06.01.11

The World Health Assembly: Reforming the WHO and Global Governance for Health

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Note: An earlier version of this post, drafted by Eric A. Friedman, O’Neill Institute Law Fellow and Lawrence O. Gostin, O’Neill Institute Faculty Director, was disseminated as an O’Neill Institute Briefing on May 18, 2011.

In late May, the World Health Assembly (WHA) discussed an ambitious agenda of reform of the World Health Organization (WHO) and global governance for health—the norms, institutions, and processes that collectively shape the health of the world’s population. This post discusses WHA agenda items of major importance.

WHO Reform
The WHO faces at least a $300 million budget deficit and finds itself in an increasingly complex global health architecture characterized by great passion and innovation, but also fragmentation and lack of global leadership. Recognizing the need for reform to be more relevant to contemporary realities and to assume its proper global health leadership role, the World Health Organization is initiating a major reform process.

The WHO reform agenda includes: (1) a proposal for a global stakeholders’ forum to help shape the global health agenda; (2) clearer articulation of WHO’s unique role and functions; and (3) managerial reforms within WHO to increase its accountability to Member States, improve organizational structure, and revise its human resource strategy. One thing to look out for: the risk that as WHO seeks to define and organize itself along particular functions, such key areas as human rights, gender, primary health care, and the social determinants of health, which are officially to be “mainstreamed,” could in practice see their place within WHO downgraded.

Last month in the Journal of the American Medication Association, O’Neill Institute Faculty Director, Lawrence Gostin, and Devi Sridhar from Oxford University offered five key proposals for reform.

Sridhar and Gostin propose:

  1. Give Real Voice to Multiple Stakeholders. The WHO would be more effective by giving real voice and representation to key stakeholders, including civil society, philanthropies, businesses, and public/private partnerships.
  2. Improve Transparency, Performance and Accountability. Stakeholders demand clarity on how their resources will achieve improved health outcomes, as they shift towards results-based financing and performance-based measures.
  3. Exercise Closer Oversight of Regions. WHO headquarters should exercise more oversight and control over regional personnel and decision-making.
  4. Exert Legal Authority as a Rule-Making Body. The agency could exert normative power through innovative treaties (e.g., a Framework Convention on Global Health) or through “soft” power (e.g., codes of practice) with strong incentives for compliance.
  5. Ensure Predicable, Sustainable Financing. The WHA should set higher member state contributions, and consider higher overheads for voluntary contributions.

The Indonesia Virus Sharing Controversy
In April, Margaret Chan, WHO Director-General, announced a landmark agreement on sharing novel influenza viruses and on equitable benefits for access to vaccines and pharmaceuticals. When Indonesia refused to share Influenza (A) H5N1 (avian influenza) with WHO, it raised a major global health and diplomatic challenge. One of the key questions that emerged was how developing countries would be able to access the vaccines and medicines needed to protect their populations against these viruses. The concern about lack of such access is what had prompted Indonesia to take its stand against sharing the virus with WHO.

The World Health Assembly is expected to adopt a framework on pandemic influenza preparedness that addresses this issue (as well as sharing influenza viruses), though only in limited ways, making the framework historic yet still a work in progress. It encourages Member States to urge industry to contribute to a WHO stockpile of vaccine doses to be distributed to developing countries and to contain initial outbreaks, to implement tiered pricing schemes for vaccines and antivirals, and to transfer technology to developing countries for developing and producing influenza vaccines. However, the framework does not place binding obligations on states.

Emerging Global Health Priorities
As part of the WHA’s packed agenda, there will be a major discussion emerging a global health priorities, including universal health coverage; health workforce; and national health plans, urging them to be based on primary health care principles and address social determinants of health.

The WHA will also be addressing long under-prioritized issues of injuries (in particular, child injuries); and non-communicable diseases. The NCD discussion is preparation of the UN high-level meeting on that topic in September. The WHA will also cover more traditional and vitally important health issues as addressed by the Millennium Development Goals.

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2011 WORLD HEALTH ASSEMBLY & GLOBAL HEALTH GOVERNANCE
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May 29th, 2011 by Matthew Anderson
From May 16th to the 24th the World Health Assembly (WHA) met in Geneva to review proposals by the WHO Executive Board (EB). The WHA is composed of delegations from the WHO member states and is the highest decision-making body in the organization. It choses the Director General, decides on the budget, and supervises the management of the organization.
This year was marked by a particularly controversial proposal by the WHO’s Director General to create a new World Health Forum. The forum would serve as a consultative body and – among other members – would include representatives of private industry. Many see this one more in the process of privatizing the WHO. Already most of WHO’s funding comes from private sources and it has been argued that WHO has fallen too much under corporate influences.
As usual, the People’s Health Movement was very active at the WHA promoting the agenda of health for all. Here is a selection prepared by PHM describing their activities at the Assembly:
* * * * * * *
People’s Health Movement (PHM) is committed to a stronger World Health Organization (WHO), adequately funded, with appropriate powers and owning the leading role in global health governance. PHM follows closely the work of WHO, through the initiative ‘Democratizing Global Health Governance’ which was launched by the PHM and several international civil society networks in May 2010.
Within the framework of this initiative, the PHM has established a ‘WHO Watch’. The watch aims primarily at building capacity in supporting the WHO to regain its leadership role in global health governance according to its Constitution. WHO Watch mobilises a large number of health activists, civil society networks and academics to provide resources and evidence-based critiques related to the secretariat reports, draft resolutions, and other materials during the preparations to the WHO governance meetings especially the Executive Board (EB) meetings and the Assemblies.
From the beginning of May 2011 and during the 64th World Health Assembly (WHA) of WHO, held from 16 to 24 May 2011, 30 members of the ‘WHO Watch’ group from over 20 countries have been working through the agenda of the 64th WHA with the assistance of high level experts from a number of collaborating networks and NGOs. The following letters and statements on some of the agenda items of the 64th WHA were drafted.
PHM letter to the 64th WHA
Distinguished delegate to the 64th World Health Assembly,
[…] The following comments on some of the agenda items of the 64th WHA were drafted for your kind consideration. More: English | Español
Statement to the 64th WHA, on agenda item 11: The Future of Financing for WHO
PHM calls upon WHO for accountability to people not dollars
The WHO is facing a financial crisis: programmes, projects and staffing face the prospect of being disbanded; the dominance of tied donor funding is having a terrible effect on administration. The WHO is also suffering from a crisis of identity and legitimacy; its role and mandate have been diluted and usurped by the proliferation of new actors in the field of global health. Inefficiencies within the organisational processes remain unresolved. More: عربى |English | Français | Español
Statement read by the PHM at the 64th WHA on future financing of WHO. More | Hear it on Youtube
Statement read by the PHM at the WHA on infant and young child nutrition
Both under-nutrition and obesity are linked to the increasing dependence of poor countries on high-income countries for food security, which has been reinforced by trade agreements, climate change, and biofuels. Nutrition strategies should address the complex socioeconomic and political determinants of malnutrition. Governments and international bodies, like WHO, must advocate for the regulation of the trade and marketing of unhealthy foodstuffs, so as to protect the health of populations – and of children in particular – from aggressive corporate influence. More >>
Statement read at the 64th WHA on Non Communicable Diseases
Statement by Medicus Mundi International (MMI) and PHM
The NCDs initiative is too narrow in particular we believe it should include mental health. It is disappointing that there is no reference to the work of the CSDH in the report. Unhealthy behaviors do play an important role in determining NCDs however there are structural determinants like education, income, gender and ethnicity which are underlying causes of NCDs and behavioral risk factors. Clearly there are important equity dimension of NCDs as emphasized by CSDH and these variations are closely linked to the social and environmental factors; not just individual behaviors. More >>
Statement read at the 64th WHA on Substandard/spurious/falsely-labelled/falsified/counterfeit medical products
Statement by Thirld World Network (TWN)
We believe that every individual has a right to access safe, quality and efficacious medicine and steps do need to be taken to ensure the safety, quality and efficacy of medicines. More >>
Time to untie the knots: the WHO reform and the need of democratizing global health
Delhi Statement, coordinated by Medico International
Health is a common good that demands collective responsibility. Instead, structural violations of the right to health are produced by the dominant market dynamics and the uncontrolled influence of profit-driven transnational corporations, supported by the policies of international financial and trade institutions – the International Monetary Fund, the World Bank and the World Trade Organization. Such violations are often unmonitored, unmeasured, and are too numerous to quantify. As they form part of a process of systematic violations of other rights – to gender equality, to water and food, to work and income, to housing and education – any commitment for the right to health cannot be conceived in isolation from a broader approach of universal social protection as a key policy to human development. More >>
More information at:
WHO Watch: http://www.ghwatch.org/who-watch
The 64th World Health Assembly through the eyes of PHM ‘Watchers’ – including daily reports: http://www.ghwatch.org/node/434

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