The Sixty-fifth World Health Assembly requested the Director-General to report, through the Executive Board at its 132nd session, to the Sixty-sixth World Health Assembly, on progress in the implementation of WHO reform, on the basis of a monitoring and implementation framework. This report provides a comprehensive overview of progress up to the end of the first quarter of 2013 in the three broad areas of WHO reform: programmes and priority-setting; governance; and management, as well as a high-level implementation plan for reform. A comprehensive, detailed and budgeted implementation plan is the basis for managing change, monitoring progress, and mobilising resources to finance the proposed reform activities. The plan and report are structured around the 12 elements of reform that were identified in the monitoring and implementation framework considered by the Sixty-fifth World Health Assembly, and include an additional element on change management. The report provides a narrative describing action taken in each area, and a status update on the outputs and key deliverables.
Governance and participation in health
This independent evaluation of the World Health Organisation’s (WHO) proposed reform package found that WHO had responded adequately to challenges pointed out by stakeholders in the area of internal governance by using a Member State-driven consultative process to re-set its priorities and programme areas. Issues regarding resource allocation and the strengthening of governing bodies, however, need further amplification. A number of recommendations were made. As the proposed reform has highly interdependent components, the report calls on WHO to establish and maintain links among governing bodies at headquarters and regional offices to promote coherence and strategic focus, and adopt an approach that recognises this interdependence. Accountability and responsibility structures for three layers of governance would need to be redesigned, with results-based management and effective performance management and development. To generate acceptance at various levels, an advocacy plan should be developed, and regular communication should be maintained with all stakeholders. The report also calls for desired outputs, outcomes and impact to be identified, the designing of indicators to measure these, and a monitoring and feedback mechanism. As the reform programme is comprehensive and involves action on a large number of fronts, the report recommends that WHO develop a prioritisation plan to allow a smooth and gradual shift.
The author observes that the role and reach of the World Health Organisation has been contested since it was created in 1948. The debate is commonly couched in terms of whether the organisation is ‘fit for purpose’ although whose purpose is not always made clear. There have been several attempts at WHO reform since its establishment, directed to making it fitter for a still contested purpose. The current round of ‘WHO reform’ was launched in 2010 following a budget crisis and it continues as the new director‐general settles into the job. The current reform program addresses: funds mobilisation, budgeting, evaluation, relationships with non‐state actors, relationships within the secretariat (between headquarters, the regions and the country offices), WHO’s role in global health governance, the emergency program and the management of the WHO’s staff. The capacity, effectiveness and accountability of WHO is critical to the project of equitable health development globally. Nevertheless, there have been shortfalls. The root causes of WHO’s disabilities are argued to include the freeze on WHO revenues, the dysfunctions associated with WHO’s highly decentralised organisational structure, and the lack of accountability of member states for their contribution to WHO decision making and their implementation of WHO resolutions. In this paper the author reviews the evolution of the current reform program and some of the major elements of the reform, with the shortfalls, disabilities and reform options within the broader context of global health governance. The author argues that the reform of WHO, to realise the vision of its Constitution, will require a global mobilisation around the democratisation of global health governance.
The past two decades have seen dramatic shifts in power among those who share responsibility for leading global health. In 1990, development assistance for health – a crude, but still valid, measure of influence – was dominated by the United Nations (UN) system (the World Health Organization, the United Nations Children’s Fund and the United Nations Population Fund) and bilateral development agencies in donor countries. Today, while donor nations have maintained their relative importance, the UN system has been severely diluted. This marginalisation, combined with serious anxieties about the unanticipated adverse effects of new entrants into global health, should signal concern about the current and future stewardship of health policies and services for the least advantaged peoples of the world.
Proposed reforms to the way the World Bank is governed tinker at the edges, promising only marginal improvements for developing countries; critics are stepping up the pressure for a fundamental rethink. The World Bank board will discuss a package of reforms to the way the Bank is governed at its annual meetings in October, hoping to agree a concrete set of actions by next spring. Despite calls from developing countries, civil society and others for root and branch change to address the Bank's gaping deficits in democracy, legitimacy and accountability, the proposals are uninspiring.
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.
A new time line with guidance from Member States has been proposed for improving a framework on engagement with non-State actors at the World Health Organization. Discussions on the framework document prepared by the WHO Secretariat were held at the meeting of the 136th session of the WHO Executive Board (EB). During the plenary session, many countries expressed their dissatisfaction with the current draft framework and Argentina proposed a draft decision to convene a working group for deciding on the way forward. This document provides the current draft of the framework.
of the major challenges with regard to the World Health Organisation’s (WHO) engagement with non-state actors is maintaining the independence and intergovernmental nature of the WHO by protecting it from the influence of vested interests. This proved to be one of the major issues raised at the 132nd WHO Executive Board (EB) session held from 21-29 January in Geneva, Switzerland. Participants called for a more flexible accreditation mechanism to authorise non-state actor participation in WHO meetings and argued that WHO’s policy of engagement should be driven by its own interests and needs, and limited to those entities with which mutually beneficial cooperation is possible. Some countries called for a single policy of engagement, while others preferred two separate policies for NGOs and private commercial entities respectively. WHO’s Secretary General supported the single policy option. Participants called for further analysis, particularly concerning the implications of differentiation, a procedure that is perceived to risk exclusion. The Executive Board requested that the director-general conduct public web-based consultations, and convene two separate consultations - one with member states and NGOs, and the other one with member states and the private commercial sector - to support the development of the respective draft policies.
The authors of this article argue that health is an important component of global security. However, the precise meaning and scope of global health security remains contested partly due to suspicions about clandestine motives underlying framing health as a security issue. Consequently, low and middle-income countries have not engaged global discourse on health security, resulting in an unbalanced global health security agenda shaped primarily by the interests of high-income countries, which focuses on a few infectious diseases, bioterrorism and marginalises health security threats of greater relevance to low and middle-income countries. Focusing primarily on African countries, the authors of this paper examine the implications of the participation deficit by the African Group of countries on their shared responsibility towards global health security. After analysing the potential benefits of regional health security co-operation, they conclude that, to ensure that global health security includes the interests of African countries, they should develop a regional health security co-operation framework.
The author points to how women and feminist activists are on the front line of the battle for ecological sustainability on the continent. Their everyday struggles, commitment, and willingness to envision a future in which justice, equity and rights harmonise with environmental sovereignty is said to have the potential to save us all. Wangari Maathai and her Green Belt Movement are said to epitomise the essence of African ecofeminism and the collective activism that defines it. As the first environmentalist to win the Nobel Peace Prize, in 2004, Maathai highlighted the close relationship between African feminism and African ecological activism, which challenge both the patriarchal and neo-colonial structures undermining the continent. Lesser -known activists, however, have also long been at the intersection of gender, economic, and ecological justice. Ruth Nyambura of the African Eco Feminist Collective, for example, uses radical and African feminist traditions to critique power, challenge multinational capitalism, and re-imagine a more equitable world. Organisations like African Women Unite Against Destructive Resource Extraction (WoMin) campaign against the devastation of extractive industries. Meanwhile, localised organising is also resisting ecologically-damaging corporatisation: in South Africa, Women Mapella residents fought off land grabs by mining companies; in Ghana, the Concerned Farmers Association, led largely by women, held mining companies accountable for pollution of local watersheds; and in Uganda, women of the Kizibi community seed bank are preserving local biodiversity in the face of the commercialisation of seeds by corporate multinationals. From Ghana to South Africa and beyond, women-organised seed-sharing initiatives continue to resist corporatisation. Activists like Mariama Sonko in Senegal continue to lead on agroecological farming initiatives for localised and sustainable food production. The author argues that the crisis of Africa’s current trajectory is a crisis of visioning: the inability of the continent’s leaders to imagine a process of development less destructive, more equitable, less unjust, more uniquely African, and – quite simply – more exciting. The positions, passions, and holistic approaches offered by African ecofeminism are argued to provide key ingredients for an alternative to the capital-centric ideals of economic growth that have defined progress so far.