Tuesday, 18 September 2012

WHO is too precious an institution for global health to fail! Global health governance and WHO reform at the 62nd session of WHO Europe

By Remco van de Pas, Wemos

“Health is too big to fail”. With these words the WHO Director General (DG) Margaret Chan addressed the 62nd regional committee meeting on 11th September in Malta. Indeed, the DG was present and outspoken during this meeting of WHO Europe. She indicated with her interventions that she is truly at the helm of the organization, steering it to a renewed leadership position in the dense landscape of global health actors and initiatives.
Well, the agenda of this year’s meeting was indeed densely packed, with important health policy frameworks being adopted by the 53 Member states in the European Region such as Health 2020, An European policy framework supporting action across government and society for health and well being and the European Action plan for strengthening public health capacities and services.  Several relevant technical briefings were organized, amongst others on the Consultative Expert Working Group on Research & Development and on actions towards achieving a sustainable health workforce. We have been actively involved in this session and in ensuing cooperation at European level.

Let me focus on two outstanding moments from this regional meeting. Firstly, the speech and interventions made by DG Margaret Chan. I have never heard her making such long comments as during this meeting. The DG was re-elected for another 5 years in office at the last World Health Assembly. She described clearly the health challenges that the world is currently facing: 

Today, the struggle to safeguard public health increasingly places health concerns in competition with the interests of powerful multinational corporations. Any health policy, no matter how sound or far-sighted, that is perceived to threaten a fragile economy, risks being put aside in the drive for economic growth and a strong GNP. (...) When we consider the nature of today’s threats to health, a simple compact between the haves and have-nots fails to capture the complexity of these threats. Many of these threats arise from the realities of a world characterized by radically increased interdependence and interconnectedness. In the very recent past, public health has moved into a unique political space. More and more, the conditions that threaten health are shaped by forces that govern the entire world. Today, international systems have more power than a sovereign government to influence the lives and opportunities of citizens, including the chances they have to enjoy a healthy life expectancy. (...) At a time when policies in so many sectors are actually increasing social inequalities, I would be delighted to see health lead the world towards greater fairness in ways that matter to each and every person on this planet. As I said, health is too big to fail. If health fails, all else fails”. 

Margaret Chan reacted in an upfront way to the position of (some) member states in relation to the WHO reform and financing for the institution in the future. As “CEO of the organisation” she demanded mutual accountability and transparency from its stakeholders and urged member states to walk their talk. She wants WHOs program budget and priorities to be defined by the member states as its owners and not only the ones that are the main donors. About the issues of global health governance she questioned member states why they had set up so many global health partnerships in the first place and to what extend this overlaps with the mandate of WHO: “Why do all these agencies have to reinvent the wheel? Over time agencies have expanded over their core mandate!” 

This corresponds with what Devi Shridhar has phrased Trojan Multilateralism: On one hand member states commit to a strong WHO that should be the leading agency in global health; on the other hand they concentrate their investment in those specific programs and priorities programs of WHO and in global health initiatives that fit best with their national interests. The tension between ”health as a common good” and “national self-interests” is strongly felt in the debate around the WHO reform.

The debate about WHO's 12th Global Programme of Work (2014-2019) and its consecutive financing was framed about WHO to be an effective, result driven organisation focusing on a number of strategic priority themes, at the same time having a sustainable and predictable finance model. This delicate issue is already on the table since a couple of years. In Malta European member states agreed that the proportion of core flexible voluntary contributions in relation to specific (tied) core voluntary contributions should increase, for WHO secretariat to be able to be more flexible and strategic with their funding. The fiscal budget year might also change so that it’s more aligned with the World Health Assembly. Unfortunately; increasing assessed contributions (the “membership fee”) and governance of private funding like from the Bill & Melinda Gates Foundation and others remain out of the discussion. The first seems impossible (it is a standard UN policy to have zero nominal growth on assessed contributions), the second one might trigger donors to invest in another global health actor instead….

Representing Medicus Mundi International Network, we contributed to the debate on the WHO reform and the Global Programme of Work with a written statement developed within the Democratizing Global Health Coalition on the WHO Reform (DGH). The statement was published on the website of WHO Europe.

Many stones still require to be unturned in before a new financing and governance model for the WHO will be established. Next mile stones in this debate are an extra-ordinary session of the WHO Programme, Budget and Administrative Committee (PBAC) in December 2012, and the WHO Executive Board meeting in January 2013. 

Margaret Chan is obviously not willing to allow member states to “make U-turns” during this reform process. But will she herself be able to walk her talk? From our side we will continue our participation and advocacy via thematic and political analysis and policy dialogues. WHO is too precious an institution for global health to fail!

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