PHM-Exch> [PHM NEWS] WHO commitment to address violence against children outsourced to a multistakeholder partnership WHO EB

Claudio Schuftan cschuftan at phmovement.org
Wed Feb 1 23:20:09 PST 2023 

From: People's Health Movement <dlegge at phmovement.org>

Questions raised regarding commodified, branded, vertical programs

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<https://mailchi.mp/phmovement/violence?e=125964ddcc>
WHO commitment to address violence against children outsourced to a
multistakeholder partnership

WHO's Executive Board, meeting in Geneva this week will consider EB152/21
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b1807d5498&e=125964ddcc>
which
reports on progress in ending violence against children at the country
level, and the development of guidance materials and high-level advocacy
globally. It sounds like unimpeachable good works but under the surface
there are problems.
Background

The original Global plan of action
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6768895940&e=125964ddcc>
‘to strengthen the role of the health system within a national
multisectoral response to address interpersonal violence, in particular
against women and girls, and against children’ was commissioned in WHA67.15
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=aacf37a94f&e=125964ddcc>
(2014).
It was reported to the Assembly in A69/9
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=92ad6f249c&e=125964ddcc>
in 2016 (presented in full here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3cdfb9bdd6&e=125964ddcc>)
and adopted in WHA69.5
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=417144bcb2&e=125964ddcc>
in 2016. It will remain in place until 2030.

The Global Plan of Action comprises four strategic directions:

   - Strengthen health system leadership and governance,
   - Strengthen health service delivery and health workers’/providers’
   capacity to respond,
   - Strengthen programming to prevent interpersonal violence,
   - Improve information and evidence.

The Global Plan of Action includes three separate sections: violence
against women and girls, violence against children, and all forms of
interpersonal violence. Different implementation partnerships and
activities are foreshadowed in relation to these separate but overlapping
foci of violence prevention.

A report on the implementation of the Global Plan of Action was submitted
to WHA74 (May 2021) in A74/21
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=affe3f5740&e=125964ddcc>
.
Focus on children

In May 2021 WHA74 adopted WHA74.17
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=884925d63e&e=125964ddcc>,
‘Ending violence against children through health systems strengthening and
multisectoral approaches’. In fact, A74/21
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b04ce549e6&e=125964ddcc>
does not single out ‘violence against children’ as being in particular need
of further attention in comparison with ‘violence against women and girls’
or ‘all forms of interpersonal violence’.

However, in a separate 2020 initiative, WHO’s Global status report on
preventing violence against children
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=03dcdadde9&e=125964ddcc>
had found that while many of the countries participating in the survey were
taking some action, 'government officials from these same countries
acknowledge that their efforts are clearly insufficient to achieve the SDG
targets’. The global status report concluded with recommendations for
boosting the implementation of the INSPIRE technical package (addressing
violence against children, see further below) by member states and by WHO.

These recommendations were carried forward by WHA74.17
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=bafc2db23d&e=125964ddcc>
.

The implementation of the Global Plan of Action, in relation to children,
appears to have been undertaken largely through the Global Partnership to
End Violence against Children
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ab7c0e87b4&e=125964ddcc>
which is a multistakeholder partnership (comprising WHO, UNICEF, US CDC,
Columbia University, and End Violence Against Children
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=cd2e48fb28&e=125964ddcc>,
a donor-supported NGO based in New York). The work of the Partnership is
based on WHO’s INSPIRE Technical Package
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=97428e3853&e=125964ddcc>
(of
which CDC staff were the principal authors).

In WHA74.17
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=61888cd6cf&e=125964ddcc>
the DG was requested to provide a report to WHA76 (May 2023) on the
implementation of its suggestions and requests. This report is provided in
EB152/21
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=90c9242521&e=125964ddcc>
.

See Tracker links to previous governing body reports, debates and decisions
in relation to violence
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3d65daa191&e=125964ddcc>.
For more data see Violence Info
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3e05ffb472&e=125964ddcc>
.
Good questions

EB152/21
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=14fab7fa44&e=125964ddcc>
reports on documents published, training events provided, consultations
held, statements issued, and progress on the Global Initiative to Support
Parents
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=85cbd920b2&e=125964ddcc>
.

EB152/21 ends with three questions:

   - At country level, what are the main challenges to and opportunities
   for scaling up health sector involvement in preventing and responding to
   violence against children?
   - What can WHO do to better integrate the recognition of and response to
   child maltreatment into routine health service provision?
   - How can WHO best support Member States to ensure multisectoral
   coordination for the prevention of violence against children with sectors
   such as education, social welfare and finance?

These are good questions. A couple of further good questions:

   - What evidence has been collected regarding the causal relationships,
   if any, between the activities sponsored through the Global Partnership
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=bb8de57689&e=125964ddcc>
   (and structured around the INSPIRE framework
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f83cbcc76d&e=125964ddcc>)
   and the various national and subnational initiatives which are reported in
   the 2020 Global Status Report
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d3cb49bd36&e=125964ddcc>
   and EB152/21
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=efba202057&e=125964ddcc>
   ?
   - Has the recent and foreshadowed investment in the prevention of
   ‘violence against children’ been matched by corresponding investments or
   plans in relation to the other two streams of the Global Plan of Action
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b152174d35&e=125964ddcc>,
   namely ‘violence against women and girls’ and ‘all forms of interpersonal
   violence’?

Multistakeholder partnerships, siloed implementation, commodified programs

The implementation of the commitments in the Global Plan of Action
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=9b328cf2bd&e=125964ddcc>,
regarding violence against children, has been outsourced to the Global
Partnership
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f68821b883&e=125964ddcc>.
As well as WHO and UNICEF this partnership includes the principal donor (US
CDC) and a donor supported NGO (EndViolence
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fb8b258718&e=125964ddcc>).
It appears that much of the expenditure through this partnership (in money
and person time) is spent outside WHO. Does this weaken human resource
development within WHO?

Is it the case that donor preferences have led to the selective focus on
violence against children alongside the relative neglect of the other two
domains of action of the Global Plan of Action? Is it the case that this
focus has had efficiency costs in terms of not addressing the broader cross
cutting issues relevant to all forms of interpersonal violence.

Has the competition for donor attention and donor funding, between the
Violence Prevention Unit (focused on violence against children) and the
Sexual and Reproductive Health Team (responsible for action on violence
against women and girls) contributed to a fragmented approach to violence
prevention generally?  Is this a consequence of the opposition of the US to
WHO’s guidelines on sexual and reproductive health?

Both teams have invested heavily in the commodification and branding of the
programs they are responsible for: INSPIRE
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=afc81ec00c&e=125964ddcc>
in relation to violence against children, and RESPECT
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1b81d50efd&e=125964ddcc>
in relation to violence against women and girls. In both cases, the clearly
articulated strategies of the Global Program of Action have been shuffled
around to create marketable brands, structured around their acronyms:
INSPIRE and RESPECT.

Is there any evidence that this kind of repackaging of clearly articulated
strategies facilitates implementation more effectively?  Does it facilitate
communication with stakeholders in other sectors such as education or law
enforcement? Or is it directed to selling the programs to donors.

The Global Initiative to Support Parents
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=648ea7aa33&e=125964ddcc>
will be welcomed by many, but stakeholders from education, who should be
major supporters, may be perplexed by INSPIRE. Likewise law enforcement
agencies, who should be among WHO’s closest partners in preventing and
responding to interpersonal violence, might likewise be perplexed by
INSPIRE, although since they are largely ignored by both the Global Plan of
Action and by INSPIRE it is unlikely to come to their attention.
‘Harmful gender norms’

Under the strategy, ‘norms and values’ (INSPIRE
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0ea9540cf5&e=125964ddcc>,
pB24), three approaches are listed including ‘changing adherence to
restrictive and harmful gender and social norms’. There is very limited
analysis of harmful gender norms, largely restricted to gender equity and
gendered roles.

There is no analysis in either the Global Program of Action or the INSPIRE
package of the roles of patriarchy, misogyny and homophobia in generating
violence nor the structural factors in different societies which reproduce
patriarchy, misogyny and homophobia.

Patriarchy thrives when men and boys are encouraged (by custom and
ideology) to project their fears and disappointments onto women and girls,
including through violence. Homophobia thrives when heteronormative people
are encouraged (by custom and ideology)  to project their fears and
disappointments onto people of diverse sexualities and orientations,
including through violence.

Ignoring the roots of ‘harmful gender norms’ can only help to perpetuate
such attitudes and the violence they sanction.
The social determination of health

There is very limited recognition of the social determinants of health in
either the Global Action Plan of Action or the INSPIRE package and no
recognition of the wider forces and dynamics which reproduce those
determinants.

This is particularly clear in the approaches suggested for the INSPIRE
strategy, ‘income and economic strengthening’. The three approaches
suggested to implement this strategy are: Cash transfers, Group saving and
loans combined with gender equity training, and Microfinance combined with
gender norm training.

These three approaches are offered as responses to poverty,
marginalisation, and alienation, but they avoid any reference to the
forces, structures and dynamics which reproduce poverty, marginalisation
and alienation and which allow, even encourage, interpersonal violence as a
response to the associated despair and frustrations.

It is significant that this document was written by the US CDC during the
Trump Presidency and co-sponsored by the PEPFAR, Together for Girls,
UNICEF, UNODC, USAID, and the World Bank.

It is regrettable that WHO is forced to outsource its program development
and implementation to organisations which are so deeply compromised in
terms of the origins of the problems they are addressing.

*PHM urges member states* to commission an independent programmatic
evaluation of the Global Partnership and the INSPIRE technical package. PHM
urges that the terms of reference for such an evaluation include questions
about the science base for the universal application of the INSPIRE
'approaches' and about the distortions of WHO capacity, coherence and
integrity created by the donor auction and the drive to transfer global
health functions out of WHO and into multistakeholder partnerships.
------------------------------

See our more detailed commentary on this item here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a845270ed0&e=125964ddcc>.
The Tracker page for EB152 is here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c633ac5ba3&e=125964ddcc>
.

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<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6a3d4dcede&e=125964ddcc>
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<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=70106895e6&e=125964ddcc>
in association with Medicus Mundi International
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c040edf505&e=125964ddcc>,
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<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ee09a1d953&e=125964ddcc>
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