In this article the authors argue that the World Health Organisation (WHO) Secretariat, Member States and observers should honestly admit that they have so far fallen very short of the WHO Mission. The authors argue that the organization has become a huge bureaucratic structure while at the same time under-resourcing its needs has made it incapable of providing a timely response to the urgent health needs happening in the world. The organization is argued to be being privatized with influence from small group of private funders. This authors observe that the limited participation sometimes turns into an uncomfortable position for many, when faced with the lack of progress in the debates or with the endless diplomatic language that is used without reaching any concrete agreements and with resolutions and decisions where that make it almost impossible to identify the substance and therefore difficult to see their real value. In the meantime millions of diseases and preventable deaths are happening far away from what is being discussed at “the highest levels” of international public health policy arena.
Governance and participation in health
The 69th World Health Assembly (WHA) adopted the Framework of Engagement with Non-State Actors (FENSA) on the concluding day of Assembly. The adoption of FENSA is the conclusion of a process initiated as part of the WHO reform in 2011. FENSA consists of an overarching framework of engagement with Non-State Actors (NSAs) and four separate policies for governing the engagements with four categories, i.e. Non-Governmental Organisations (NGOs), private sector, philanthropic foundations and academic institutions. The overarching principles set out the common rules for all NSAs and treat all NSAs on an equal footing. The separate policies provide certain customised aspects of the overarching principles to the respective categories of NSAs. The framework regulates five types of engagements: participation, resources, advocacy, evidence, and technical collaboration. The WHA resolution that adopts the FENSA decides to replace the two existing policies governing WHO engagements with NGOs and the private sector. Further, the resolution requests the Director-General to start the implementation immediately and take all necessary measures to fully implement FENSA. Further, it requests the Director-General to expedite the full establishment of WHO’s NSA register.
Developed countries are reported to be turning against the World Health Organization’s framework of engagement with non-State actors (FENSA), by putting conditions for its adoption as negotiations on it enter into the last stage. Member States from Europe are reported to be raising three issues to block the adoption of FENSA. First, that the adoption of FENSA is possible only when there is a clear understanding on the implications of its implementation, especially financial and human resource implications. Secondly, that the Secretariat be given flexibility to suspend FENSA norms while engaging with non-State actors to respond to emergencies, and thirdly that the implementation of FENSA be at all three levels of WHO viz. headquarters, regional and national.
Kenya is currently revising its community health strategy (CHS) alongside political devolution, revisioning responsibility for local services. This explores drivers of policy change from key informant perspectives and perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. The authors conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives from policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members in two purposively selected counties: Nairobi and Kitui. There was widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas that informants felt should change included: lack of clear supervisory structure and adequate travel resources, uneven coverage and inequity in community health services, limited community knowledge about the strategy and home-based HIV testing and counselling. The recommendations point towards a more people-centred health system for improved equity and effectiveness, if the policy is to be effectively implemented.
Partnerships, and their accompanying networks, are now presented as an essential ingredient for fair SDG implementation. But what happens in practice? Network analysis reveals how development ‘partners’ may in fact informally depart from established rules and relationships, with the end result that networks may amplify the very disparities of power they were intended to reduce. In this seminar, Moira Faul argues that with a better understanding of how partnership works, network members could rewire relationships for more inclusion, and ultimately better policy and practice solutions.
The 138th Meeting of the Executive Board (EB138) of the World Health Organisation (WHO) taking place from 25 to 30 January 2016 in Geneva includes a host of issues, including reviews of the WHO’s governance, finance and emergency structure. In the opening remarks of WHO Director-General Margaret Chan, the topics touched on ranged widely from Ebola to Road Safety, with an emphasis on Universal Health Coverage in her final paragraph. A pointed reference to the “explosive spread of Zika virus in new geographical areas”, was a conscious effort to highlight the potential threats of infectious disease beyond Ebola, and the much needed reform of the WHO’s emergency structures. She commented on Universal Healthcare Coverage as “the most efficient way to respond to the rise of non-communicable diseases” , although the PHM note the debates on how the proposal for UHC has shifted the focus from how services should be provided to how services should be financed, with private sector providers and private insurance assumed to be part of the solution, despite evidence that this can lead to ‘health-defeating’ market failures. The Director General noted, however, that some policy recommendations on child obesity “pick a fight with powerful economic interests”. These remarks were welcomed by PHM if followed through with changes in the organisation’s relationship with big business.
The interdependence of states and increasing movement of people, the spread of contagious diseases and the heightened complexity of global health issues make cooperation among countries indispensable. Unfortunately resourcing remains a critical challenge to effective health governance. The authors argue that financial resources are not really a major challenge for Sub-Saharan Africa as it is usually perceived. According to the International Monetary Fund (IMF), Sub-Saharan Africa’s economic growth has been robust and capital inflows higher than the developing countries’ average. Notwithstanding threats to the region seems poised for better prospects. The authors argue that health governance should be given a higher significance if growth rates are to be sustained and strategies developed for collaboration between governments and non-state actors. Many Sub-Saharan Africa countries still view non-state actors with suspicion, but the authors argue that those that have embraced them as development partners have reaped some positive results in the provision of health services, such as in the role of mission services in health care provision in Botswana and Malawi. They suggest enhancing a multi-pronged cooperation between African state and non state actors and that the porous borders across countries necessitate regional cooperation to effectively combat the spread of diseases.
This paper examines prospects for enhanced regional migration governance and protection of migrants’ rights in the Southern African Development Community (SADC). Migration in this region is substantial in scale and diverse in nature, incorporating economic, political and mixed migration flows. In addition to movements between countries within the region, migrants also come from across the African continent and even further afield. At its foundation in 1992, SADC as an institution initially embraced a vision of intra-regional free movement, but this has not become a reality. If anything, there has been a hardening of anti-migrant attitudes, not least in the principal destination country of South Africa. There have also been serious violations of migrants’ rights. Attempts at regional coordination and harmonisation of migration governance have made limited progress and continue to face formidable challenges, although recent developments at national and regional levels show some promise. In conjunction with the 2003 SADC Charter of Fundamental Social Rights and 2008 Code on Social Security, incorporation of migrants into the SADC 2014 Employment and Labour Protocol could signal a shift towards more rights-based migration governance. The paper concludes by arguing that there can be no robust rights regime, either regionally or in individual countries, without extension of labour and certain other rights to non- citizens, nor a robust regional migration regime unless it is rights-based.
The Centre for Health Human Rights and Development(CEHURD) through the Coalition to Stop Maternal Mortality due to Unsafe Abortion, marked the Global Day of Action on Safe and Legal Abortion on the 28th of September 2015. The global trending hash tag on social media was #BustTheMyth that all messages on myths and facts on abortion were attached to while sending out to followers on social media. A petition was read in line with the theme; Because every woman and Girl Counts and a campaign to have 1 million signatures was launched. The campaign sought to have one million signatures to be presented to parliament and the Speaker of Uganda Parliament, the Rt. Hon. Rebecca Kadaga and entire legislative council, to consider having a proper and clear law on abortion. Two social media campaigns in line with the theme were launched to boost the main campaign with the hash tags; #BustTheMyth and #LetHerSpeak: Because every woman and girl counts.
The WHO Executive Board is composed of 34 members technically qualified in the field of health. Members are elected for three-year terms. The main Board meeting, at which the agenda for the forthcoming Health Assembly is agreed upon and resolutions for forwarding to the Health Assembly are adopted, is held in January, with a second shorter meeting in May, immediately after the Health Assembly, for more administrative matters. The main functions of the Board are to give effect to the decisions and policies of the Health Assembly, to advise it and generally to facilitate its work. The full set of documents under consideration at the 138th WHO Executive Board meeting are available online at the organisation's website.