At the World Health Assembly in May, civil society organisations criticised the rich countries for refusing an increase in their assessed contributions to WHO and opposing actions by the agency which would be contrary to the interests of their corporations. THE Framework for Engagement with Non-State Actors (FENSA), initiated to safeguard the independence, integrity and credibility of the World Health Organisation (WHO), now seems to bear the threat of facilitating and legitimising corporate capture of the organisation, civil society groups have charged. 'Many proposals by rich countries in draft FENSA text [are] promoting corporate capture of WHO in the name of promotion of engagements without discussion on any comprehensive mechanism to avoid conflict of interest. These proposals, if accepted, would institutionalise the undue corporate influence on WHO,' said Lida Lhotska of the International Baby Food Action Network (IBFAN) in a press release. Over the last 20 years, the proportion of WHO's budget which is met through mandatory assessed contributions has fallen from 75% to 20%. This is a consequence of continuing new functions being added to the organisation and a continuing freeze on assessed contributions. The remaining 80% is met by voluntary donations, including from the rich countries, the World Bank and the Bill & Melinda Gates Foundation.
Public-Private Mix
Between 2009 and 2010, the author reports that the South African government spent about R1.49bn hiring nurses for the public health sector from nursing agencies. In that period, the provincial spending on agency nurses ranged from a low of just under R36.4m in Mpumalanga to a high of R356.4m in the Eastern Cape. In that financial year, this article reports that more than 5,300 registered nurses could have been employed by provincial governments instead of agency nurses, according to the published research. The government’s spending on agency nursing is argued to be a result of nursing vacancies, poorly managed staff absenteeism, sub-optimal planning for patient loads and not involving nurses in decisions on their shifts or how best to cover hospital wards. Nursing agencies provide a vehicle for nurses to moonlight, as they could be employed concurrently in a public or private sector hospital as well as the agency. These agencies are not obliged to ask nurses whether they have concurrent employment. The author argues that the nursing agency spending is, however, an indication of the bigger crisis in South African nursing.
Private healthcare is wasteful and over-dependent on hospitals, which makes it too expensive for a large group of working people to join medical schemes, Health-e news reports. As a result, scheme membership has stagnated at around 8,5 million people and is skewed towards older, sicker members. This was the assessment of healthcare consultant Dr Brian Ruff, speaking at the opening day of the Board of Healthcare Funders (BHF), the group that represents medical schemes and administrators in South Africa. Ruff said that families with an income of R7000 to R12000 a month may be able to afford membership of around R300 a month, yet no medical scheme could provide such a cheap service.
The author presents in this paper how in the name of 'reform', against a backdrop of a funding crisis, a greater collaboration between WHO and big business is being justified. She provides a historical overview of the process which began in 1992 with the drive for UN 'reforms', naming it as a euphemism for the neoliberal restructuring of the world body. Both the idea of attracting more funding from private foundations and the commercial sector and the notion of dealing with global health and nutrition matters through multi-stakeholder approaches are argued to carry major risks to WHO's role as the highest authority in international public health. Even though the regular World Health Forum is abandoned at the moment, the notion of greater involvement of the private sector as legitimate 'stakeholders' in public health affairs is not. She calls for an urgent reflection on whether this path should be pursued, noting that the 'privatisation' of public agencies and spaces increases the reliance on private sector funding, as well as inviting profit-motivated actors into public decision-making forums, and sometimes removing specific public issues from the public sphere altogether. This is seen to be the opposite of ensuring financial independence of public institutions and safeguarding and enlarging of spaces for public debate.
Pax is a private sector rural manufacturing enterprise in Edo State Nigeria that is a joint endeavour of the monastic and local communities. It has professionalised the production of traditional natural remedies to demonstrate that herbal medicines can be a force for innovation and progress in health care. An estimated two-thirds of Nigerians are reported in this paper to use these products, often in tandem with other medicines. The company holds that open dialogue, scrutiny and regulation are crucial if the economic potential of the sector is to be realised, and that traditional medicine must be modern, professional and based on science if it is to contribute to improving health systems and outcomes. More than 30 Pax products are reported to be government-certified. The paper argues that traditional medicine and pharmaceutical industries could be fostered in Nigeria; but that indigenous knowledge, resources and enterprise still remain under-exploited.
The Malawi government has said that medical services in all public health facilities will remain free. Minister of Health spokesperson Henry Chimbali told Nyasa Times that government has introduced by-pass fees [and not user fees] in referral hospitals in order to decongest the facilities. He also noted that the ministry will review the current arrangement between the Ministry and Christian Health Association of Malawi (CHAM) saying the current Memorandum of Understanding (MoU) dates back to 2002, is well overdue for review and needs to take into account some of the emerging issues that have taken place such as the passing into law of the new Act on Public Private Partnership Agreements (PPPs) which is the basis of the arrangement between the Ministry of Health and CHAM. The proposal is to work out a mechanism that will see greater access to quality health services by all Malawians especially those in rural and hard to reach areas. He also noted that the Ministry of Health seeks to establish a Health Fund to support health service delivery and widen coverage of medical insurance for those who can afford it.
This is a response to a BMJ paper 'Do the solutions for global health lie in healthcare?' where in the run-up to the Second International Conference on Nutrition (ICN2), the author warned against downplaying the fundamental differences between the commercial interests of multinational food companies and those of public sector agencies. If public health officials do not acknowledge the divergent interests, he suggested, they risk harming their public health mission, institutional integrity and ultimately public trust. In the response, the author suggests that the current discourse ignores the problem of involving food transnational corporations in public decision-making processes, acceptance of funds and resources in the name of partnership or stakeholder engagement. The trend to increase such engagement reduces and almost eliminates public policy spaces without corporations. The author argues that that robust, comprehensive conflict of interest safeguards do not exist with respect to global food and nutrition governance. This obscures the fact that conflicts of interest are an important legal concept and that establishing conflict of interest policies are an integral part of UN agencies’ duty to establish the Rule of Law.
Ahead of the first meeting of the drafting group on Framework for Engagement with Non – State Actors (FENSA), Civil Society Organisations and Social Movements expressed their deep concern on perceived attempts to facilitate a corporate takeover of WHO. The joint statement signed by over 40 organisations called on WHO member states to take such time as is necessary to achieve a robust framework for engagement with non-state actors, to protect the WHO from undue influence. Further, the statement also called on member states to support the director general's proposals to increase the assessed contributions. The framework was initiated to safeguard the independence, integrity and credibility of WHO, but the organisations have a strong apprehension that the negotiations on FENSA may fundamentally alter the influence of the private sector and philanthropic foundations and NGOS sponsored by the private sector in a manner that compromises the credibility of WHO.
The authors write from the 68th World Health Assembly, where a drafting group of Member States are discussing the Framework of Engagement With Non-State Actors (FENSA). This process aims to determine the rules of engagement between WHO and non-State actors (NSAs), a moniker encompassing academia, nongovernmental organizations, philanthropic foundations, and the private sector. Many from civil society view this process as a way of safeguarding WHO's independence from private interests. The authors outline the fault lines in the proposals of contentious issues. During the open-ended process, India supported including language in paragraph 44 that named specific industries WHO should exercise caution in engaging with, such as the food, beverage, alcohol, and infant formula industries. India further proposed, "WHO's engagement will be strictly limited to assisting such industries to comply with WHO's norms and standards or guideline or policy." On behalf of the African group, Zimbabwe asserted that the "framework should explicitly list the types of industries that WHO will deal cautiously with and the reasons for the cautious engagement," also naming alcohol, food, and beverage. Greece argued, "strict rules should govern its [WHO] engagement with the pharmaceutical industries." Finland recommended a "high level of restriction" for engagement with industries that have "clear interests in health policies," referencing non-communicable disease control. Yet these calls were rejected by Canada, Denmark, Norway, and the United States. U.S. sought to eliminate the line concerning "other industries affecting human health" altogether. Other issues up for debate have been secondments from the private sector, as well as restrictions and/or ceilings on financial contributions from non state actors. The authors urged member states to ensure that FENSA creates a strong enough "fence" to safeguard public health.
Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, the authors present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders, community leaders and men in the community. The authors observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organisation, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders was reported to have turned into resistance.