Panel Dissects Future Challenges Of WHO Budget, Administration

The World Health Organization needs to streamline its functions and make more space for civil society, and international health systems must be strengthened in order to achieving public health goals, said panellists at this week’s Geneva Health Forum.

Innovative financing mechanisms will also be necessary to ensure that general health solutions – rather than solely disease cures – are found. And new media – including online health databases – can be used to bridge global health divides and bring isolated rural healthcare practitioners needed help.

Budgeting For Leadership: Streamlining WHO

Dev Ray, the former chief of WHO Governing Bodies, said there are places where the organisation “may have gone a bit astray.” He spoke at a 20 April session during the 19-21 April health forum.

The WHO’s budget is one major area of concern. In the early days, only 20 percent of the budget was from voluntary contributions, and 80 percent was supplied by mandatory contributions. Now, it is the opposite.

“This is not sustainable for leadership,” said Barry Bloom, a professor at the Harvard School of Public Health. Much of this funding is targeted at one disease at a time, which does not aid health systems in general.

It also creates poor incentives, where programme directors must be responsive to the desires of donors, said Ray.

There has also been a massive expansion of actors in the health field springing up to fill the gaps. For instance, between 40 and 70 percent of healthcare in sub-Saharan Africa is provided by faith-based organisations, said Bloom.

There also may be a danger with the WHO’s increased links to the private sector, which date from former Director General Gro Harlem Brundtland, who led the WHO from 1998 to 2003, said Yves Beighbeder a previous legal expert in the WHO human resources department.

This “possible commercialisation of the WHO … brings discredit to its mandated neutrality and scientific expertise” and “curtails its responsibility to the whole world, including poor countries,” Beighbeder added. Budget balance might help remedy the problem.

“If WHO is to become relevant again [and] re-establish its leadership role in health, which I think it has lost” said Ray, then it has to refocus on norm-setting functions.

Also problematic are the organisations’ lack of engagement with critics and civil society. A group of people sits just outside the WHO campus every day to protest the organisation’s response to the Chernobyl disaster. Why, asked Ray, are they not welcomed into the building?

Also, the WHO’s decision-making meetings – the annual World Health Assemblies – have been getting steadily shorter, and covering a wider range of issues, he said. This disadvantages those from small nations that must fly in from capital against the larger nations – the US, the UK, France, India, China and Brazil, for example – who can afford to have experts based in Geneva as well.

A representative of the International Baby Food Action Network later commented from the audience that the space for NGO participation at the WHO “is shrinking,’ and that at this year’s Assembly, NGO groups have been told there would not be space for their meetings.

Collaborative Innovation > Competition

By 2006, US$1.2 billion was about what it cost to research and develop a new drug, said Shing Chang, the research and development director for the Drugs for Neglected Diseases Initiative (DNDi).

But drug research need not be so prohibitively expensive, he said. The competition model of drug research used by the private pharmaceutical sector tends to drive up the cost of individualised production, he argued.

Oriented towards market exclusivity, the end goal of the competition market is to come up with something that no one else can sell. This means companies spend time and money researching patentable “me too” drugs rather than catering to patient needs, and gathering experiences and knowledge in-house and individually. Competition leads to repetition, Chang said.

Collaboration, on the other hand, can drive down costs, he said, citing the DNDi model. DNDi’s total research and development costs between 2003 and 2009 were $77 million dollars. With this, it has made available two new treatments for malaria and a combination therapy for sleeping sickness; it also has the largest pipeline of new drugs and improved treatments for leishmaniasis, Chagas disease and sleeping sickness, Chang said.

Innovative Financing, and Using Internet To Bridge Health Divides

Healthcare is currently a space without clear rules, said Bloom. There are “a plethora of actors” in overseas development for health, from bilateral and multilateral donors, to NGOs and private philanthropic and commercial operations.

But fewer than 5 percent of international donor funds are going to support national health systems. And funding is often targeted at a specific disease – and frequently ignores chronic illness, which is a major cause of death and a serious disease burden.

In order to strengthen health systems, innovative funding is needed. And health information systems must be strengthened too.

“We must get out of the concept that healthcare equals hospitals and doctors’ offices,” said Krishnan Ganapathy, the president of Apollo Telemedicine Networking Foundation in India. Today, 1 billion people have access to the internet, and 4.6 billion have mobile phone subscriptions, he said.

The convergence between healthcare and telecommunications could be revolutionary. Doctors could guide patients or nurses in care over a webcam; mobile phones could be used to check bar codes on medicines to determine if the drug is within the expiry date or at risk of being counterfeit, for example.

Antoine Geissbulher of the Hôpitaux Universitaires de Genève talked about “moving the knowledge of experts where it is needed without moving the experts themselves” through the use of internet-based and mobile platforms.

New sharing platforms were presented by David Abreu of the Geneva-based Council on Health Research for Development – discussing geographically organised information on Health Research Web – and M.K. Nabeel – presenting India-based Solution Exchange, an initiative for the sharing of development solutions between similar communities, which he said was designed to meet a “felt need for information.”