[Ip-health] Civil Society Statement On the World Health Organization’s Proposed Framework of Engagement with Non-State Actors (FENSA)

K.M. Gopakumar kumargopakm at gmail.com
Wed May 25 06:48:01 PDT 2016

*Civil Society Statement*

*On the World Health Organization’s Proposed*

*Framework of Engagement with Non-State Actors (FENSA)*

69th World Health Assembly, May 2016

We, the undersigned Civil Society Organisations (CSOs), believe that the
independence, integrity and credibility of the World Health Organization
(WHO) are non-negotiable for the fulfilment of its constitutional
functions. Actions of a few dominant donor countries, venture philanthropy
foundations with large conflicted investments, private sector and private
sector influenced NGOs and entities erode WHO’s capacity to do its job.

The existing safeguards – to protect WHO from undue influence and to avoid
or properly resolve conflicts of interest – are not sufficient and have
been inconsistently enforced. That is why we, public interest advocates
from civil society, stand ready to support the development of a robust
effective framework to regulate relationships with non-state actors (NSAs).
The on-going negotiations on the *Framework of Engagements with Non-State
Actors* (FENSA) could have been an opportunity to adopt such a framework.

We fear that the upcoming FENSA negotiations during the World Health
Assembly may be used by certain Member States (MS) to further dilute the
existing policies regulating the engagements with the private sector and
weaken stronger provisions that have been negotiated so far.

Compared to existing measures, the current draft FENSA does bring certain
improvements. For example, proactive disclosure of financial contributions
and the prohibition of secondments from the private sector. *However,* *major
concerns* *are left unaddressed*.

*FENSA, in its* *overarching section puts private sector entities on an
equal footing with other NSAs, failing to recognize their fundamentally
different nature and roles*. It uses the principle of ‘*inclusiveness’* for
all five *‘types of interactions’* (resources, participation, evidence,
advocacy and technical collaboration) to all NSAs. When applied to major
transnational corporations, their business associations and philanthropic
foundations, this categorization of interactions, combined with an alleged
right to inclusiveness, will once and for all, legitimize the framing of
public health problems and solutions in favor of the interests and agendas
of those actors.

FENSA, for example, proposes technical collaboration with the private
sector, including capacity building, with no adequate safeguards.  It seems
that there is opposition from developed countries to a clause that would
exclude private sector resources for activities such as norms and policies
development and standard setting. FENSA removes the existing minimum
restrictions on accepting financial resources from the private sector to
fund salaries of WHO staff.  If the WHO relies on funds from the private
sector for *any *operational expenses, it risks showing favouritism toward
those sectors in its standard-setting, expert-advisory, and other public
health functions.

*FENSA’s proposal to expressly allow business interest groups to obtain
“Official Relations”* *status under the label of Non State Actors will,
once and for all, legitimize lobbying by business associations and
philanthropic foundations at WHO governing bodies.*  This will normalise
the inclusion of business agendas into public health decision-making. This
seems in direct contradiction with FENSA’s stated principles that any
engagement must *“protect WHO from any undue influence, in particular on
processes in setting and applying polices, norms and standards*”; and *“not
compromise WHO’s integrity, independence, credibility and reputation.”  *

Member States have so far failed to rectify FENSA’s *flawed definitions and
conceptualization of conflicts of interest.  *Thus FENSA ignores the prime
purpose of institutional conflict of interest policies that is to
ensure that “*an institution's own financial interest”* and those of its
senior officials do not *“pose risks to the integrity of the institution's
primary interests and missions.”*  FENSA blurs the distinction between a
conflict of interest which is *within* an actor or institution, with
or diverging interests”* *between *actors. The issue of conflicting
interests is, of course, important.  But it has to be dealt with through
robust risk assessment measures and political debate. *Had the correct
conceptualization of conflicts of interest been applied throughout the
entire FENSA process the document would have taken a different form.  *

We fear that FENSA’s poor conceptualization of conflicts of interest
will be transferred to and felt at national level and that it will be used
to redefine national rules, undermining any chance of effective safeguards.

Some Member States that resist the development of strict conflict of
interest rules for WHO have developed relatively strict conflict of
interest policies, e.g. to prevent industry from unduly influencing
regulators and elected officials in their own jurisdictions. For example,
OECD Member States who have committed to follow the *OECD Guidelines* *for
Managing Conflict of Interest in the Public Service* at the domestic level,
are now obstructing the development of a WHO comprehensive conflict of
interest policy. Similarly, the UK *National Institute for Health and Care
Excellence* (NICE) prohibits involvement of any experts from the private
sector, yet the UK delegation resists inclusion of such a provision in
FENSA. Canada’s Federal Government prohibits financial contributions by
corporations to political parties and limits the amount of contributions by
individuals. *Member States must shed such double standards.*

Finally, we note that, referring to the *2030 Agenda for Sustainable
Development*, at the last minute some Member States inserted into the draft
Resolution and the FENSA document, references to *“multi-stakeholder
partnerships”.* Yet the entire FENSA fails to address how WHO should
appropriately approach public-private hybrid entities, that undoubtedly
create avenues for undue influence on policy-making. The OECD Guidelines
have highlighted public-private partnerships, sponsorships and lobbying as
particular *“at risk areas”* for conflicts of interest.

We call on Member States to:

·      *Not approve a faulty FENSA at WHA*: this process will define the
role of our highest global authority in public health for years to come and
needs to be done correctly.

·      *Evaluate the process,* *re-**open transparent debate, clarify
concepts, obtain missing evidence*, including from WHO civil servants and
public interest advocates, and do an in-depth review of the adequacy of
existing relevant WHO policies. WHO must emerge from this process as an
agency able to fulfill its mandate.

·      *Stop developing FENSA under contradictory objectives:* both as an
instrument to attract voluntary financial resources for WHO and, at the
same time, as a safeguard to protect its mandate.  It can’t be done.  If
WHO is to fulfill its constitutional mandate, Member States must find other
financial solutions: lift the freeze on assessed contributions and increase
their levels of funding.  This would end WHO’s dependency on voluntary,
often earmarked and volatile contributions.  It would resolve the most
important – financial –  institutional conflict of interest of WHO and at
the same time prevent wasting resources on implementing an ill-conceived

   - *Strengthen rather than weaken the safeguards against undue influence
   from the private sector:* at the very least, FENSA should not dilute the
   existing WHO safeguards contained in policies regulating WHO’s relations
   with NGOs and the private sector.  FENSA should acknowledge the
   especially high risks posed by inappropriate interaction with food,
   beverage, baby food, alcohol, pharmaceutical, medical technology, and
   tobacco industries in all WHO work.

   - *Strengthen these safeguards by developing a comprehensive and
   effective conflict of interest policy*: if conflicts of interest had
   been effectively addressed, some of the recent public health emergencies
   would have been dealt with more efficiently, moreover also saving public

   - *Fully protect WHO from the undue influence of venture philanthropy
   and corporate funding:* WHO should be fully funded by Member States.  In
   addition, FENSA should set out clear rules regarding acceptance of cash or
   in-kind contributions from these NSAs, recognizing that such forms of
   funding to WHO risk unduly affecting WHO’s integrity, independence and
   effectiveness in fulfilling its mandate.

   - *Protect the integrity of Official Relations:* ensure that the
   Official Relations policy is adequately discussed after this WHA so that it
   becomes a safeguard against undue influence, not a wide open lobby channel
   to influence the work of WHO governing bodies.

This statement is endorsed by the following:

1      ACHEST

2      Active-Sobriety, Friendship and Peace (Norway)

3      Actionsgruppe Babynahrung AGB (Germany)

4      AIMI (Indonesia)

5      All India Drug Action Network

6      Amref Health Africa

7      Associação IBFAN Portugal

8      Association of Breastfeeding Mothers (UK)

9      Association for Improvements in the Maternity Services (AIMS) (UK)

10   Baby Milk Action (UK)

11   Birthlight

12   BUKO Pharma-Kampagne

13   The Berne Declaration (Switzerland)

14   CEFEMINA - Feminist Center for Information and Action (Costa Rica)

15   Centre for Health Science and Law  (Canada)

16   Corporate Accountability International (US)

17   Blue Cross Norway

18   Diverse Women for Diversity (India)

19   Drug Action Forum (India)

20   El Poder del Consumidor (Mexico)

21   European Alcohol Policy Alliance

22   FIAN International

23   First Steps Nutrition Trust (UK)

24   Fondazione Lelio e Lisli Basso ISSOCO, Italy

25   Geneva Infant Feeding Association

26   Global Alcohol Policy Alliance (GAPA)

27   Health Innovation in Practice (HIP), Geneva

28   The A Team (UK/USA)

29   IBFAN (Global)

30   IFARMA Foundation (Colombia)

31   INFACT Canada

32   Initiativ Liewensufank (Luxembourg)

33   IOGT International

34   Institute for Alcohol Studies (UK)

35   International Code Documentation Centre (ICDC)

36   Health Action International (Global)

37   Initiative for Health & Equity in Society (India)

38   Lactation Consultants GB

39   La Leche League GB

40   LOCOST (India)

41   Medico International (Germany)

42   Medicus Mundi International - Network Health for All

43   Midwives Information & Resource Service (MIDIRS) (UK)

44   Mission Salud

45   NGO Forum for Health (NGO F4H)

46   Osservatorio Italiano sulla Salute Globale (OISG), Italy

47   Peoples Health Movement

48   Public Services International

49   Research Foundation for Science Technology & Ecology (India)

50   Responsible Approaches to Infant Feeding (NZ)

51   School of Public Health, University of the Western Cape (Australia)

52   Society for International Development (SID)

53   SOYNICA (Nicaragua)

54   The Baby Feeding Law Group Ireland

55   The International Federation of Business and Professional Women

56   Third World Network

57   Transnational Institute (Global)

58   Treatment Action Campaign (South Africa)

59   Terra Nuova

60   UK Health Forum

61   Wemos (The Netherlands)

62   World Obesity Federation (Global)

63   World Public Health Nutrition WPHNA (Global)

64   Young Professionals Chronic Disease Network (Global

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