By Evelyn Depoortere (ITM)
There are so many different interests and stakes related to the formal agenda at a World Health Assembly (WHA) that it seems virtually impossible to understand what is going on at all the various levels: the technical, tactical, and political, just to name a few. Here are the impressions of a newbie, who was only one of several hundreds of people passing through the “Palais des Nations” this week.
A hot potato at the 65th WHA was the report of the consultative expert working group on research and development (CEWG), which mainly proposes to delink R&D costs from prices of the final market products, and therefore requiring a significant increase in public spending on R&D from all countries. By Wednesday morning four different proposals for resolutions were on the table, ranging from a virtually unconditional implementation of the CEWG’s recommendations, to putting off any commitment until a (in practice undefined?) future. While initially the agenda item was swiftly dealt with by proposing a working group to draft a common resolution proposal (hereby precluding any country statements), this plan failed when Argentina called for a “point of order”, and the Bahamas were dramatically interrupted in the middle of their statement on maternal and childhood nutrition. An immediate change of the agenda followed, suspending the item on nutrition and starting the country statements on the CEWG report. Unfortunately, the chair did not allow going overtime (into the lunch break), so only one of the civil society organisations got a chance to speak. (The CSOs issued a joint statement on Monday calling on world leaders to stand for UHC.) On Thursday evening, when leaving the WHA, a drafting group was still working, so I imagine the item will be back on the agenda today.
The Wednesday evening session on IHP+ unfortunately did not attract such a big audience (difficult to compete with a GAVI session taking place at the same time), but the absentees were wrong. The session provided a good variety of speakers, with both high and low income country signatories being quite enthusiastic about their experience with IHP+. Especially the representative from Ethiopia, one of the first signatories, gave a rather compelling presentation; they have implemented a “one plan, one budget, one report” approach which seems particularly convincing. However, it was a bit disconcerting to hear that in spite of all the nice declarations on ownership, alignment, etc., donor countries increasingly tend to go back to the project approach,. Also, this perceived need for donor countries to convey simple messages to the tax payers, i.e. in terms of the number of lives were saved still persists, even though some stressed the importance of contribution over attribution.
Finally, it would be impossible to say anything about this WHA without mentioning the WHO reforms, the main agenda item on Thursday. Unfortunately I had to leave before the end of it, but one major point of discussion was the place of social determinants of health (SDH) on the strategic overview of the 12th general programme of work 2014-2019. While the criteria and categories for priority setting and programmes were based on a consensus reached during a working group meeting in February,Brazil brought the issue back on the table, very strongly advocating for an additional category on the SDH. There is no doubt that everybody in the room agreed on the importance of SDH in this strategic overview; the main difference between the opinions was whether SDH are to be considered an overall WHO core value and therefore should be present in all activities, or whether they should appear as an additional category, and as such giving them higher visibility and (assumingly) moving them from rhetoric to practice. A relevant discussion, but the reiteration of the same arguments for about two hours in a virtually plenary session clearly exposed the fact that there is a lot of room for improvement in the functioning of the WHA .