<div dir="ltr"><div class=""><img class="" id=":3ho" src="https://mail.google.com/mail/u/0/images/cleardot.gif" alt=""></div>EQUINET NEWS IS THE ELECTRONIC MAILING LIST OF THE NETWORK FOR EQUITY IN<br>
HEALTH IN EAST AND SOUTHERN AFRICA (EQUINET)<br>
<br>
<a href="http://www.equinetafrica.org/" target="_blank">http://www.equinetafrica.org/</a><br>
<br><div id=":32p" class="" style="overflow:hidden">
<br>
<b>Editorial</b><br>
<br>
<b>ENGAGING IN GLOBAL HEALTH: WHO SETS THE AGENDA?</b><br>
Bente Molenaar Neufeld, The Centre For Trade Policy And Law, Canada<br>
<br>
The World Health Organization (WHO) states in its constitution that it aims<br>
to achieve "the attainment by all people of the highest possible level of<br>
health." The World Health Assemblies (WHAs) provide a key opportunity to<br>
engage on the achievement of this aim. Yet in an interesting study by<br>
Kitamura et al. in May 2013 in Health Policy reviewing the agendas of the<br>
WHAs between 1970 and 2012, the authors concluded that "agenda items of the<br>
WHA do not always reflect international health issues in terms of burdens of<br>
mortality and illness."<br>
<br>
So how are countries and stakeholders shaping the WHA agenda?<br>
<br>
One way is through the WHO Executive Board (EB), particularly as it plays a<br>
role in setting the provisional agenda for the WHA. EB members are<br>
individuals nominated by countries with technical expertise in health. Of<br>
the 34 members of the Executive Board, seven are from the African region.<br>
Currently these are from Cameroon (2011-2014), Chad (2012-2015), Namibia<br>
(2013-2016), Nigeria (2011-2014), Senegal (2011-2014), Sierra Leone<br>
(2011-2014) and South Africa (2013-2016). As EB members, they are<br>
well-positioned to be heard and to bring concerns from their regions to the<br>
table. They can also block issues being discussed. The WHO secretariat also<br>
plays a role in agenda setting. Procedurally, the provisional EB agenda is<br>
proposed by the WHO Director-General. Getting issues on the agenda for the<br>
WHA is, however, not difficult. According to the rules of procedure, every<br>
proposal brought by a member state and any proposals submitted by the DG<br>
should be included in the provisional WHA agenda. So how are these policy<br>
levers being used?<br>
<br>
Take the 2014 EB agenda for example. Many agenda items were not<br>
controversial as they are carried over from previous years, after broad<br>
agreement around their importance. This included non-communicable diseases<br>
(NCDs), neglected tropical diseases and reform of the WHO. Other agenda<br>
items may be more controversial. For example, when in 2012 the United States<br>
of America and Thailand successfully petitioned to include lesbian, gay,<br>
bisexual and transgender (LGBT) access to health in the WHO EB agenda for<br>
consideration it provoked debate, with Egypt and Nigeria, on behalf of their<br>
regions, asking for the item to be deleted.<br>
<br>
This issue exemplified how health concerns can reflect and raise political<br>
division. Bringing health into diplomacy platforms, including that of the<br>
WHO, poses a challenge for how to avoid foreign policy concerns<br>
overshadowing health issues. The US delegate, Nils Daulaire, speaking about<br>
the demands for deletion of the LGBT item in 2012 said that it was<br>
"unprecedented for WHO member states to come together to attempt to remove<br>
an item legitimately placed on the Executive Board agenda by another member<br>
state. We believe it is important to afford each other the courtesy to<br>
discuss these important health items, even those with which not everyone<br>
agrees. Changing this deeply-established precedent risks politicizing all EB<br>
agenda items moving forward." At the same time, countries are sensitive<br>
about health platforms being used to advance wider foreign policy agendas.<br>
<br>
On the specific agenda item, a compromise position was reached to delete it<br>
and to ask the DG to consult with members on how to address the public<br>
health issues for future discussion. African diplomats in Geneva noted that<br>
the issue could continue to cause a stalemate unless the DG brings<br>
compromise solutions from her consultations within the regions. In the 2014<br>
EB the item thus appeared as '[deleted]' on the final agenda, and there was<br>
no discussion of it, as Member States had not agreed on a title or content<br>
of accompanying documentation for it. Until they do, the item will not be<br>
discussed.<br>
<br>
Agenda setting can and does thus fall victim to politics and requires<br>
diplomacy to reach solutions that are acceptable to the membership. However<br>
African countries have successfully brought items to the WHA agenda, such as<br>
that of ethical recruitment of health workers. What may restrict both the<br>
inclusion and action on agenda item may be the limits set by the General<br>
Program of Work (GPW). The GPW is set for the organization every 5 years.<br>
Unless a suggested item falls within the GPW and has funding allocated to<br>
it, it is unlikely to make it onto the formal agenda. The Organization is<br>
currently working on its 2014-2019 GPW and bases its' plans on a set of<br>
distinct categories in the GPW that have been agreed to by Member States -<br>
that is communicable diseases, non-communicable diseases, promoting health<br>
through the life course, health systems, and preparedness, surveillance and<br>
response. One reform of the WHO underway, according to the WHO website, is<br>
to "allow greater flexibility in allocating resources to priorities within<br>
these categories", which may then give flexibility for new agenda items not<br>
yet covered in the GPW.<br>
<br>
Even when issues make it to the WHA agenda, will they receive adequate<br>
attention?<br>
<br>
The agenda of both the EB and the WHA have become longer and longer over<br>
the years. In May 2013, for example, the WHA agenda included numerous<br>
weighty issues, including health post 2015, NCDs, communicable diseases<br>
(including malaria and neglected tropical diseases), WHO reform,<br>
substandard/spurious/falsely-labelled/falsified/counterfeit medical products<br>
and a range of other issues. With such packed agendas, smaller delegations<br>
to the WHA face challenges in participating when equally important issues<br>
are being discussed at the same time. Dr. Emmanuel Makasa, health attache at<br>
the Zambia high commission in Geneva noted in one 2013 meeting in the region<br>
that African delegations have responded to this by working as a group: "We<br>
work together as the African Group of Health Experts in Geneva to tackle<br>
issues and engage as a group, which helps with our individual member state<br>
staff shortages and different professionals present at the meetings."<br>
<br>
A lengthening agenda may also reflect the widening reach of global factors<br>
and policies in health, or the widening range of concerns claiming for<br>
attention. Either way, countries need proactive strategies to get their<br>
health concerns onto the global agenda, to ensure that they obtain attention<br>
and are addressed. It implies long term thinking, preparing and<br>
collaborating with partners in advance to develop positions and organizing<br>
the evidence, expertise and alliances to raise and advance agenda items. As<br>
Chigas et al. highlighted in 2007 those who can early on "frame the<br>
definition of the problem and the terms of the collective debate, can have<br>
enormous influence on the subsequent negotiations and their outcomes."<br>
<br>
Please send feedback or queries on the issues raised in this briefing to the<br>
EQUINET secretariat: <a href="mailto:admin@equinetafrica.org">admin@equinetafrica.org</a>. The Centre for Trade Policy<br>
and Law is working with EQUINET on a research programme on GHD in<br>
association with the ECSA HC Strategic Initiative on Global Health<br>
Diplomacy. For more information on the issues raised please visit<br>
<a href="http://www.equinetafrica.org" target="_blank">www.equinetafrica.org</a></div></div>