<div dir="ltr">

<h1 style="margin-top:12.0pt;margin-right:0cm;margin-bottom:6.0pt;
margin-left:21.55pt;text-align:center;text-indent:-21.55pt;line-height:115%" align="center"><span dir="LTR"><span style="font-size:14.0pt;line-height:115%;font-family:
Calibri;mso-fareast-font-family:Calibri;mso-bidi-font-family:Calibri;
mso-ansi-language:EN-GB" lang="EN-GB">Comments on ‘The future of financing for WHO’</span></span></h1>

<h1 style="margin-top:24.0pt;margin-right:0cm;margin-bottom:6.0pt;
margin-left:21.6pt;text-align:center;line-height:115%" align="center"><span dir="LTR"><span style="font-size:12.0pt;line-height:115%;font-family:Calibri;
mso-fareast-font-family:Calibri;mso-bidi-font-family:Calibri;mso-ansi-language:
EN-GB" lang="EN-GB">64th World Health Assembly (WHA), May 2011</span></span></h1>

<p class="MsoNormal" style="text-align:justify;line-height:115%"><span style="font-size:10.5pt;line-height:115%;font-family:Calibri;
mso-fareast-font-family:Calibri;mso-bidi-font-family:Calibri;mso-ansi-language:
EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Distinguished delegate of the WHA,</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">People’s Health Movement (PHM) is
a global network of organisations and individuals working locally, nationally
and globally in more than 80 countries for ‘health for all’. Our basic platform
is articulated in the</span><span style="font-size:11.0pt;
font-family:Calibri;mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"><a href="http://www.phmovement.org/en/resources/charters/peopleshealth?destination=home"><span style="color:black;mso-ansi-language:EN-GB"> </span><span style="color:#000099;
mso-ansi-language:EN-GB">People’s Charter for Health</span></a><span style="color:black"> which was adopted at the first People’s Health Assembly in
Dhaka, Bangladesh in December 2000. More information about PHM can be found at</span><a href="http://www.phmovement.org/"><span style="color:black;mso-ansi-language:
EN-GB"> </span><span style="color:#000099;mso-ansi-language:EN-GB">www.phmovement.org</span></a><span style="color:black">.</span></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">PHM is committed to a stronger
World Health Organisation (WHO), adequately funded, fully utilising the powers
of the Constitution and playing the leading role in global health governance.
PHM follows closely the work of WHO, through the governing bodies and the
secretariat at all levels. Across our networks we have technical experts and
grass roots organisations with close interests in many of the issues coming
before you over the next few days.</span><span style="font-size:
11.0pt;font-family:Calibri;mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Over the last week, 30 members of
the PHM WHO liaison group from over 20 countries have been working through the
WHA Agenda with the assistance of high level experts from a number of
collaborating networks and NGOs. This workshop was part of our Global Health
Governance Initiative (a joint project of PHM, Third World Network, Health
Action International, Medicus Mundi International and Medico International) which
involves both watching and advocacy. We are particularly concerned regarding
the Director General’s (DG) report “The Future of Financing for WHO: Reforms
for a Healthy Future” (Doc. A64/4).</span><span style="font-size:
11.0pt;font-family:Calibri;mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">The WHO is facing a financial
crisis: programmes, projects and staffing face the prospect of being disbanded;
the dominance of tied donor funding is having a terrible effect on
administration. The WHO is also suffering from a crisis of identity and
legitimacy; its role and mandate have been diluted and usurped by the proliferation
of new actors in the field of global health. Inefficiencies within the
organisational processes remain unresolved.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:Calibri;
mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">These crises have been building
over several decades. They also reflect questions about the role of the UN, the
sovereignty of nation states and the democratic deficit that exists at the
global level of governance more generally.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:Calibri;
mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">The driver of the reforms
foreshadowed in the DG's report is the financial crisis in which the WHO finds
itself. In accordance with the demands of the donors, the report simply
addresses issues of effectiveness, efficiency, responsiveness, objectivity,
transparency and accountability <i>(A64/4, p.6)</i>. However, while the report
sets out broad directions for the WHO, it has few concrete recommendations and
inadequate analysis of the financial crisis. Most worryingly, the key document
– the “detailed development plan for the programme of reform” <i>(A64/4, p.6,
footnote 2) –</i> has not been posted even a few days before the Assembly.
Calling for endorsement of a general plan without detail is asking member
states to sign a blank cheque.</span><span style="font-size:11.0pt;
font-family:Calibri;mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><i><u><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Core business</span></u></i><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">The focus on “core business” could
well turn out to be a narrowing of the mandate of the WHO. The DG has
previously stated that certain key areas of work of the WHO, including action
on the social determinants of health, human rights and gender, are to be
‘mainstreamed’. Mainstreaming is a euphemism and will lead to reduced focus,
analytic capacity and drive. There are powerful interests that would like to
see WHO restricted to a technocratic role on communicable disease control and
‘health security’, and distanced from issues such as economic development,
justice and peace, despite the fact that these are critical determinants of
health and are wholly encompassed in the WHO Constitution.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><i><u><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Organizational effectiveness</span></u></i><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">There is a need for greater
coherence between the country, regional and global levels of the WHO. But there
is nothing in the report about the concrete changes required. The issues of
accountability, coordination and management are complex and difficult. But it’s
time to stop talking about organizational effectiveness and to start drawing up
an agenda and implementing real reform.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:Calibri;
mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><i><u><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Management and accountability</span></u></i><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">The WHO has not escaped from the
new religion of performance-based funding. Of course, the WHO should have clear
plans and be capable of self-evaluation and impact monitoring, but subjecting
itself to a narrow form of performance management could undermine its mandate,
authority and independence. Much of what the WHO does (convening, facilitating,
leading, advocating, coordinating and persuading) cannot be measured through
simplistic performance-related results and indicators. Management and
accountability in the WHO call for leadership and diverse methods of
evaluation.</span><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">As the directing and co-ordinating
authority on international health work, the WHO should also take the lead in
promoting accountability and transparency in its functioning and the fulfilment
of its mandate. This should include transparent and participatory audit of its
movement towards achievement of the ‘highest attainable standard of health for
every human being’, including provision for the ‘right to information’ for its
constituents.</span><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><i><u><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Human Resources (HR)</span></u></i><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">The goals of reform should precede
changes to HR policies, planning and management. However, the need to downsize
is preceding and informing the process of reform. It is a direct response to
the WHO’s financial crisis, and not to a rational and evidence-based
determination of staffing needs for the fulfilment of its mandate. Of course
there are many improvements that need to be made to the WHO’s systems of
recruitment and HR management but the evidence and logic to support reducing
the number of core staff and supplementing them with temporary staff and
sub-contractees has not been presented.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:Calibri;
mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"><br>
<i><u>Financing and communication</u></i></span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">To fulfil its mandate the WHO
needs a budget that is adequate, predictable and untied. <span style="mso-spacerun:yes"> </span>WHO’s state of financing is untenable; only
18% of WHO’s funding comes from core, assessed contributions. The rest is
cobbled together from multiple streams of voluntary donations, grants and
in-kind support, much of which is conditional. A high proportion of voluntary
contributions by member states undermines the organisation’s independence and
results in huge inefficiencies. Increasing dependence on private philanthropies
and corporates carries serious risks of further distorting WHO's priorities.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">It is time that the assessed
contributions formula for countries is reviewed and revised; and it is time for
a fair and adequate system of public financing for the WHO. We propose that
member states collectively commit to increasing assessed funding so that it
reaches 50% of the overall budget over the next five years.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">The report calls for the WHO to
widen its resource base by drawing on the private and commercial sector but it
makes no mention of how its independence will be protected, nor does it say
anything about the management of institutional conflicts of interest. WHO
should set a cap on the amount of tied funding received from the corporate
sector. Independent monitoring of public-corporate relationships are required
to prevent or deter unsafe or inappropriate relationships from forming. The
funding of WHO programmes by corporates and other donors should be explicitly
identified on the website. These safeguards to prevent the privatisation of the
WHO and the corporate capture of policy making should be spelled out before
setting off a revitalised programme of private and corporate fundraising.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><i><u><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">WHO’s effectiveness at country
level</span></u></i><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Effectiveness at the country level
should be “a key outcome of reform and an immediate priority in the agenda for
organisational alignment”. WHO does have a role in promoting inter-agency
cooperation but its unique role is supporting access to evidence, information
and best practice in the fields of social determinants, intersectoral
collaboration, primary health care, health system strengthening, health care
financing, rational use of medicine and other critical areas. Whether this is
carried out through country representatives or regional offices, WHO should be
accountable at the global, regional and country level for the effectiveness of
these functions and for the protection of people’s health.</span><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><i><u><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">Global health governance</span></u></i><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p style="margin:0cm;margin-bottom:.0001pt;text-align:justify"><span style="font-size:11.0pt;font-family:Calibri;mso-bidi-font-family:
Calibri;color:black;mso-ansi-language:EN-GB" lang="EN-GB">It is essential that the reform of
the WHO be framed around the health needs of people instead of being centred
upon the financial crisis. Health policy making over the last 30 years has been
distorted by the pressure of odious debt, the defence of intellectual property
and the rationalisation of an unjust global economy. The WHO should speak truth
to power.</span><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"></span></p>

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Calibri;
mso-bidi-font-family:Calibri;mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>

<span style="font-size:11.0pt;font-family:Calibri;mso-fareast-font-family:
"Times New Roman";mso-bidi-font-family:Calibri;color:black;mso-ansi-language:
EN-GB;mso-fareast-language:HI;mso-bidi-language:HI" lang="EN-GB">The proposed World Health
Forum has the potential to promote the interest of the private sector at the
expense of a member states’ driven process. The rationale and need for such a
forum is not made clear; and there is no discussion about how such a proposal
would avoid undermining or duplicating the role and mandate of the WHO. The WHO
must not pursue public-private partnerships without ensuring safeguards against
corporate influence over policy making and pernicious conflicts of interest. We
urge you to consider the risks of this proposal and hope you will not to
endorse it in its current form.</span><br><br><b>Please refer to the <a href="http://www.ghwatch.org/who-watch">WHO Watch</a> section on the <a href="http://www.ghwatch.org/">Global Health Watch website</a>.</b><br><br clear="all">
--<br>PHM Global Secretariat<br>People's Health Movement (PHM)<br>Email: <a href="mailto:globalsecretariat@phmovement.org" target="_blank">globalsecretariat@phmovement.org</a><br>Web: <a href="http://www.phmovement.org" target="_blank">www.phmovement.org</a><input type="hidden"><input type="hidden"><div>
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