The World Health Organization is undergoing major reform including working to stabilise its fiscal future, and members are trying to set out careful terms for working with and receiving support from entities referred to as non-state actors, such as private foundations and organisations.
The issue was expected to be addressed at yesterday’s meeting of the new WHO Financing Dialogue. No information about the closed-door meeting has been made available to the press. [Update:] Speeches and presentations given at the Financing Dialogue have been added to the WHO website, available here. [end update]
At the 133rd meeting of the Executive Board held on 29-30 May, delegates discussed at length the issue of WHO engagement with non-state actors. They looked at how such engagement fits into the multisectoral landscape of global health as well as the mandate of WHO to promote and protect the health of all peoples. Ultimately, the matter was handed back to WHO secretariat to consider the contentious points brought up during discussions by member states.
The Board noted the report, and delayed the decision on whether to endorse the framework of NSA engagement until the next Executive Board meeting (in January), after allowing the secretariat to further “enrich” the framework with the principles discussed during the 133rd Executive Board.
In recent years, the term “multisectorality” has been a word chosen by policymakers to describe the dynamic scene of global health, and the concept of multisectorality was a focal point at the Executive Board meeting.
The role of the WHO engagement with non-state actors (NSAs) is a component of the WHO reform that was passed during the World Health Assembly, which took place in the days before the Executive Board meeting. Member states were unanimous in calling for clarity and transparency in both the establishment of guidelines and the engagement process itself with NSAs.
Drawing on opinions expressed throughout governing body discussions and in consultations with the stakeholders concerned with WHO governance reform, the report [pdf] on WHO reform presented overarching principles for WHO engagement with NSAs, defining separate operational procedures for both non-governmental organisations (NGOs) and private commercial entities. The four overarching principles are:
The report also states that discussions on WHO’s engagement with non-state actors have been based on two central concepts: 1) the intergovernmental structure in which WHO member states have the exclusive right of decision-making, and 2) the differences and increased complexity between today’s global health landscape and that which existed in 1948 when WHO was founded.
Typology of Engagement
Members and non-members of the Executive Board generally supported the guidelines that described WHO-NSA engagement based on six basic types of interaction (typologies): consultation, collaboration, financing, contractual, NSAs in WHO governance, and WHO as part of the governance of NSAs (e.g. GAVI Alliance).
In the Board meeting, Senegal, speaking on behalf of the AFRO Region, agreed with the general approach put forward by the principles and typology framework. Switzerland also supported an approach based on typology of interaction rather than categories of actors because it would facilitate engagement with NSAs. The Swiss delegate said, “WHO must be in a position to dialogue with all stakeholders, and must be open to public private partnerships (PPPs).”
Conflicts of Interest
Management of conflicts of interest (COI) emerged during discussions as a crucial component of the NSA framework. Countries were divided on how to deal with and differentiate between different types of NSAs that might engage with WHO.
Argentina called for, and Brazil also supported, the establishment of an ethics committee to deal with problems of conflicts of interest, to ensure that policy on conflicts will not to be simply declaratory but would be active in decision-making as well.
Senegal wanted to “see a strong approach when it comes to dealing with problems of COI. The same rules should be applied at regional and country levels.” Senegal said that the system must be “rigorous, transparent, and applicable at all levels of our organisation.”
Citing noncommunicable diseases (NCDs) as a prime example of the importance of a multisectoral approach to overcome public health challenges, the United States (which is not a member of WHO Executive Board) commented that such a framework on NSA engagement is necessary to maximise mobilisation of resources while ensuring WHO is protected from conflict of interest.
The delegate speaking on behalf of the US urged the secretariat to support member states in situations when conflict of interest in national policies arises, because it is often difficult and complex to differentiate between NGOs with only public health interests, those with private interests, and those that serve state interests.
Flexibility was another aspect deemed desirable by many WHO member states. The US said flexibility is needed in order to access expertise on any given issue. The United Kingdom expressed its concern that the framework should not be an “overly prescriptive model,” but rather the broad framework of principles should “leave room to manoeuvre.”
NSA Perspectives
Corporate Accountability International urged WHO member states to follow the precedent set by WHO Framework Convention on Tobacco Control Article 5.3 to make a strict distinction between public interest and profit-driven organisations. They underscored member states’ leading role in setting policy, stating that member states should prohibit industry from regulating through voluntary standards.
In a statement [pdf] by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), industry expressed a desire for a framework that would create opportunities for partnerships between WHO and non-state actors. However, IFPMA cautioned, “differentiation [of NSAs] should not mean discrimination” and that WHO should consider the potential “value to global health” that each NSA might contribute when approaching this engagement framework “in order to achieve progress and avoid inefficient fragmentation.”
Financing Dialogue
The WHO Financing Dialogue that launched yesterday (24 June) is another key element of WHO reform, related to non-state actor engagement. The key principles that underpinned the financing dialogue are transparency, predictability and flexibility among member states and other funders. The discussion was expected to focus on how WHO can best deliver on priorities in collaboration with Member States and WHO’s network of partners in global health, according to the WHO website.
In light of these discussions, establishing a sound framework for non-state actor engagement remains an obvious impediment in moving forward with WHO reform.
As said in the WHO Financing Dialogue Brochure, “health governance is no longer the exclusive preserve of nation states. Civil society networks, non-governmental organizations, philanthropic foundations, trade associations, the media, corporations and individuals have all found a new voice and influence on health….Business as usual cannot be an option and transformative change is needed. As the challenges are highly interdependent, a new approach is needed to address them.”
William New contributed to this report.
Brittany Ngo is currently completing her Master’s in Health Policy and Global Health at the Yale School of Public Health and previously obtained a Bachelor’s of Arts in Economics from Georgetown University. Through her studies she has developed an interest in health-related intellectual property issues. She is a summer intern at Intellectual Property Watch.