[Ip-health] TWN Info - WHO: Vague and inadequate reform plans criticised, nothing on financing

Sangeeta ssangeeta at myjaring.net
Thu Jul 28 04:19:15 PDT 2011

Title : TWN IP Info - WHO: Vague and inadequate reform plans criticised,
nothing on financing
 Date : 28 July 2011


TWN Info Service on Intellectual Property Issues (Jul11/02)
28 July 2011
Third World Network

Dear All, 

Please find below a news report on the concept papers on reform recently
released by WHO.

WHO held a mission briefing in Geneva on 1 July and thereafter released a
summary of the discussion that took place during the mission briefing. The
report below also contains the summary of the discussion. 

Sangeeta Shashikant
Third World Network

WHO: Vague and inadequate reform plans criticised, nothing on financing
Published in SUNS #7197 dated 25 July 2011

London, 22 Jul (Sangeeta Shashikant) -- Preliminary proposals for reform of
the World Health Organisation (WHO) have been questioned and criticised.

Dissatisfaction with WHO's reform plan was revealed following a mission
briefing held on 1 July 2011 by the WHO Secretariat for Geneva-based
government delegates on the first draft of concept papers on the "World
Health Forum", "Governance of WHO" and "Independent Formative Evaluation of
the World Health Organization".

The concept papers released at the end of June and discussed with
Geneva-based missions were required by decision 129(8) of the Executive
Board (EB) as part of the move to set out a more transparent and inclusive
process for the reform of WHO.

The concept papers do not address the most pressing issue in WHO, that is,
the poor financial health of WHO. Addressing the financing of WHO was
Director-General Dr. Margaret Chan's raison d'etre for embarking on the
reform and the basis on which Member States supported her call for reform.
And yet, mention of the matter is conspicuously missing from the papers.

[At present, Member States' assessed contributions only constitute 18% of
WHO's budget. Voluntary contributions, most of it earmarked for specific
projects, make up the rest.]

The EB decision also requires the creation of a platform for web-based
consultations by the end of July 2011. As per the decision, regional
committees are expected to hold strategic discussions on the reform process
based on concept papers to be updated after Geneva-based consultations. The
outcome of the regional meetings, the consultative process, and the draft
proposals prepared by the Secretariat or proposed by Member States on the
reform are to be considered by a Special Session of the EB that will take
place on 1-3 November 2012.

The reform of WHO has taken centre stage following the last World Health
Assembly in May, which saw Dr. Chan pressing for the endorsement of her
report titled "The Future of Financing for WHO" (A64/4) that contained a
broad, far-reaching reform agenda that would reshape the way in which the
organization operates, is governed, makes decisions and is financed.

During the Assembly, several Member States expressed their discomfort over
some aspects of the Director-General's reform plan, but these concerns were
skilfully side-stepped by Dr. Chan, leading to the rapid adoption of the
Secretariat's resolution on the reform process, which did not measure up to
Member States' expectations (see SUNS #7155 dated 23 May 2011).

However, Member States' discontent with Dr. Chan's approach to reform
continued to brew, forcing the matter onto the agenda of the EB that met on
25 May immediately after the conclusion of the Assembly (see SUNS #7163
dated 6 June 2011).

WHO's official summary of discussions on the mission briefing (not open to
NGOs or the public) on the first draft of the concept papers reveals a
general discontent by Member States with the WHO's approach to reform.

An analysis of the concept papers also reveals many shortcomings. For
example, the paper on the World Health Forum (WHF) fails to justify the need
for an additional forum in times of financial difficulties and to
distinguish between public interest NGOs and commercial entities. As such,
the paper does not address the concern that the WHF will provide strategic
opportunities to the private sector to influence WHO's health agenda and the
issue of conflicts of interest.

The paper on independent evaluation is limited in scope, with inappropriate
time-lines that would hamper it in informing the reform process, as well as
problematic proposals on how the evaluation will be undertaken. The paper on
governance of WHO simply lacks basic details on the reforms proposed.

Many of these observations were also made by Member States during the
mission briefing, some of which have been captured by WHO's official summary
of the mission briefing.

General observations made by participating Member States were also noted by
the official summary. Member States pointed out that, "The areas covered by
the reform programme go beyond the three concept papers" and that, "There is
a need to ensure appropriate linkages between the three papers". Further,
"While the reform process should remain Member States driven, the
Secretariat is encouraged to provide analyses and options to facilitate
discussion among Member States".

The Secretariat has also been tasked with providing "a paper with an
overview of the whole reform package"; "an additional concept paper on
managerial reforms"; and "figures on the project costs for the development
of the reform programme".

[Observations on each of the concept papers were also contained in the
official summary. These observations are noted below following an analysis
of each of the concept papers.]


According to the concept paper, "there is a need to promote greater
coherence and to provide an opportunity for a more inclusive dialogue
between the many different actors involved". It added that "at present ...
there is no single platform that allows interaction between governments,
global health organizations, partnerships, regional organizations,
multilateral and bilateral agencies, philanthropic foundations, CSOs (civil
society organisations), private sector organizations and other relevant

It claims that the Forum will make it possible "to capture a wide range of
views and perspectives on major and future issues in global health" adding
that, "It will not take decisions affecting individual organizations, nor
will it change the decision-making prerogative of WHO's own governing

The paper proposes that the first Forum be held over three days in November
2012 and once established will be convened every two years for a further two
cycles after which it will be reviewed. It also proposes that the Forum will
be open to all Member States and other stakeholders but the participation
should be "small enough to allow structured debate and clear conclusions".

The paper anticipates the costs to amount to $775,000 with participants
largely self-financing their participation. According to the paper, the WHO
Director-General will convene a steering committee of Member States and
organizations to oversee preparations once the proposal is finalized in
January 2012.

This WHO concept paper fails to address the many concerns of Member States
and civil society raised during the World Health Assembly and the subsequent
EB session last May. The suggested Forum seems to be the making of an
"exclusive club" rather than an "inclusive" setting, as it is only open to a
select group of entities. Moreover, to increase engagement with voices less
heard, perhaps the first step should be to improve WHO's engagement with
civil society by simplifying the accreditation process, allowing NGOs the
freedom to make interventions without scrutiny and censorship by the
Secretariat and the holding of public hearings.

The added value of an additional forum such as the Forum is questionable
particularly so at a time when the WHO is in financial difficulties and is
attempting to rationalize its governance structures.

The concept paper is premised on the assumption that all stakeholders are
interested in advancing public health. It fails to distinguish between
public interest CSOs and the commercial sector (including entities with
strong links with the private sector) as well as the varying commercial or
other interests that the stakeholders may have.

According to a civil society letter signed by 11 public interest groups and
networks, the Forum poses "a clear risk of institutionalizing conflicts of
interests in WHO". However, the concept paper fails to acknowledge the
likelihood of conflicts of interests. For instance, it is unclear how WHO
will ensure that influential industries such as the pharmaceutical, food and
beverage industries will not influence policy-making and norm-setting in the
context of WHO, through the Forum.

On a similar note, it also seems naive to assume that the Forum will capture
the views of all stakeholders in an appropriate way since views are likely
to vary, often with significant divergent positions. It is also more likely
to be the case that the voices of a few, such as donors, private sector and
other organizations close to the WHO Secretariat are likely to be captured
in the conclusions of the Forum, while giving the misleading impression that
it represents the view of all stakeholders.

Despite WHO's claim that the WHF will not change the decision-making
prerogative of WHO's governing bodies, it is simply unlikely that
conclusions emerging from the forum (that is, attended by powerful and
influential health players) will not have an impact on the decisions taken
by Member States at the EB. It is apparent that the WHF will provide
strategic opportunities to international health players, in particular, to
the donors and private sector to influence WHO's health agenda.

Several of these concerns were also raised by Member States and have been
captured by the official summary.

The summary notes that several countries questioned the added value of the
Forum, with concerns raised as to whether the Forum "would serve as an
effective forum for hearing the voices of other stakeholders, e. g. whether
civil society organizations and local communities would be engaged in the
process; and how potential conflicts of interests would be addressed if the
private sector participates".

There were also concerns about "the role of [the Forum], the duplication
with existing forums, and whether discussions at [the Forum] would be
infringing on the decision-making authority of [the World Health Assembly]
and EB".

Member States also noted that "Further deliberation [was] required on the
criteria for invitation, the rules of engagement, as well as the number of
participants", "noting the need to get a balance between inclusiveness and
having a manageable number that allows focussed and strategic discussions".

Member States also requested that the Secretariat provide "further details
on the estimated costs which appear to be an underestimate; and whether the
resources will be derived from WHO's existing budget or will require
additional funding". Member States further questioned whether it was
"premature" "to decide whether the [Forum] should be convened every two
years for a further two cycles, and suggested to review after the first


The concept paper on independent evaluation prepared by the WHO is a
proposal to conduct evaluation on its programme on health systems
strengthening (HSS). The paper puts forward three aims for conducting this
evaluation: (i) to develop an approach to independent evaluation of the work
of WHO to improve programme performance; (ii) to enhance work in the area of
health systems strengthening; and (iii) to inform the reform process.

On the link to the reform process, the paper notes: "An independent
formative assessment of a thematic area of work for the Organization will
also contribute to shaping and guiding several elements of WHO reform, for
example, improving results-based planning and accountability, and increasing
WHO's effectiveness at the country level".

The concept paper also proposes that the evaluation be carried out by an
independent consortium comprising a multi-disciplinary team of 8-10
individuals, to be selected following a public "Request for Proposals" for
an Evaluation Consortium and Work Plan.

The concept paper further states that the EB will provide oversight for the
evaluation that includes selecting the consortium, determining and reviewing
the terms of reference and work plan as well as receiving regular reports on
the activities, observations and recommendations of the Consortium. The
Director-General is also expected to propose that the EB establishes a
sub-group of the Board as an Evaluation Oversight Committee to carry out the

As WHO is embarking on the path of reform, the call for an independent
evaluation is timely. While the concept paper accepts that the reform should
be informed by the evaluation, the time-lines suggest that this may not
happen. The paper envisages that preliminary findings of the independent
evaluation will be available only by May 2012, by which time it is
anticipated that specific details of WHO's reform would have been finalized.

Logically, findings of the evaluation should guide the reform of WHO
including by identifying areas that need to be reformed and specifying
actions that need to be undertaken to effect change. This will ensure that
WHO's reform agenda is evidence-based. However, as noted, the time-lines of
reform and evaluation are at odds. In addition, the limited scope of the
evaluation raises questions as to whether WHO's performance can be evaluated
on the basis of evaluation in the sole area of health systems strengthening

[HSS covers only 1 out of 8 programme cluster areas of WHO. Hence, other
critical programme areas such as Family and Community health; HIV/AIDS, TB,
Malaria and neglected diseases; Non-communicable diseases; Innovation,
Information and Evidence and Research; and Health Action in Crisis, that are
of critical importance to developing countries will be left out of the

However, it appears from the concept paper that WHO is determined to embark
on reforming the Organisation without the benefit of a comprehensive
independent evaluation.

The concept paper also proposes a bidding process from which the consortium
will be selected, adding that the consortium will be free of conflicts of
interests. However, the paper fails to shed light on whether WHO will be
targeting consultancy service providers such as McKinsey/Deloite, or
academia or CSOs or all of the above including private sector entities.

It also does not set out the definition of "conflicts of interests" that
will apply. For example, would consultancy service providers that provide
services to the pharmaceutical and other industries be excluded from the
process? Further, the concept paper fails to explain how exactly the process
and the selection will be free of conflicts of interests, and the procedure
that will be followed if the proposals received through the bidding process
are generally not satisfactory.

Following these concerns and shortcomings, it seems inappropriate for an
independent evaluation to be conducted by a group of persons selected
through a bidding process.

Similar concerns have also been raised by participating Member States. The
official summary notes that, "There were questions as to why the focus is
put on Œhealth systems strengthening'"; and "whether other areas (such as
health promotion and prevention) could also be covered".

"There were concerns about the time-line, with proposals to advance the
schedule. It was suggested that, instead of waiting for the EB meeting in
January 2012 to start the evaluation, the EB bureau could act as the interim
oversight team to get the work started earlier", the official summary adds.

According to the official summary, "Questions were raised about the
feasibility of using the JIU mechanism for the evaluation" and "It was noted
that given the technical and programmatic nature of the evaluation (in para
4 of the paper), this is outside the scope of the JIU". [JIU refers to the
UN's Joint Inspection Unit].

The official summary also notes that Member States also requested more
information on the selection of the consortium, and that "It was suggested
that selection of the consortium should also be Member States driven and
conflict of interest must be avoided".

"The Secretariat committed to provide draft Terms of Reference for
consultation and review by bureau of the EB".


This concept paper identifies four broad areas for reform.

The first is the need for "the governing bodies' work to be more focussed
and strategic so that they effectively carry out their Constitutional
functions". This includes "alignment of the governing bodies' resolutions
with corporate priorities, ensuring a more strategic and disciplined
approach to decision-making by the [World] Health Assembly and enabling the
necessary oversight of programme and financial implementation, including the
fiscal soundness of Organizational practices."

The second area of reform is better alignment between the global and
regional governing bodies, to achieve greater coherence and avoid
duplication between the two levels.

The third area of reform proposed is "better sequencing of the different
governing body Meetings" which includes "strengthen the role of the
Programme, Budget and Administration Committee of the Executive Board, and
to review the timing and duration of its meetings in order to increase its
oversight and preparatory functions, in particular with regard to the
consideration of the Proposed programme budget; to ensure that the Board and
its committees address a number of issues - especially managerial matters -
more effectively and take final executive decisions on them without referral
to the Health Assembly; to plan a leaner but more substantive agenda of
agreed technical and policy priorities for the Health Assembly and thus
facilitate more strategic debate; to explore the need for further subsidiary
bodies of the Board, for example, on programme development; and to consider
a more tactical use of the Independent Expert Oversight Advisory Committee,
for example, requesting it to perform thematic reviews".

The fourth area of reform proposed is the "promotion of more active
engagement and participation of all Member States in the governance of the
Organization" which includes "more informed participation by all Member
States so that the governance processes are truly inclusive; and increased
attention to the re-balancing of the way in which Member States exercise
their role as informed and active participants of the governing bodies by,
for example, provision of sufficient briefing on the historical and
technical background of issues under consideration".

The concept paper further suggests the setting up of an open-ended working
group of the EB with the mandate of developing the agenda for change in the
domain of WHO's governance.

At the May EB, Member States requested the Secretariat to prepare concept
papers with the aim of facilitating discussion on WHO reform. However, the
concept paper on the "Governance of WHO" fails to provide much insight on
the problems related to "Governance", the reasons for reform, the possible
solutions and the action that may need to be taken to implement the
solutions. For example, while the concept paper speaks of the need for
better alignment between the global and regional governing bodies, the paper
is silent on the source of, and reason for the lack of coordination and
duplication between global and regional governing bodies as well as options
to ensure better alignment.

Further, the proposal of an open-ended working group of EB suggests that
Member State participation in the working group would be limited. (The EB is
limited to 34 Member States already.)

On this concept paper, the official summary notes that "governance of WHO
refers not only to Œgoverning bodies'", but is a "broader concept". It
further notes that "The proposed four areas to be covered in the paper are
generally supported", however, "The Secretariat is requested to provide
further elaboration, include more analysis and provide some options to
facilitate further discussion".

It also states that, "Further information is requested in particular on the
following areas - Œthe regional and country offices dimensions', Œgovernance
at the three levels of the WHO', and Œthe method of work of the governing

On the open-ended working group of the EB, the official summary states:
"There were questions on whether participation would be restricted to EB
members. It was noted that in accordance with the Rules of Procedures of the
EB, all Member States can participate on an equal footing. The EB can decide
to limit the number of participants, but only in exceptional cases". +

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