[Ip-health] TWN Info: WHO Reform debate to continue, February fixed for member-driven priority setting

Sangeeta ssangeeta at myjaring.net
Fri Jan 27 07:48:24 PST 2012

Title : TWN Info: WHO Reform debate to continue, February fixed for
member-driven priority setting
Date : 27 January 2012


TWN Info Service on Intellectual Property Issues (Jan12/05)
27 January 2012
Third World Network
www.twnside.org.sg <http://www.twnside.org.sg>

WHO Reform debate to continue, February fixed for member-driven priority

Geneva, 23 January (K. M. Gopakumar & Sangeeta Shashikant**): The reform
debate formally set in motion in January 2011 will continue during the World
Health Assembly and the Executive Board meeting following the Assembly
according to the outcomes of the 130th session of the EB that took place on
16-23 January 2012.[1] <#_ftn1>

Key reform issues remained unresolved and outstanding, as Member States (MS)
demanded more information and time for discussion. To satisfy these demands,
the EB outcomes sets out a detailed timeline for the Secretariat to provide
more information, for member states¹ feedback on Secretariat¹s proposals and
for further debate.

In the meantime the EB has fixed 27-28 February 2012 for the first
intergovernmental working group meeting on programmes and priority setting.
This meeting will chaired by the current Chairman of the EB Mr. Rahhal El
Makkaoui, from Morocco.

[A member state driven process on programmes and priority setting was agreed
to at the Special session of the EB (EBSS) held in November 2011 after the
Secretariat¹s proposals to limit WHO's programme activities to five core
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 as well as identifying limited
flagship priorities and priorities within five core areas of work was
rejected by MS.[2] <#_ftn2> ]

Deliberations at the EB on the 9 documents on WHO reform prepared by the
Secretariat were structured under three broad themes i.e. programmes and
priority setting, governance and managerial reforms.[3] <#_ftn3>

These deliberations led to a Decision on Programmes and Priority Setting and
a Chairman¹s Summary  (Chair¹s Summary). The Decision sets out the scope of
work and time lines for the intergovernmental process on programmes and
priority setting that will take place in February. The Chair¹s Summary
touches more on issues of governance, managerial reforms and preparations
for reform discussion during the WHO governing bodies¹ meetings in May.
[Chair¹s Summary while commonly used in other international organization is
not usually seen in the WHO decision-making context. According to sources,
this method was opted for to avoid MS negotiation. Dr. Margaret Chan, the
Director General of WHO and the EB Chairman, both requested that no
negotiations take place on the Summary. Certain member states were
uncomfortable with this approach. China sought clarification from the Legal
Advisor as to whether the Chair¹s Summary should be in the form of a
decision or a resolution. Legal Advisor clarified that there was no need for
a formal decision unless Member States requested].

Programme and Priority Setting

The decision on programme and priority setting sets the scope of work and
terms of reference for the member state driven process.

According to the EB decision, the scope of work of the member state driven
process is to make recommendations to the up-coming WHA on ³the categories,
methodology, criteria and timeline for programmes and priority setting in
order to serve as a guidance for the development of the next and future
general programmes of work, recognizing the important linkages to other
elements of the WHO reform process².

The EB decision then outlines the four specific objectives of the process,
which are: 
(a)  ³to review and consider proposals  on priority setting contained in the
background  paper EB1 30/ 5 Add.1 taking as a basis  for priority setting:
country needs, the relevance of WHO for all countries, its specific
comparative advantage and its leading role in global health";

(b) "to elaborate methodology, criteria and the timeline for the
priority-setting process";

(c)  "to consider possible ways of grouping WHO¹s work into categories,
including but not limited to the  seven categories contained in Documents EB
130/5 Add.1 as proposed for the framework for the next general programme of

(d) "to identify additional analytical work by the Secretariat emerging from
these discussions, which will continue to the development of the next  and
future general programmes of work²;

The EB decision notes that the member state meeting on programmes and
priority setting to be held in Geneva in February can be followed up with
any number of meetings or discussions, as necessary, to be agreed at the
February meeting in order to finalise the work before WHA in May.

The EB decision also requests the Secretariat to hold a presentation on the
afternoon of 26th February on current priority-setting practices, the
strength and weakness of those practices and the relationship between the
country cooperation strategies, the general programme of work formulation
process and the programme and budgeting process.
NGOs in official relations with WHO will be allowed to observe the
presentation but will not be allowed to participate in the member state
process. However the EB decision notes that a web based consultation will be
organized for such NGOs to present their views according to the agreed scope
of work. 
The EB decision also states that presentations to be made on the 26th
February will be circulated three days in advance of the meeting, while the
other documents will be made available at least 7 days prior to the February
meeting. These documents are: (a) a three page summary paper of the 26th
February presentations; (b) mapping of the functions of the organization
(Article 2, WHO Constitution) in relation to the categories proposed in
document EB 130/5 Add.1 including cross cutting global needs and areas of
work; (c) an analyses of country cooperation strategies that identifies the
needs of countries in a way that allows a determination of what WHO should
focus its work on and where WHO is best placed to add value; (d) a roadmap
and timeline for the preparation of the next general programme of work and
the programme budget 2014 -2015.
The EB decision also calls for the following documents to be made available
for the meeting: the Eleventh General Programme of Work, 2006-2015;
Medium-term Strategic Plan 2008-13 (amended); Documents EB130/5 Add.1 and
Add.2; Documents EBSS2(1); Documents EB 118/7 on[SS1] <#_msocom_1>
Strategic Resource Allocation and World Health Statistics 2011.
[WHO document EB130/5 Add.1 was prepared on the request of the EBSS for a
background document. However in this document, the Secretariat divides WHO¹s
functions in Article 2 of WHO constitution into seven categories.
These categories are: (1) Supporting the achievement of the health-related
Millennium Development Goals (primarily Goals 4, 5 and 6) will bring
together HIV/AIDS, tuberculosis, malaria, and maternal and child health,
with a focus on integrated service delivery; (2) Promoting risk reduction,
prevention, treatment and monitoring of non-communicable diseases, mental
health, disability and injuries; (3) Strengthening the structure,
organization and financing of health systems with a particular focus on
achieving universal coverage, strengthening human resources for health and
increasing access to medical technologies including medicines; (4)
Surveillance of, and response to, disease outbreaks and acute public health
emergencies, and the effective management of humanitarian disasters; (5)
Work on health information, information systems, evidence for health
policy-making, innovation, and research and monitoring of trends, to include
analysis and strategies to address the social, economic and environmental
determinants of health; (6) Convening governments and other stakeholders and
facilitating partnerships in line with WHO¹s role as the coordinating and
directing authority on international health work, with a particular focus at
country level on the development of national policies and strategies; (7)
Establishing effective corporate services that enable the efficient
functioning of the whole Organization.

The Secretariat also classifies countries into 5 groups i.e. countdown
countries; small island developing states; countries in fragile
circumstances; newly industrialised and middle-income countries; and OECD
countries. [Countdown countries refers to 68 States that bear the highest
burden of child and maternal mortality and whose progress in MDG achievement
is monitored by a UN group through the countdown process.]

The Secretariat¹s categorization of WHO¹s functions and classification of
countries did not receive approval during the EB deliberations.
In fact during the deliberations, Member states said that information in
EB130/5 Add 1 was insufficient and thus decisions cannot be taken. Member
States also pointed to the lack of information on the criteria used to
categorise WHO¹s activities.
Senegal on behalf of the members of the African Regional office called for
an in-depth study on resource allocation and staff at the three levels of
the WHO. It also sought clarification on Secretariat¹s classification of
countries in EB130/5 Add. 1. Senegal also stressed the role of WHA in the
programme and priority setting.
Ecuador on behalf of UNASUR said that time was required to reflect on the
details provided in EB130/5 Add.1, adding that at least two WHO documents
were provided just two days before the EB meeting. However it also noted the
lack of information particularly on the Secretariat¹s categorisation of
functions and classification of countries. It also stressed on a member
driven process on programmes and priority setting.
China said that that it did not support the classification of countries
mentioned in EB 130/5 Add.1 stressing that this approach did not make sense
and it was against the UN language.
India noted that the Secretariat¹s country classification was on the basis
of development indicators rather than disease burden. India also sought more
information on further break down of the financial and human resource
allocation of assessed and voluntary contributions.
[Dr. Chan clarified that the categorization and classification was an
attempt to systematize the available information as well as the current
activities of the Organization].
Estonia on behalf EU said that even though time was limited it was important
to reach a clear decision on priority setting. It stressed on the need to
carefully look at the categorisation of countries and asked the Secretariat
to investigate experiences of UNDP, World Bank etc. Lastly it also observed
that the Secretariat¹s suggestion to spend 50% of the resources at the
country level is premature at this stage.
Most member states noted that priority setting should be based on individual
country needs. However the US disagreed, preferring instead a top-down
approach i.e. of global objectives guiding regional and local objectives.
On the topic of ³Governance², the Chair¹s summary states that MS are invited
to submit comments on two of the Secretariat¹s proposals i.e. (i) the draft
revised terms of reference for the Programme Budget and Administration
Committee (PBAC) and (ii) proposals for increasing linkages between Regional
Committees and the global governing bodies and harmonisation of the Regional
Committees. [These proposals are contained in EB 130/5 Add.3]
The Chair¹s summary further states that MS can submit their comments through
the password protected website open to all MS before 29th February and that
MS which do not have access to that website are invited to contact the
Secretariat for details on how to register for the site. Based on the
feedback the Secretariat will prepare revised proposals for submission to
the 131st session of EB, through the PBAC, the Summary adds.
The Chair¹s Summary further notes that the Secretariat will revise the
proposed options for the schedule of the governing bodies, incorporating the
proposal for a revised schedule of meetings of the Regional Committees,
Executive Board, PBAC and WHA. This document will also include a detailed
analysis of the advantages and disadvantages, feasibility and cost of
different options, the Summary adds. Further the Secretariat will also take
forward the work on streamlining national reporting as well as further
develop proposals for management of resolutions, the Summary notes.  [The
Secretariat¹s proposals on the aspects mentioned are in EB 130/5 Add.3]
In relation to governance, the EB also considered Secretariat¹s proposals on
engagement with NGOs and private-for-profit sector as well as not-for-profit
philanthropic organisations contained in EB 130/5 Add.4.[4] <#_ftn4>
On this the Chair¹s Summary notes that ³Further consultations with Member
States will be required on ³WHO¹s engagement with other stakeholders,
including  nongovernmental organisations and industry, and  the proposals to
review and update principles governing  WHO  relations with nongovernmental
organisations and to develop comprehensive policy frameworks to guide
interaction with the private-for- profit sector , as well as not-for-profit
philanthropic organisations².
Regarding partnerships the Chair Summary states ³We have agreed on the
importance of partnerships and on the need for better management and greater
oversight by the governing bodies, in particular the Executive Board.
Members of the board have proposed a review of WHO hosting arrangements,
along with further efforts to harmonize work with hosted partnerships².
[In EB 130/5 Add. 4 the Secretariat proposed handing over oversight of WHO¹s
partnerships to the EB after concluding that the Standing Committee on
Nongovernmental Organizations was unsuitable for this purpose.]
Of all the governance related issues, the topic of WHO¹s engagement with
other stakeholders was the most controversial as the discussion focused on
the criteria for the inclusion of non-state entities and on the need to
differentiate between PINGOs (Public Interest NGOs) and BINGOs (Business
Interest NGOs).

India proposed a greater participation of civil society. Barbados, Chile and
some others highlighted the need for setting out clear guidelines to protect
against potential conflicts of interest. France asked for procedures to
ensure the independence of public health experts, adding that while dialogue
with other actors should happen, decision making process should remain with
Member States. Norway called for an evaluation of WHO engagement in
partnerships and their added value.

Switzerland and US said it was not necessary to go too far in
differentiating between types of NGOs since divisions are arbitrary and all
stakeholders come to the WHO with their specific agendas. Switzerland
welcomed the proposal of increasing stakeholders involvement, both of NGOs
and the private sector.

Dr. Chan, in her response to the issue of conflicts of interest played down
the issue, stating that ³Everybody has an interest², and calling for all
actors to be transparent and accountable.

Managerial Reforms
According to Chair¹s Summary the Secretariat will further elaborate the
proposals for the predictable financing mechanism, and the contingency fund,
based on the feedback received and present it to the next EB in May 2012 for
[WHO¹s document EB 130/5 Add 5 contained a road map for increasing
predictability of WHO finance from the current level of 50% to 70%.  The
main strategy proposed was the holding of a pledging conference in 2013 to
secure pledges for the programme budget that will begin in 2014.]
On the issue of financing, the majority of MS sought clarification as to
whether assessed contributions are allocated to cover WHO¹s core functions
or to fill up the gaps remaining after the allocation of voluntary
contributions. The US stressed that assessed contributions should not
subsidize costs associated with voluntary contributions.
Concerns were also expressed over the pledging conference particularly over
how it would increase financial predictability. Secretariat was asked to
explore other possible solutions. On contingency fund for outbreaks
delegates sought clarification on how the fund would be managed in
harmonization with regional funds for emergencies.
In response, Dr. Chan clarified that assessed contributions were used to
support core-functions and governing bodies meetings and that Secretariat
³will not accept any money that do not go with priorities². She also
expressed hopes that the mechanism will increase transparency and prevent
civil society organisations from saying that WHO ³is in bed with industry².
The Chair¹s Summary further invites MS to submit comments on the draft
evaluation policy through the password protected web site open to all Member
States before 29th  February[SS2] <#_msocom_2>  . Based on these comments
the Secretariat will prepare a revised draft of the evaluation policy for
the consideration of the EB in May through the PBAC.
[In document EB 130/5 Add.8 WHO proposes a ³WHO evaluation policy². This
policy sets the basic rules for both internal and external evaluation of the
different WHO levels].
On the matter of stage one of the independent evaluation of WHO, the Chair¹s
Summary states that  ³..the Executive board has welcomed the offer of the
External Auditor to carry out this step , and  expects  that the report of
stage one will be presented to the Sixty fifth World Health Assembly, and
will include the proposed road map for stage two of the independent
[A two stages process of independent evaluation of WHO to guide the reform
was agreed to at the EBSS. The EB decision provides more clarity on the
evaluation process]
Further it also states that the Secretariat will update the Terms of
Reference for stage one of the independent evaluation based on the written
comments submitted by the Joint Inspection Unit of the United Nations (UN)
The Chair¹s Summary also notes that the EB welcomed the agreement of the
Joint Inspection Unit to update their reports of 1997 on decentralisation
within WHO and of 2003 on management and administration of WHO.
Preparations for upcoming meetings of the Governing Bodies
Chair¹s Summary states that the Secretariat will prepare a consolidated
report covering all aspects of WHO reform for submission to the upcoming WHA
in May 2012 adding that the WHA will have an opportunity to review and
discuss all proposals on reform. The Secretariat¹s report will cover
programmes and priorities, governance and managerial reforms incorporating
the outcome of the Member State driven process on priority setting, showing
linkages and indicating areas where consensus has been reached and those
areas where further discussion is required.  The report will also include
the elements of reform agreed in the Special EB session in November 2011 and
the further elaboration of the proposals where the EB has requested
additional work. The report will also include a draft implementation plan,
with a budget and monitoring framework for consideration by the WHA.
Further, the Chair¹s Summary proposed the extending the one-day PBAC meeting
in May to three days and 131st session of the EB from one day to two days to
ensure sufficient time for considering the Reform proposals.
**This report has been prepared with some input drawn from the reports
produced by the WHO Watchers linked to the Peoples¹ Health Movement. Their
reports are available at http://www.ghwatch.org/node/448

[1] <#_ftnref1>  See
.info.110101.htm for more information on the beginnings of WHO reform

[2] <#_ftnref2>  See
.info.111104.htm for a report on the EBSS took place in November 2011.

[3] <#_ftnref3>  See http://apps.who.int/gb/e/e_eb130.html for the WHO

[4] <#_ftnref4>  See Overhaul needed on rules on NGOs' relationship at


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