[Ip-health] TWN Info: WHO Members opt for modest reform and request more work

Sangeeta ssangeeta at myjaring.net
Sun Nov 13 20:41:33 PST 2011

Please find below an article on the outcome of the discussion on WHO reform
that took place during the Special Session of the Executive Board that met
from 1-3 November 2011.

Sangeeta Shashikant
Third World Network

WHO: Members opt for modest reform and request more work
Published in SUNS #7258 dated 11 November 2011

Geneva, 10 Nov (K. M. Gopakumar and Sangeeta Shashikant) -- Governments at
the World Health Organisation (WHO) have agreed on a modest reform package
for the organisation, asked the Secretariat for more information and
analysis to be done, and decided on an independent evaluation.

The Special Session of the WHO Executive Board (EB), which met from 1-3
November at the WHO headquarters in Geneva, declined to fully accept the
reform proposals contained in the Director-General's Report (EBSS/2/2)
titled "WHO Reform for a Healthy Future" (DG's report).

The DG's report presented 18 recommendations covering reform proposals in
three broad areas, i. e., programmes and priority-setting, governance and
managerial reforms.

However, Member States settled for a more modest outcome, and instead sought
more information and analysis from the Secretariat on a number of issues
related to these three areas. They have also decided to proceed with an
independent evaluation to provide input into the reform process through a
two-stage approach, the first of which will consist of a review of existing
information with a focus on financing challenges for the organization,
staffing issues and internal governance of WHO. The approach to stage two of
the evaluation will be developed in consultation with Member States.

Decisions on the three areas can be seen as an attempt by Member States to
regain control of, and set brakes on, the reform process, which has been
pushed at an unprecedented speed by Dr. Margaret Chan, Director-General of
the WHO.

WHO's Reform Agenda was formally initiated at the January 2011 EB session.
While it was endorsed at the 64th World Health Assembly (WHA), the reform
agenda was not implemented due to concerns raised by a vast number of
developed and developing countries at the EB session in May 2011, leading to
a decision to hold a Special Session in November to discuss the reform
agenda (see SUNS #7077 dated 31 January 2011, SUNS #7155 dated 23 May 2011,
and SUNS #7163 dated 6 June 2011).

The Special EB session considered the 18 recommendations in the DG's report
that was prepared on the basis of feedback received on four initial concept
papers on governance of WHO, independent formative evaluation, the World
Health Forum and managerial reforms.

The wide-ranging proposals put to the EB left many delegates and civil
society observers wondering as to the actual motivation for the DG's reform
plan. The reform agenda was initiated to secure a predictable, flexible and
sustainable financing for WHO, and yet after many papers and meetings, there
is little clarity on the issue of finance and no agreement as to how this
will be achieved. At the same time, the reform plan has metamorphosed into a
broad range of issues, many of which involve basic management and procedural

Some observers have suggested privately that the push for reform is closely
linked with Chan's re-election ambitions.

Deliberations at the Special Session of the EB raised a number of pertinent
points on programmes and priority-setting, governance and managerial
reforms, with decisions taken on each of these matters.


The decision on programmes and priority-setting establishes "a Member
State-driven process to take place following the Executive Board at its
130th session in January 2012, with a view to providing recommendations on
methods for programmes and priority setting, for the consideration of the
Sixty-fifth World Health Assembly in May 2012".

To support the process, the Secretariat is also requested to develop a
background document for the 2012 EB session that will include: (a) a
detailed description of current criteria and mechanisms for
priority-setting, and the relationship between country-level, regional and
global priorities, including elements of bottom-up and top-down
prioritization; (b) a description of the current activities carried out at
headquarters, regional and country level, including programmes as well as
financial and human resources allocated to each level and cluster; (c) a
description of the application of criteria and priorities to planning and
the impact of criteria and priorities on resource allocation and results;
(d) proposals for how criteria and priorities could be set and applied in
the future; and (e) a detailed proposal, with a timeline, for the Member
State-driven process established by this decision.

This decision is the outcome of an informal consultation among Member States
undertaken during the Special Session (see SUNS #7253 dated 3 November

It clearly rejects the DG's proposals, which proposed limiting WHO's
programme activities to five areas, i. e., health development (determinants,
risks, diseases and conditions); health security (public health and
humanitarian emergencies); strengthening health systems and institutions;
evidence on health trends and determinants; convening for better health;
identifying limited flagship priorities as well as priorities within five
core areas of work; and the Secretariat developing a detailed proposal for
priority-setting to be submitted to the January 2012 EB meeting through the
Programme, Budget and Administration Committee.

The decision clearly puts the issue of priority-setting in the hands of
Member States. At Germany's insistence, the decision also includes a request
for more information to guide the Member State priority-setting process.

A delegate participating in the EB said privately that the background
information requested will likely bring forth more information on allocation
of resources provided to WHO's programmes.


The decision on Governance, also drawn from the DG's report, contains three
paragraphs. The first paragraph outlines five agreed principles. Four of
these principles generally pertain to WHO's governance, while the fifth
principle contains guiding principles for WHO's engagement with
stakeholders. The four agreed general principles are: (a) Governance needs
to be a fully inclusive process, respecting the principle of
multilateralism; (b) WHO's governing bodies have a key role in
priority-setting, with the Health Assembly to play a policy and strategic
role and the Executive Board playing a strengthened advisory executive and
oversight role; (c) WHO should seek to strengthen and make maximum use of
existing mechanisms and structures; and (d) the General Programme of Work
should guide the work of the governing bodies.

The agreed guiding principles for WHO's engagement with other stakeholders
are: (i) the intergovernmental nature of WHO's decision-making remains
paramount; (ii) the development of norms, standards, policies and
strategies, which lies at the heart of WHO's work, must continue to be based
on the systematic use of evidence and protected from influence by any form
of vested interest; (iii) any new initiative must have clear benefits and
add value in terms of enriching policy or increasing national capacity from
a public health perspective; and (iv) building on existing mechanisms should
take precedence over creating new forums, meetings or structures, with a
clear analysis provided of how any additional costs can lead to better

The second paragraph of the decision lists nine agreements on governance
reform without spelling out details. Paragraphs (a) to (f) pertain to the
function and role of the governing structures of WHO while paragraphs (g) to
(i) pertain to WHO's role in coordination of international health and
engagement with non-state actors.

The third paragraph of the decision requests the DG to submit the following
to the January 2012 EB session: (a) A proposal for revised terms of
reference for the Programme, Budget and Administration Committee in order to
strengthen its role as referred to above; (b) Further analysis on ways to
increase linkages and alignment between Regional Committees, the Executive
Board and the (World) Health Assembly as well as on proposals to harmonize
the practices of Regional Committees; (c) Proposals for a revision of the
annual timeline of the meetings of governing bodies in order to optimize
their synergies and effectiveness; (d) Further analysis of proposals to
promote engagement with other stakeholders; (e) Further analysis on
modalities to improve Member State involvement with and oversight of
partnerships including the possible expansion of the mandate of the Standing
Committee on Non-governmental Organizations in this regard; and (f)
Proposals on how to streamline national reporting in accordance with
Articles 61 to 65 of the WHO Constitution while using modern tools.

The decision adopted by the EB does contain most of the proposals put
forward in the DG's report such as the EB filtering draft resolutions
against criteria to limit the number of resolutions to be presented to the
World Health Assembly; to rationalize intergovernmental working groups by
entrusting certain negotiations to the Board; to prepare "omnibus"
resolutions; to limit reporting on implementation of resolutions to a
maximum of six instances; to hold an additional EB session etc.

Many Member States spoke against these specific proposals.

Syria, on behalf of members of the Eastern Mediterranean Regional Office
(EMRO), stressed that an additional EB session would incur additional costs,
and suggested extending the existing sessions instead.

Ecuador, speaking on behalf of UNASUR (Union of South American Nations),
noted that intergovernmental working groups should not be abolished, because
they are the "most representative" of Member States, and are "very
strategic" and thus should be retained.

The issue of WHO's engagement in partnerships at the WHO was a particularly
divisive issue. A draft decision included a paragraph (derived from the DG's
report) on expanding the mandate of the Standing Committee on
Non-governmental Organisations to provide guidance on WHO's work with

Several EB Members that preferred not to mix partnership issues with matters
concerning NGOs vehemently objected to this proposal.

Papua New Guinea expressed its concern that the proposal would be
"counterproductive", while India considered it "premature", preferring to
deal with them individually. Brazil, a non-EB Member, also added its voice
to the opposition, saying that the two issues should not be mixed. The
United States, on the other hand, was keen to expand the NGO Standing
Committee to include partnerships.

The final outcome requests further analysis on this matter.

Language on WHO's engagement with stakeholders also did not make it into the
final decision. An initial draft text proposed: "Engagement with other
stakeholders shall be conducted in line with the proposals contained in
paragraphs 89 and 90 of the report of the Director General, as appropriate,
while taking into account the importance of full engagement of Member States
and of managing conflict of interest".

[Paragraph 89 of the DG's report proposes "multi-stakeholder forums", while
paragraph 90 proposes "separate consultations with different groups of
stakeholders to provide input on specific issues".]

Many countries preferred the proposal in paragraph 90, to the establishment
of multi-stakeholder forums, as the latter would involve private sector and
entities that are driven more by commercial rather than public health
interests. However, some other countries such as the US insisted on the
multi-stakeholder forum as a mode for engagement.

Divergence of views resulted in only an agreement recognizing the need to
strengthen engagement with stakeholders, taking into account conflicts of
interests and that in the longer term options for a framework to guide
interaction between all stakeholders active in health should be explored.
The DG was also requested to conduct further analysis of proposals to
promote engagement with other stakeholders.

None of the proposals of engagement suggested in the DG's report were
explicitly endorsed by the EB. In fact, Chan revealed lack of support for
the idea of convening a regular multi-stakeholder event also known as the
"World Health Forum", that she had presented at the 2011 WHA. There has been
significant concern that such a forum will increase the influence of the
private sector and donors in setting the health agenda in the WHO.

Chan informed Member States at the Special EB session that this idea had
been abandoned.


The decision on managerial reforms contains six paragraphs.

The first paragraph welcomes the DG's proposals in five areas while
recognizing the need for complementary work, especially on the strategic
allocation of resources: (a) organizational effectiveness, alignment and
efficiency: strengthen country offices, promote alignment, synergy and
collaboration, improve knowledge management; (b) financing of the
Organization: improve financing of administration and management costs,
strengthen financial controls, improve Organization-wide resource
mobilization; (c) human resources policies and management: revise the
workforce model and contract types, streamline recruitment and selection
processes, improve performance management processes, implement a mobility
and rotation framework, enhance staff development and learning; (d)
Results-based planning, management and accountability: implement a new
results chain, sequence planning to reflect country needs, prepare a
realistic budget, create a new resource allocation mechanism, improve
monitoring and reporting, strengthen the internal control framework,
increase the capacity of audit and oversight, strengthen the
conflict-of-interest policy, establish an information disclosure policy; (e)
Strategic communications: build communications capacity, develop
communications platforms, improve public and stakeholder understanding of
the work of WHO.

The second paragraph urges "caution and recognized that further analysis and
consultation would be needed before action could be considered in several
areas of reform, notably the proposals relating to strategic relocation of
staff, resources, programmes and operations; and introduction of an annual
Œbudget re-costing mechanism' to protect against currency".

The third paragraph requests the DG to develop for the consideration of the
2012 January EB session: (a) a detailed proposal for mechanisms to increase
predictability of financing and flexibility of income, which supports
priorities set by Member States; (b) a detailed proposal to establish a
contingency fund for public health emergencies; (c) a draft formal
evaluation policy, including a mechanism for oversight of evaluation by the
governing bodies informed by insights provided by the Independent Expert
Oversight Advisory Committee (IEOAC).

The same paragraph requests the DG to develop a proposal for a timeline for
development of the programme budget and general programme of work, taking
into consideration good experience of the medium-term strategic plan each
for the period 2014 onwards, with an analysis of the advantages and
disadvantages of changing the periodicity of the programme budget to three
years and report to the
65th World Health Assembly in May 2012.

It also asks for clarification on the proposals with respect to enhancing
the networks and relationships between regional offices, and between groups
of country offices within and across regions; and on enhancing capacity for
effective resource mobilization, particularly at the country-level. It
further requests the DG to develop a proposal for a new resource allocation
mechanism, through the 16th meeting of the Programme, Budget and
Administration Committee in May 2012.

In the fourth paragraph, the decision decides to proceed with a two-stage
independent evaluation to provide input into the reform. The first stage
will consist of a review of existing information with a focus on financing
challenges for the organization, staffing issues, and internal governance of
WHO by Member States, following up where possible on questions forwarded
from this EB for more information. This stage is expected to be completed
for consideration of the 65th World Health Assembly.

According to the decision, the first stage review will provide a roadmap for
stage two of the evaluation, which is expected to be considered by the
Assembly in 2013, as an input into the revised General Programme of Work.

The decision adds that stage two of the evaluation will be built on the
results of stage one and further consultations with Member States, focusing
in particular on the coherence between and functioning of the organization's
three levels. However, this evaluation would proceed in parallel with other
aspects of the reform as an input.

The decision also requests the DG to identify the appropriate entity for the
first stage of the evaluation and to further develop in consultation with
the UN Joint Inspection Unit, the External Auditor, and the IEOAC an
approach to stage two of the evaluation in consultation with Member States.
The DG is to present the outcome of the consultation to the EB's January
2012 session.

The decision on independent evaluation is a significant shift from an
earlier Secretariat proposal which proposed limiting the scope of the
evaluation to only WHO's health system strengthening programme. However,
many Member States particularly Germany have been pressing for the scope to
be expanded to enable the evaluation to inform the reform process.

Differences also emerged over the appropriate entity to carry out the
independent evaluation. A draft text proposed that an "External Auditor"
conduct the stage one evaluation. The US supported the idea of selecting an
external auditor while many others such as Brazil, Ecuador and Germany were
opposed to this. Some Member States instead proposed the UN Joint Inspection
Unit (JIU).

Since no consensus was achieved, the decision requests the DG to identify
the appropriate entity for the first stage evaluation and to present it to
the EB session in January.

During discussion on managerial reforms, it also emerged that the
Secretariat had taken certain steps to trim down its human resources. The
statement of the Staff Association revealed that the restructuring of human
resources had already resulted in a loss of jobs for nearly 150 staff.

The lack of information over measures taken with regard to human resources
prompted Brazil to request that the DG stop taking further measures until
further instructions were received from the governing bodies. Canada
demanded a report on this matter from the Secretariat in the upcoming EB.

The decision also requests the UN JIU to update their reports on: (a)
Decentralization of Organizations within the United Nations System - Part
III: the World Health Organization (JIU/REP/93/2), and (b) Review of
Management and Administration in the World Health Organization (WHO)
(JIU/REP/2001/5). +

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