chairman’s report from February meeting of MS on priority
   setting (A65/40<http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_40-en.pdf>,
   http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_40-en.pdf) and guide
   further development of the draft 12th GPW (A65/5
Add.1<http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_5Add1-en.pdf>,
   see below also);****
   2. Endorse a set of principles regarding governance of WHO; ****
   3. Scheduling of the meetings of governing bodies; ****
   4. Alignment between the work of regional committees and the EB;****
   5. Harmonisation of procedures and protocols across regions;****
   6. Revised terms of reference for the PBAC; ****
   7. Streamlining decision making in governing bodies****
   8. Engagement with stakeholders and partnerships;****
   9. Strengthening technical support to MS;****
   10. Staffing policy and practice****
   11. The new ‘financing dialogue’;****
   12. Internal controls;****
   13. Accountability, risk management, conflict of interest and ethics;****
   14. Evaluation policy;****
   15. External auditor’s Independent Evaluation (Stage I)****
   16. Strategic communications****

PHM Comments on selected decision points****3. Scheduling: giving the
donors control of the agenda?****

The 65th WHA is invited to consider a number of options for re-scheduling
the meetings of governing bodies. It appears that the favoured option would
involve the annual cycle starting with regional committees in the first
quarter of the year followed by the PBAC and EB leading then to the
‘financing dialogue’ with donors and ending with the Health Assembly in the
last quarter.

This arrangement would have the EB prepare a draft program budget which
then goes directly to the donors (the financing dialogue) and only after
the donors have decided what to fund does it come to the Assembly,
scheduled in the last quarter of the year.

It is hard to avoid the image of the Secretariat auctioning its programs to
the donors and then presenting the assembly with a fait accompli with
respect to the program budget.

Apart from this indignity, the proposed arrangement will give Secretariat
inadequate time to prepare for the new programme to start in January. ****
5. Harmonising across regions****

The DG brings forth a number of initiatives and proposals for harmonising
(or standardising) the ways in which the regions work.

We are concerned about the passage in para. 33 which would allow Regional
Committees to invite the observers that “they wish to attend”. If
accreditation follows a known official procedure, then there is no place
for picking and choosing which organisations get accredited. There is a
pressing need to reform the procedures, rules and protocols for the
participation of civil society in global and regional governing bodies.

WHO is a member state body and this is part of its strength.  However,
there is untapped value to be gained from building a more collaborative
relationship with public interest civil society organisations at the
country, regional and global levels.

Closer involvement of civil society as observers in RCs would strengthen
the accountability of regional committees and bring fresh perspectives for
discussion. Civil society collaboration would add value to program
implementation as well as policy making and accountability.****
7. Streamlining decision-making in governing body meetings****

Under this heading the DG refers to a number of proposals for tighter
discipline on late resolutions; for new mechanisms to vet resolutions
coming to the governing bodies and for arbitrary limits on repeat progress
reports.

We support more discipline in managing late resolutions submitted to the
WHA.

We firmly oppose the proposal that Officers of the Board might curtail the
right of Member States (MS) to propose resolutions to the governing bodies.
 There may be merit in reflecting on earlier resolutions and seeking
coherence between resolutions on related subjects but this should not
restrict the sovereign right of MS to table resolutions on matters they
deem important.

We reiterate the intergovernmental nature of the WHO, and of the processes
taking place within its governing body meetings. In this context, we wish
to caution against the seemingly increasing trend of using summaries of
discussions developed by Chairs of intergovernmental meetings.

The Chairman’s summaries under recommendation in para. 43 have no legal
status and are not binding documents. They are not decisions, and do not
reflect the intergovernmental nature, or capture the diverse opinions, of
the meetings they summarise. They also face the difficulty of
implementation, hence accountability, because of lack of consensus
(necessary for any intergovernmentally agreed text).

We urge MS to delete points (a), (c) and (d) from para. 43. ****
8. Effective engagement with other stakeholders****

The DG reviews the different kinds of partnerships and relationships that
WHO engages in, including: with other intergovernmental bodies, private
sector organisations and non-government organisations.

We appreciate the commitment to review WHO’s relationship with NGOs at
global, regional and country levels and the recognition of the importance
of discerning clearly between different types of NGOs engaging with WHO.

We note with concern the recent trend for the Secretariat to hold separate
consultations with public interest organisations and private interest ones
including the private sector. Ensuring transparency in such processes
necessitates the presence of all stakeholders in the same room for
discussion.

We appreciate also the focus on clearer protocols for managing conflicts of
interest of various kinds and look forward to finalisation and
implementation. We urge an explicit commitment to excluding private sector
entities from direct involvement in policy-formation and norm-setting
activities.  ****
9. Strengthening technical support to Member States****


The DG articulates a commitment to strengthening technical and policy
support to member states and reports on a number of initiatives to this
end. We commend this commitment and the progress which has been made.

We appreciate that the value of policy dialogue at the country level
including civil society is recognised and the new emphasis on the role of
the WHO country office in promoting such dialogue. Community based NGOs can
contribute to policy formation and to constituency development for policy
implementation.

We appreciate the commitment to refine the role of country cooperation
strategies (CCS) in shaping the WHO work program and in particular the
recognition that the objectives articulated in the CCS must be funded. PHM
calls for greater accountability and transparency with respect to CCSs.

*10. Staffing policy and practice *

The DG reports on a number of initiatives designed to promote improved
staff performance, and a more flexible mobile workforce.

WHO works in a complex and shifting environment and getting staffing
policies and practices right is of critical importance for the organisation
and for global health. There is a range of debates over regional
representation, recruitment policies, types of employment and mobility.

There are clear risks associated with the proposed move to short term
contracts, greater mobility and contracting out.  If these options have
been subject to robust analysis and evaluation this work should be
published.

It will be difficult for member states to endorse a particular staffing
strategy in the absence detailed description and evaluation of current
practice and evaluation of options for policy reform.  ****
11. Financing dialogue****

The DG’s comments on results based financing and the so-called financing
dialogue presume the continued freeze on increases in assessed
contributions.  This freeze is disabling WHO.  We urge MS to re-open
consideration of a substantial increase in assessed contributions. We urge
donors to convert earmarked contributions to untied grants.

The DG commits to ‘results-based budgeting and resource allocation’ based
on the new (12th) general program of work (GPW).  We have commented
elsewhere that the outline GPW which has been published (A65/5
Add1<http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_5Add1-en.pdf>)
is completely silent with respect to planning for, budgeting for and
accountability for cross-cutting issues such as the right to health, trade
and health, gender equity and the social determinants of health.

The discussion of the scheduling of governing body meetings and the timing
of the financing dialogue highlights the power that donors will have over
the Program Budget before it is adopted by the Assembly.  This is not
compatible with the claim that WHO is a MS driven organisation. ****
13. Accountability, risk management, conflict of interest (COI) and ethics**
**

The DG provides a detailed discussion of conflict of interest and describes
the role of the new Ethics Office in managing COI.

The DG foreshadows a new transparency and disclosure policy to be unveiled
at the EB in Jan 2013.****
15. Stage I of Independent Evaluation****


The Assembly is invited to note the report of Stage I of the Independent
Evaluation (mislabelled as A65/5 Add.2 and actually published on the DG’s
WHO Reform page<http://www.who.int/dg/reform/evaluation_report_stage1_reform_proposals.pdf>(
http://www.who.int/dg/reform/evaluation_report_stage1_reform_proposals.pdf).
****
Draft outline of General Program of Work (GPW), 2014-2019 Document A65/5
Add.1 <http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_5Add1-en.pdf> (
http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_5Add1-en.pdf)****


This draft outline of the GPW 2014-19 is presented first to the PBAC and
will then be considered by the Assembly. A more detailed version will be
considered by the regional committees in late 2012; a revised version goes
to by the PBAC in December 2012; and then to the EB in Jan 2013 and for
final adoption by the Assembly in May 2013.

The draft outline GPW is scheduled for discussion with the DG’s
Consolidated Report on WHO Reform because it seeks to operationalise the
principles developed in the WHO Reform discussions.  ****
PHM Comment: The ‘cross-cutting’ issues (in particular, social
determinants, trade relations, the right to health, primary health care,
gender equity) are completely neglected in this GPW and in the DG’s
Consolidated Report.****


PHM recognises the logic of adopting a particular set of categories for
budgeting purposes. Such categories are always going to be arbitrary and
carry the risk of privileging those categories as against alternative
possible categorisations.

A more coherent and integrated GPW requires effective planning, budgeting,
evaluation and accountability mechanisms for the cross cutting issues as
well as the ‘categories’ which are adopted as line items for budget
purposes.

These cross cutting issues include social determinants, trade, the right to
health, primary health care and gender equity.  In this GPW some of these
issues are identified as over-arching principles (PHC and trade are
completely absent) but there is nothing in the GPW or the DG’s Consolidated
Report about strategic planning and accountability in relation to issues.

The achievement of the right to health and gender equity for example can
only be assessed in relation to what is happening on the ground in
countries. There should be robust reporting from country and regional
offices on the achievement of these objectives.

WHO’s evaluation framework needs to make provision for meaningful
evaluation in relation to all of the agreed cross cutting issues, at the
global, regional and country levels including targets and milestones..

The planning function is also vulnerable in relation to the cross cutting
issues.  The draft GPW identifies Preparedness, Surveillance and Response
as one of the five categories. The risk is that the cross cutting issues of
human rights, the role of primary health care, gender issues and social
determinants in epidemics and disasters will be neglected. Disasters,
including ‘natural’ disasters always impact more devastatingly on the poor
who suffer lack of basic housing and sanitation.

The Rio Declaration on Social Determinants of
Health<http://www.who.int/sdhconference/declaration/en/>has called for
monitoring and accountability mechanisms. (See
also resolution WHA62.14 on Reducing health inequities through action on
the social determinants of
health<http://apps.who.int/gb/ebwha/pdf_files/WHA62-REC1/WHA62_REC1-en-P2.pdf>,
http://apps.who.int/gb/ebwha/pdf_files/WHA62-REC1/WHA62_REC1-en-P2.pdf.)
 The WHO EB endorsed the Rio Declaration in its 130th session last January,
and recommended to the 65th WHA a draft resolution text with that very
content (EB130.R11<http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_R11-en.pdf>).


There is no reference in the GPW to the issues of planning, evaluation and
accountability in relation to SDH, at the time when MS are about to
consider a draft resolution on the matter!

****
Stage I Evaluation Report on WHO Reform Program (ref. to A65/5Add.
2<http://www.who.int/dg/reform/evaluation_report_stage1_reform_proposals.pdf>,
http://www.who.int/dg/reform/evaluation_report_stage1_reform_proposals.pdf)*
***


*The issues before the Assembly *
At WHA64 a decision was taken to hold a special session of the EB in
November 2011 and the DG was commissioned to prepare papers for this
meeting.  One of the papers circulated in July 2011 dealt with
evaluation<http://www.who.int/dg/reform/en_who_reform_evaluation.pdf>.
These papers were reworked into a single
paper<http://apps.who.int/gb/ebwha/pdf_files/EBSS/EBSS2_2-en.pdf>for
the EBSS.

The EBSS (in EBSS2(3)<http://apps.who.int/gb/ebwha/pdf_files/EBSS/EBSS2_DIV2-en.pdf>
)

****

“4. Decided to proceed with an independent evaluation to provide input into
the reform process through a two-stage approach, the first stage 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 by Member States, following up where possible to produce more
information in response to questions arising from the Executive Board at
its  special session. Ideally, stage one should be completed in time for
the Sixty-fifth World Health Assembly;”****

“5. Decided further that the first stage review  will also provide a
roadmap for stage two of the evaluation, the goal of that second stage
being to inform the Sixty-sixth World Health Assembly, through the
Executive Board at its 132nd session, as an input into the general
programme of work. Stage two of the evaluation will build 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. As one input into reform, this evaluation will proceed in
parallel to other aspects of the reform;’ ****


An independent evaluation of the WHO reform process was conducted in
February/March 2012 by the Comptroller and Auditor General of India.

The Assembly is invited to note the findings of the (Evaluation Report of
Stage 1<http://www.who.int/dg/reform/evaluation_report_stage1_reform_proposals.pdf>)
and recommendations, as well as the Roadmap for Stage II.****
PHM Comment****The Evaluator has COMPLETELY failed to address the first
term of reference. ****

The team has undertaken an evaluation of the WHO Reform Program as
implemented so far (see Stage I Evaluation
Report<http://www.who.int/dg/reform/evaluation_report_stage1_reform_proposals.pdf>,
from page 57). This they were not asked to do; at least, not by the
Executive Board.  The (unmandated) evaluation of the Reform Program is very
positive.

The evaluator has created a new set of terms of reference for the
evaluation which bear no relationship to those adopted by the EB (see page
9).

He has not reviewed the existing information with respect to finance,
staffing and internal governance. This he was asked to do.

He has provided a ‘road map’ for Stage II of the Evaluation (which was part
of the brief) but in view of his very positive assessment of the reform
process to date - an assessment which was not commissioned by the EB - it
would seem unwise to proceed on the basis of his advice (unless with
extreme caution) and unwise to rely on him to undertake the next stage of
the evaluation. ****
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