The WHO reform, its controversial aspects and the DGH proposals

1. The WHO reform, its controversial aspects and the DGH proposals Nicoletta Dentico Democratising Global Health coordinator Geneva, 13 October 2011

2. Running behind a train moving fast, and in various unclear directions

3. A fewpreliminaryconsiderations • The WHO reformprocessprovides the agency a historicwindow of opportunity: drawing on itsstrenghts, WHO needs to rediscoveritsfundamentalmultilateralidentityand re-assertitselfasthe“directing and coordinating authority”for the realization of the right to health. • Thisrealization of the RtHisthe core business of the WHO, clearlyembeddedin itsconstitution; • The uniqueness of the organization: the WHO isthe onlyoneentity with with normative power on health, a keyfeatureat a time of global healthchallenges in a scenario of “ confusedtransition” in global governance for health

4. speaking of healthgovernancetoday …. • Fragmentation: the uncontrolledblossoming of initiatives and agencies • Lack of country ownership • Lack of accountability • Institutionalweakening of mandatedbodies • Duplication of activities/ responsibilities • Wastedresources • Drainedabsorptivecapacity • High transactioncosts

5. WHO reform for a healthy future The goal of the reform is improved health outcomes, with an emphasis on: • refocusing core business to address the 21st century health challenges facing countries; • reforming the financing and management of WHO to address health challenges more effectively; • transforming governance to strengthen global health. http://www.who.int/dg/reform/en/index.html

6. Expected outcomes of the reform (WHO web) • Refocusing core business. WHO will narrow the scope of its work to what it can do best, working on priority issues identified by Member States, with adequate financing for these areas of focus. These areas of core business are: (1) health systems and institutions; (2) health and development; (3) health security; (4) evidence on health trends and determinants; and (5) convening for better health. • Reforming the financing and management. These reforms will result in: increased organizational effectiveness; clearly differentiated roles and responsibilities among headquarters, regional and country offices; improved results-based management and accountability; flexible, predictable and sustainable financing, and strengthened resource mobilization and strategic communication; and a new, flexible human resources model that emphasizes the recruitment and retention of excellent staff. • Transforming governance. These changes will lead to increased effectiveness of the governance of WHO, in part by clarifying the roles of the governing bodies. A reformed WHO will also play a larger role in global health governance by bringing coherence to the many initiatives involved in global health.

7. Why a reform? The rationale of the WHO reform has yet to be established, based on a solid, in-depth situation analysis. The reform was introduced through considerations on financial difficulties and prospects for future financing of the agency. As of today, not one single document has yet been made available by the Secretariat on WHO’s financing, i.e. the root causes of the current situation, present constraints, limitations of the system, opportunities for potential savings and ideas for future sustainable funding.

8. The nature of the reform This process is a major political and strategic move. Of course, it has key managerial implications, especially in terms of securing the accountabilty chain across the WHO structures. This reform must be placed in the context of a globalised economy and its market-driven prescriptions, the current financial crisis, the UN reform agenda and the need for reasserting WHO as the leading intergovernmental agency for health.

9. Pondering the risks of the currentproposals The risk of the proposals currently put forward is that they undermine, rather than reinforce, WHO’s constitutional mandate, further diluting the right to health perspective by 1. stressing WHO’s role as « convenor », 2. opening the door to private and corporate for-profit entities to take part into policy setting on global health. Giving more influence to private for-profit actors in international public health decision-making processes runs counter to basic democratic principles

10. The need to slow down the train The unprecedented speed of the reform process, coupled with its opacity and the nurtured lack of participation makes it very hard even for Member States to follow its route with any real ownership and capacity to contribute. Yet, it is precisely the Member States - the legitimate constituency of the WHO – which should drive the entire process

11. the quest for a public dialogue In addition to impairing proper governmental guidance and contributions, the current WHO reform further suffers from the exclusion of public-interest members of the civil society. Yet, public interest groups have taken this initiative with the serious attention it deservesDGH coalition

12. keyissues to look into • Whyis the patientill? need to make a solid situation analyis of the reasonswhywehave come to thislevel of vulnerability (pathology)? • Ground rules (cfr. CoI) needed to walk in the the thickforest of global healthactors. We do notallpursue the same public interest goal – as IK remindsusagain and again, healthis the secondbiggest global business sector; • Sustainable and predictablefunding– at a time of financialcrisis, the world isawash in money so long ascountrieswill set in placepolicies to tapit & use it in a mannerthatenhances the development agenda.