[Ip-health] WHO: Informal meeting to negotiate text on engagement with non-State actors

[Mirza Alas]

*TWN Info Service on Health Issues (Oct15/10)19 October 2015Third World
Network*

*WHO:  Informal meeting to negotiate text on engagement with non-State
actors*

Geneva, 19 October (K M Gopakumar) – An informal meeting of World Health
Organization Member States to negotiate the Framework of Engagement with
Non-state Actors  (FENSA) text begins on Monday 19 October

The 3-day meeting will be held at the WHO Headquarters in Geneva.

The 68th World Health Assembly (WHA) requested the Director General (DG) of
WHO to submit the finalised draft text to the 69th WHA (in 2016) through
the 138th session of WHO’s Executive Board. The resolution also requested
the DG “to develop the register of non-State actors in time for the
Sixty–ninth World Health Assembly, taking into account progress made on the
draft framework of engagement with non-State actors”.

Towards this end the DG was “to convene as soon as possible, and no later
than October 15, an open-ended inter-governmental meeting (OEIGM) to
finalize the draft framework”. The OEIGM held on 8-10 July could not finish
the negotiations and was therefore suspended, to resume on 7-9 December.

The informal meeting is part of a process to seek consensus on the FENSA
text among Member States prior to the formal resumed OEIGM in December.

This meeting is expected to discuss the specific-issue meetings organised
by the Chair of OEIGM in September.  The Chair had organised four one-day
consultations focussing on the following specific issues:

   - Advocacy and technical collaboration (1 September)
   - Resources (persons and financial contributions) and protection of
   WHO’s normative work  (9 September)
   - Level of transparency, oversight and role of the independent Expert
   Oversight Advisory Committee and the Role of the Engagement Coordination
   Group and the feasibility of implementation (18 September)
   - Caution with particular industries, official relations versus
   accreditation and non-compliance (22 September)

Third World Network (TWN) learned that only 20 to 25 Member States
participated in the above-mentioned consultations in September.

The FENSA process was originally initiated as a part of WHO’s reform
process under the governance reform pillar. However, a majority of Member
States while welcoming the engagement with non-State actors (NSAs)
expressed the need for a robust regulatory framework to avoid the risks of
such engagement, especially the conflict of interests and the undue
influence exercised by NSAs on WHO’s work.

FENSA contains an overarching framework of engagement with NSAs and
specific policies to regulate each NSA viz. NGOs, private sector,
philanthropic foundations and academic institutions.

The overarching framework contains the following parts:  rationale,
principles, benefits and risks of  engagement,  definition of NSAs, types
of interaction, management of  conflict of interest and other risks of
engagement,  specific provisions on WHO’s engagement with certain types of
industries, association with WHO’s  name and emblem and secondment,
relation of the framework to WHO’s other policies, official relations,
accreditation of NGOs, oversight of engagement, provisions related
noncompliance  and monitoring framework.

The specific policies spell out the details of the application of the
overarching framework that are specific to each NSA.

There is consensus on a substantial part of the FENSA document. However,
there is no consensus on many critical issues. This difference primarily
emanates from the difference in approaches. The majority of WHO Member
States, especially developing countries, wanted to have robust safeguards
against the undue influence, conflict of interests and other risks from the
engagement of NSAs in general and the private sector in particular.
However, developed country Member States want less rules for regulating
engagements with NSA especially with the private sector. This is clear from
the submission of the United Kingdom. It states: “we believe it is vital
that the policy be a platform for a proactive engagement with all actors
that have a legitimate and positive role to play in advancing public health
for all. So it should enable more engagement, not less, but with a clearer
and more robust framework around that engagement. We feel it is important
that the document fully captures that enabl ing spirit”.

Thus many developed countries especially the United States and the UK are
using the FNESA negotiation to increase the engagement with the private
sector and philanthropic foundations, thus resisting any robust safeguards.
Often the US and the UK and other developed countries are proposing the
removal of very limited safeguards against the risk of engagements with NSA
especially with the private sector. For instance, during the negotiation it
was learnt that the UK and the US proposed secondment from the private
sector to WHO i.e. employee of a private sector entity is placed in the WHO
for carrying out the work of the organization.

The WHO Secretariat’s approach to FENSA is of late is very much aligned
with the developed countries. A developing country delegate told TWN that
during the OEIGM in July on the issue of secondment the Secretariat
insisted that the use of personnel including from the private sector is
critical for emergency response. However, during the presentation it turned
out that no personnel from the private sector was used for the recent
emergency response on Ebola.

Another developing country delegate revealed to TWN that often the approach
of the Secretariat is that a robust framework would deter NSAs from
engaging with the WHO, instead of supporting a robust framework especially
provisions like transparency takes a stand that more transparency rules
would expose WHO to legal challenges.

Some of the main areas of differences are explained below:

*Definition of resources and secondment*

FENSA identified resources, especially accepting resources from NSAs, as a
form engagement.  The original definition of “resources” proposed by the
Secretariat includes personnel and many Member States opposed to the
definition because it would then result in accepting secondment from NSAs
to WHO.

TWN learned that the Chair has proposed a new definition of resources based
on the Chair’s consultation in September. According to this new definition
NSAs are allowed to contribute goods and services but the FENSA would not
be applicable if an individual from a NSA provides services to WHO without
a contract between the NSA and WHO. The Chair’s earlier proposal on
secondment is still there and it reads: “WHO does not accept secondments
from Non-State actors.” An observer pointed out that the new definition
does not resolve the problem; rather it legitimises the issue of secondment.

*Conflict of Interest*

Even though the language on conflict of interest is marked in green as an
indication of consensus but the entire paragraph is still in brackets. The
main issue with the conflict of interest provision in the FENSA text is the
lack of clarity with regard to its implementation. This lack of clarity
primarily emanates for the absence of a comprehensive conflict of interest
policy in WHO especially to manage the institutional conflict of interest.
According to a developing country delegate the Secretariat has made no
commitment with regard to the development of comprehensive conflict of
interest policy.

*Engagement with Certain industries*

Another unresolved issue is the WHO’s engagement with certain industries
which has implications for the protection of public health. FENSA proposes
non-engagement with the tobacco and arms industries.  However, there is no
clarity or consensus over whether WHO needs to distance itself from the
affiliates of these industries.

Similarly many developing countries also demand that apart from the tobacco
and arms industries WHO should either distance itself or restrict its
engagement with food and beverages industries or agribusiness corporations.

Developed countries do not agree with this proposition. It is learnt that
the Chair’s text proposes a particular caution while engaging with certain
industries which are negatively affecting human health or affected by WHO’s
policies, norms ad standards. According to an observer the Chair’s text
does not spell out the details of “particular care”. As a result the
Secretariat has the discretion to determine what constitutes the
‘particular care’.

*Transparency*

There is a difference of opinion among Member States with regard to
accessing the due diligence, risk assessment and risk management reports
from the Secretariat.  Both the Secretariat and developed countries oppose
provision of the full due diligence and risk assessment reports to Member
States. It is learnt that the Chair is proposing a consensus text that
emerged out of the consultation, which provides a summary of due diligence
and risk assessment and risk management undertaken by the Secretariat.
However, there is no consensus with regard to making the full report
available to the Member States even at the request of Member States in this
regard.  According to an observer the lack of information would make it
difficult to monitor the implementation of FENSA.

*Private Sector Policy*

There are many contentious issues in the private sector policy. Some of
these are related to the conditions for accepting resources from the
private sector, as follows:

   - the proposed condition to accept resources from entities whose
   business activities are unrelated to WHO as well as compatible with WHO’s
   mandate and work  their activities

   - the condition not to accept financial resources from private sector
   entities whose activities are undermining the mandate of  WHO

   - the proposal for a ceiling on in the specified voluntary contribution
   from the private sector to prevent the private sector from picking and
   choosing programmes for funding. It is to avoid the risk of donor-driven
   programmes.

Both the Secretariat and developed country Member States oppose any of the
above-mentioned conditions for the acceptance of resource from the private
sector. According to one developing country delegate the Secretariat often
asserts that these conditions would hamper resource mobilisation from the
private sector.  According to a Secretariat document, in 2012 only $25
million, or 1.5% of WHO’s income was received from the private sector. (
http://www.who.int/about/who_reform/governance/mapping-of-WHO-engagement-with-non-State-actors.pdf?ua=1
)

TWN learned that the Chair has proposed a broad exception to the FENSA
framework to respond to the emergency situations. This would also be
deliberated at the informal meeting on 19-21 October.

According to several observers, the FENSA exercise would be futile if it
either lowers the regulatory safeguards for the engagement with NSAs
especially with the private sector or merely restates the *status quo*.+


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