<span lang="EN-GB">Chapter 1. Programmatic Priorities</span>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">PHM appreciates the summary of ‘challenges
and opportunities’ (Cl 10-18) provided by the Director General, including the
reference to the widening inequalities and problems regarding the ‘cost of
technologies’. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">Missing from this summary, however, was any
reference to the rise and rise of transnational corporations which straddle
countries and have a great deal of autonomy because of this.<span style="mso-spacerun:yes"> </span>TNCs are a major feature of the global health
environment and the challenge of regulating TNCs for public policy purposes,
including health, is one that WHO must confront.</span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We note with concern the proposition that
“WHO should focus on what it does best” (Cl 23). This is dangerous.<span style="mso-spacerun:yes"> </span>The unstated corollary is that as new
organisations arise who do some of the things WHO does, WHO should
withdraw.<span style="mso-spacerun:yes"> </span>WHO must maintain capacity
across the breadth of its constitutional mandate.<span style="mso-spacerun:yes"> </span>The proliferation of specialised,
vertically-oriented global public private partnerships has significant hidden
costs associated with health system fragmentation and donor incoordination; these
can offset any benefits arising from their technical specialisation.</span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We urge member states to be cautious about
accepting the proposal for a formal priority setting process within each of the
proposed five core areas (Cl 45-47). The paper is completely silent on what
kinds of priorities might be developed and what kind of process might be
involved. To simply endorse such a proposal would be signing a blank cheque.<span style="mso-spacerun:yes"> </span></span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We are concerned that the setting of
priorities within the five core areas would impact negatively on WHO’s work at
the country level. Countries face different problems in different circumstances
and WHO needs to have a full capacity to address the different needs of
countries in relation to all aspects of health development, health security and
health systems.<span style="mso-spacerun:yes"> </span></span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We recognise that there are imbalances with
respect to staffing and expenditure across the different clusters at Headquarters,
for example, there has been severe neglect in recent years of the rational use
of medicines and of national drug policies.<span style="mso-spacerun:yes">
</span>However, we are not convinced that this should be interpreted in terms
of ‘prioritisation’ rather than one of management decision making, allocating
resources to the places where they will do most good.<span style="mso-spacerun:yes"> </span>In large degree such failures in management
are structural in nature, linked to the ways in which tied funds distort
resource allocation and promote the autonomy of clusters.<span style="mso-spacerun:yes"> </span>We urge that this proposed ‘prioritisation’
exercise be deferred while the structural issues are addressed. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<h1><span lang="EN-GB">Chapter 2. Governance</span></h1>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">PHM agrees that the Governance of WHO and
WHO’s role in global health governance are critical issues for attention in
this present WHO Reform initiative. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">Considering first the role of the Executive
Board, we are apprehensive regarding the proposal for the EB to take the role of
gatekeeper to the Assembly. We recognise that not all draft resolutions are
strategically oriented, well structured and include consideration of financial
implications. The solution does not lie in gate-keeping; rather the EB needs to
work to improve the quality of the resolutions.<span style="mso-spacerun:yes">
</span></span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We agree that there is a need to strengthen
the executive role of the EB and to ensure that it more effectively oversees
the work of the Secretariat.<span style="mso-spacerun:yes"> </span>The
proposals advanced to this end need further elaboration and discussion.<span style="mso-spacerun:yes"> </span></span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We are concerned about the proposals: to
impose tighter time limits on speakers at both the Board and the Assembly; to
limit the number of resolutions coming before the Assembly (Cl 68); and to
filter resolutions coming before the Assembly for their perceived priority (Cl
72). The capacity of member states to submit resolutions is part of the
democratic spirit of the Constitution and should not be compromised lightly. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The problem is not simply that people speak
for too long; too often their contributions are irrelevant, meandering and
self-serving. If people are addressing substantive and complex issues time
keeping should be flexible. There is a need for more interventionist chairing
with respect to relevance and substance as well as time, and for closer mentoring
of new representatives, particularly when it is evident that they are not
familiar with the issues upon which they are speaking. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We are concerned by the proposal to limit
the number of progress reports to six instances. If there is no need to
continue reporting on a particular resolution such a decision can be taken by the
Board and reported to the member states for appeal. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We strongly support the proposal that
regional committees and regional directors report formally to the Board and the
Assembly (Cl 78).<span style="mso-spacerun:yes"> </span>However, we have
reservations about the proposal to ‘standardise’ the work of regional
committees but some process of benchmarking to find and share best practice
models with respect to regional practice would make sense. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">Turning now to WHO’s role in global health
governance we point to a serious flaw in the conceptualisation of global health
governance (Cl 85). To limit the scope of global health governance to ‘policy
and priority setting for health’ excludes trade, finance and the regulation of
TNCs.<span style="mso-spacerun:yes"> </span>These are powerful determinants of
population health. To ignore WHO’s responsibilities in relation to these
determinants is a major weakness of this paper.</span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We do not agree that accountability with
respect to WHO partnerships should be given to the Standing Committee on NGOs
(Cl 96). WHO’s role in relation to such partnerships needs to be reviewed in
the Board and in the Assembly in relation to the strategic directions of the
Organisation, not reduced to bureaucratic protocol.</span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">Finally the paper fails to deal with WHO’s
relations with public interest NGOs. This issue has been raised for decades by
civil society but has thus far been ignored. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We urge that WHO re-launch the 2001 Civil
Society Initiative with a view to deepening dialogue and cooperation with public
interest NGOs at all levels of WHO’s work. The criteria and processes for
organisations entering into official relations with the WHO need to be reviewed
including a clear distinction between public-interest NGOs and
business-interest NGOs. </span></p>
<h1><span lang="EN-GB">Chapter 3: Management Reform</span></h1>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">PHM supports the proposals for improving
organisational effectiveness, especially the strengthening of country offices. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">Many of the recommendations in this chapter
are basic principles of good management (for example, more effective knowledge
management, streamlined recruitment and selection and enhanced staff
development).<span style="mso-spacerun:yes"> </span>We need to ask why these
have not been core features of WHO management for years. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The recommendations to increase the
predictability and flexibility of funding, including longer term commitments
and increases in untied donations will require a stronger commitment to WHO
than many member states have hitherto shown.<span style="mso-spacerun:yes">
</span>We urge member state representatives to communicate clearly to their
governments that WHO is in a financial crisis and that for a relatively small
increase in their contributions an institution which is critical for achieving
the MDGs can be restored to good health.</span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We commend the objective of organisation-wide
resource mobilisation (Cl 142) but we are not confident that the five
strategies offered are sufficiently focused and have sufficient leverage. The
anarchic funding practices of recent years are in part due to the structural
autonomy of the clusters. Structural reform is a critical pre-requisite for
more coherent fund raising. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The proposal to revise the existing
workforce model (Cl 150-151) appears appropriate in overview but the devil is
in the detail. It is not clear how the new workforce model will impact on
regions and countries in contrast to Headquarters.<span style="mso-spacerun:yes"> </span>The balance of short and long term functions
may be different at the different levels of the Secretariat.<span style="mso-spacerun:yes"> </span>This should be considered. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We note the proposed mobility and rotation
framework (Cl 155). This may be a good idea but there is no rationale provided
of why mobility is to be encouraged and what kinds of principles might govern
such a system.<span style="mso-spacerun:yes"> </span></span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The need to reform the current system of
‘results based management’ is clear.<span style="mso-spacerun:yes">
</span>Whether the new results chain, the revised planning framework and the
proposed new timelines will address the underlying problems is less clear. It
would make sense to trial these propositions in one of the core areas, such as
health systems strengthening.<span style="mso-spacerun:yes"> </span></span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The proposals (Cl 168-170) for a longer
program budget period, for dropping the medium term strategic plan and for
moving the general program of work to three budget cycles may all be a good
ideas but the rationale is not provided. The paper simply says that it would
make it easier for donors and ‘would improve planning’.<span style="mso-spacerun:yes"> </span>It would be important to ensure that the
longer planning time frames do not reduce WHO’s ‘agility’. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We welcome the commitments to increased
accountability and transparency (Cl 176 et seq) but most of the proposals are
very general and hard to assess for this reason. However, we particularly welcome
the proposed tightening of policy on institutional conflicts of interest. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The discussion of ‘independent evaluation’
(Cl 190 et seq) is not clear.<span style="mso-spacerun:yes"> </span>Perhaps
priority might be given to developing an Evaluation Policy (Cl 196) which might
set forth more clearly the logic and processes for progressing the other ideas
presented here.<span style="mso-spacerun:yes"> </span></span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The proposal on Strategic Communications
(Cl 199 et seq) appear to be more about public relations than effective two way
communication with the various constituencies with whom WHO deals, including
the public interest NGOs. </span></p>
<h1><span lang="EN-GB">Concluding</span></h1>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">The People’s Health Movement is committed
to a strong WHO, adequately funded, fully utilising the powers of the
Constitution, properly accountable to member states and playing the leading
role in global health governance. </span></p>
<p class="MsoNormal"><span lang="EN-GB"> </span></p>
<p class="MsoNormal"><span lang="EN-GB">We congratulate the Director General, the
staff of the Secretariat and the Member States for progressing the Reform
Initiative to this stage. PHM is committed to Health for All, Now! and sees the
restoration of WHO to its rightful place in global health governance as
fundamental to achieving this vision.</span></p>