11 December 2017 News

New Beginnings at the WHO

Emerging Voice for Global Health Sana Contractor writes about her participation in a recent WHO’s Executive Board meeting

On 22 November 2017, the WHO’s Executive Board met in Geneva to discuss their strategic plan for the next five years – the 13th General Programme of Work (GPW). Owing to the good connections between ITM’s Unit of Health Policy and Medicus Mundi International (MMI), I was part of the delegation of “non-state actors” present at the meeting, and had the opportunity to present comments on the draft GPW, on behalf of MMI.

The WHO is frequently criticised for having turned into an 'outmoded, underfunded, and overly politicized' agency, that is losing relevance. As someone who works in public health, however, the opportunity to speak at the Executive Board meeting was undoubtedly exciting. This was also the new Director General Dr. Tedros’ first Executive Board meeting and given his dynamic election campaign and active public engagement, I was curious to see how the meeting would play out. Needless to say, I was not disappointed.

Dr. Tedros started the day by addressing the member states, conveying an urgency to restore faith in the WHO and respond to emerging global health crises with both creativity and speed. He reminded Member States that WHO cannot continue with 'business as usual' – there is a need for a paradigm shift if the organisation is to remain relevant in the new global health landscape. In the (rather ambitious) GPW this is reflected in both strategic shifts (stepping up global leadership, driving impact in every country and focusing global public goods on impact) and organisational shifts (measuring impact, transforming partnerships communications and financing, reshaping the operating model to drive country, regional and global impacts, building critical processes and tools and fostering a culture change in the WHO). While the document was received positively by most member states, who appreciated the transparent, consultative and swift process that was undertaken in its development, there were also concerns raised regarding deviation from WHO’s core functions of setting normative standards and providing strategic and technical support, into a more operational role.

As a civil society actor, I also reflected on what I saw as weaknesses in the new approach. For instance, perhaps in response to questions raised over WHO’s accountability and impact, the GPW looks to demonstrate impact and hence prove itself to be a 'good investment'. A detailed impact framework and 'triple billion' targets have been set up. However, it is worth considering whether this is the best way to assess WHO’s effectiveness given its mandate and functions. There is a danger that setting such targets could foster a tendency to pick the lowest hanging fruit; as some countries pointed out, regional and country disaggregation is required so that the focus will not only be on big countries, as there is a danger that the 'billion targets' would focus attention first on countries with large populations. Moreover, is it possible to isolate/separate the WHO’s specific impact (as opposed to other players), even with the most sophisticated contribution analysis? And does this serve any purpose? One wonders whether the setting of such 'marketable' targets erroneously puts WHO at par with other global health partnerships, turning the organisation into just another player in the global health ecosystem, rather than a leader.

These and other concerns are shared by other civil society networks and organisations in the global health space as well, and their oversight to ensure that the WHO is democratised and remains independent, will be critical going forward. Prior to the meeting, some commentaries on the draft (see links below) and a heated Twitter exchange (between Richard Horton and Anthony Costello) had already suggested that the moves of the new Director General are being carefully scrutinised by global health players. Those concerned with the WHOs governance, independence, integrity and relevance in the coming years will hopefully continue this oversight especially in the run up to the Executive Board meeting in January.