On 17 and 18 October 2013 the WHO held an informal consultation regarding its engagement with non-state actors. The discussion paper guiding the consultation reads: “This paper proposes ways in which engagement with nongovernmental organizations (NGOs) and private entities can be improved, including the strengthening of due diligence, management of risks and conflicts of interest, and increasing the transparency of engagement.”
It is interesting how the semantics and debate regarding WHO’s relations with other actors have changed over time. WHO spoke in the 80s and 90s mainly of cooperation with NGOs. Read for instance the excellent consultation report from 1997 “A new global health policy for the 21st century, an NGO perspective”. This perspective shifted in the first decade of this century to cooperation with NGOs and Civil Society Organisations. The Civil Society Initiative in 2004 contributed to a proposed renewal of a “policy for relations with Non-Governmental Organisations”. This proposal however did not pass the World Health Assembly in 2004, as some countries opposed it.
In 2011 WHO started a process of reform, due to financial, organizational and legitimacy challenges. One part of the reform focuses on governance with external stakeholders. In 2009 already an attempt to create a so-called committee C of the World Health Assembly was blocked by member states. In 2011 a proposal for a world health forum, a multi-stakeholder platform, that would assist in policy shaping for WHOs governing bodies, did not pass either.
And now it is 2013. As NGOs we have had over the years several consultations with WHO how to move forward on this governance matter. During the last Executive Board meeting in May 2013 the represented WHO member states, but not all of them, proposed to develop overarching principles for engagement with non-state actors. Since then the WHO secretariat has reshuffled some of its staff working on this governance matter and appointed a special envoy on the engagement with non-state actors, Prof. Thomas Zeltner, the former head of the Swiss Federal Office for Public Health.
So there I found myself, representing a non-state actor (or a civil society organization, or a non governmental organization, or a stakeholder?) in this consultation last week. Within our constituencies, we have little confidence in this reframing and lumping together of all different actors, as can be read in this statement. Rather than non-state actors, we see ourselves as part of the extended state.
The consultation itself was chaotic. It was too open in its scope and could have been much more guided by the WHO secretariat. It was not a constructive sharing, as civil society, commercial actors and (some) member states all had to defend their points and positions. It felt like being in a zoo, in the middle of a cacophony of different sounds.
Dominant multi-stakeholder paradigm
I believe that there are two crucial issues; the first is that the multi-stakeholder, neoliberal “the-world-is-flat” paradigm has become the dominant form of governance within UN and other multilateral bodies. This model can be best envisaged by the framework proposed below by Julio Frenk and Suerie Moon in an article on Governance Challenges in Global Health (March 2013).
WHO is preparing for (and defending) its role and position in a new global coordination mechanism for NCDs as well as in the new UN Interagency Task Force on the Prevention and Control of NCDs. WHO has to follow this multi-stakeholder approach, because otherwise financial donors (both member states and others) would find another multilateral platform to work on the NCDs. The stakes are simply too high. With the rise of NCDs in low-income countries and emerging economies, and with their relation to food and beverage consumption, there are many interests from governments, transnational companies as well as NGOs to be involved in this global market place. WHO can only follow and try to influence this direction from within (via due diligence, management of risk and transparency procedures) or otherwise risks to be bypassed.
Still lacking vision of WHO’s role in global health governance
This leads to the second issue. While there has been much debate about the finance, governance and organization of WHO, there has been little talk about WHO’s vision and strategy to address public health challenges in a globalized, rapid changing world. Growing health and social inequalities, ecological health erosion, food and water insecurity are enormous challenges for public health in the 21st century. Yes, WHO has a new global program of work valid for the coming years, but it hasn’t got a clear strategy how to be engaged and position itself in the global governance around these modern public health challenges. Fair enough, WHO is an intergovernmental organization, and is not allowed this progressive, autonomous, mandate by its member states.
In the late 70’s (comprehensive primary health care and health for all by the year 2000!) and late 90’s (a new global health policy for the 21st century), it was still evident where WHO wanted to go. This is less the case in 2013. What is the public health value I sign up with if I keep engaging myself the coming years with WHO? After this consultation, I sincerely do not know. Will WHO be open to work with organizations on alternative models to protect public health? The biggest risk for WHO is not that it will be underfunded, but that it will lose further legitimacy as the leading global public health authority.
Remco van de Pas, Wemos Foundation
First published in International Health Policies, 25 October 2013