by Remco van de Pas, Health policy adviser, Wemos, the Netherlands
This week, the 132nd Executive Board of the World Health Organization (WHO) is taking place. An important board meeting because it provides crucial directions for the leading institute on global health which is currently re-defining its place in global health.
Its agenda provides an overview of relevant global health topics, such as non-communicable diseases, the social determinants of health, UHC, health workforce & migration, pandemic-influenza-preparedness, etc. The amount of documents that member states have to prepare is considerable. It has become very difficult for one single member state to prepare all topics alone and have a relevant input into the discussion. Following the example of the EU, other countries also increasingly coordinate their positions per region – for example for Latin America, the Middle East and Africa. Over the years, non-state organizations, civil society and academia have developed a greater interest in the field of global health diplomacy. The People’s Health movement has developed WHO Watch, a critical civil society analysis and advocacy platform towards fairer and just policies by WHO. WHO Watch has made a comment on the EB documents and is providing daily reports from its proceedings. The Health diplomacy monitor also provides a guide to the EB discussions.
I focus hereby on WHO’s reform process. The Medicus Mundi International network has been involved in these deliberations over the last 3 years. To set the tone, Director-General Margaret Chan provided in her opening speech a good overview of the global health challenges that the world is facing. The response she offered to deal with these challenges was rather disappointing, though. Her opening speech provided references to many medical and technical solutions for public health gains, without making clear how these medical solutions contribute to solving the problems of our time, such as climate change; an increasing world population, growing inequalities and the food crisis. Her speech indicated exactly why WHO’s role in global health is being questioned by many. Richard Horton, the editor of the Lancet, has been similarly critical on Twitter this week, arguing that many decisions of the WHO are motivated by a mere survival reflex. He quite bluntly stated: “If the Board of a FTSE100 company had a Board like WHO’s Executive Board, it would have been convicted of failed governance long ago”.
Without going into details, some very relevant reform issues have been discussed at the board, such as a new financial mechanism to fund the organization; governance mechanisms on engagement with NGOs and the new 12th Global Program of Work, the program strategy for the coming 6 years. Basically, WHO will open its work towards more cooperation with (and funding by) NGOs, philanthropy foundations and the private sector. While fully taking into account potential ‘conflicts of interest’, the WHO will move forward towards a wider engagement with non-state stakeholders. This is the direction most member states, especially the US and the EU countries, favour to keep the organization relevant and funded. The program of work will be more results oriented and focused on 6 defined categories of work. Funding the organization will be facilitated via a ‘financing dialogue’ that is somewhat resembling a replenishment fund, and in which states and non-state funders come together. How remaining funding gaps for less ‘sexy’ issues like environmental health or social determinants of health will be covered remains unclear.
I see two overall trends. The first one is what Devi Shridhar has defined as Multi-bi financing. “Multi-bi financing refers to the practice of donors choosing to route non-core funding—earmarked for specific sectors, themes, countries, or regions—through multilateral agencies such as the World Health Organization (WHO) and the World Bank and to the emergence of new multistakeholder initiatives. The shift to multi-bi financing likely reflects a desire by participating governments, and others, to control international agencies more tightly” .
Secondly, via these new financing mechanisms, there will be an institutionalization of the UN global compact mode within WHO; further cooperation between businesses and the UN to advance work on global health issues. Simon Peres made this principle very clear at the Davos club meeting, also known as the World Economic Forum, this week: “The world is becoming ungovernable, Governments have found themselves unemployed because the economy has become global while governments remain national. Global companies are replacing the role of governments”.
What this all implies for global health remains to be seen, but it is truly disappointing that the WEF gets so much attention, while WHO’s role in global health governance remains undiscussed, even by the member states of its organization.