The International Baby Food Action Network and the Third World Network review the World Health Organisation’s (WHO) reform process from a civil society perspective. (The WHO DG report on the reform is also included in this newsletter). The organisations argue that the reform process has not been transparent, as the Secretariat has withheld vital documents, such as the reports by consultants used to develop the reform agenda. With regard to stakeholders, they argue that it is important that WHO identifies the different types of social, political and economic actors with which it interacts and clearly distinguishes those that are related to commercial interests. The organisations refer to the WHO 12th General Programme of Work (GPW) as a sign of its direction, noting the unclear includion of work on the right to health, social determinants of health, primary health care and gender equality.
Governance and participation in health
This report covering all aspects of World Health Organisation (WHO) reform was commissioned by the WHO for submission to the 65th World Health Assembly in May 2012. It addresses the three substantive areas of WHO reform: programmes and priority setting, governance and management. First,with regard to programmes and priority setting, the draft general programme of work, as it is developed over coming months, will demonstrate: how agreed criteria have been used to identify priorities; how high-level goals have been set; and how WHO’s core functions, comparative advantage and organisational position have been used to focus its the work. Guidance from Member States will influence the development of a first full draft for discussion by the regional committees later in 2012. Next, the section on governance consolidates proposals under four main headings: more rational scheduling, alignment and harmonisation of governance processes; strengthening oversight; more strategic decision- making by governing bodies; and more effective engagement with other stakeholders. The focus of recent work has been the internal governance of WHO by Member States. More detailed work and consultation is called for in relation to the streamlining of national reporting to WHO as well as engagement with other stakeholders. Finally, the management chapter has been reorganised to reflect the fact that stronger technical, normative and policy support for all Member States should be a key outcome of reform.
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.
Utilisation of long-lasting insecticide-treated bed nets (LLITNs) by under-five children has been reported as unsatisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies have focused exclusively on coverage and ownership of LLITNs, so to address this research gap, researchers examined the effect of skill-based training for household heads on net utilisation. The study included 22 villages in southwest Ethiopia, with totals of 21,673, 14,735 and 13,758 individuals at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages (which received training) and 68.4% in the control villages (which did not) reported that they had utilised a LLITN the night before the survey. At six months, 81% of individuals in the intervention villages and 79.3% in the control villages had utilised LLITNs. Among under-five children, net utilisation increased by 31.6% at six months and 38.4% at twelve months. The researchers conclude that household level skill-based training demonstrated a marked positive effect in the utilisation of LLITNs. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITNs should be accompanied by a skill-based training of household heads to improve its utilisation.
This article evaluates progress in implementing the United Nation’s Global Strategy on Women and Children’s Health since it was released in September 2010. The Commission on Information and Accountability for Women’s and Children’s Health was created in December 2010 to oversee the implementation of the Global Strategy. Since then it has met with stakeholders twice and developed a strategic plan of action. Feedback from those meetings indicate that developing countries – in particular, African countries – face major obstacles in gathering birth and maternal mortality data. The future of the Commission remains uncertain, however, with stakeholders expressing skepticism about whether or not external funders will meet their commitments. In order to succeed in reducing maternal mortality, a combination of interventions is needed, including education on reproductive health issues; access to effective birth control and safe abortion; universal prenatal care; diagnosis and referral of high-risk pregnancies; a high percentage of births overseen by skilled attendants; and safe motherhood protocols for managing normal and high-risk births. However, reaching a consensus on which interventions should be funded is complicated, the article concludes, given the sensitive nature of maternal health issues, specifically family planning and safe abortion, which are opposed by conservatives.
Civicus argue that the Southern African Development Community (SADC) region is experiencing a major backslide in democratic freedoms. Recent restrictions on civil society in the region, whether through regressive laws, policies or vigorous persecution of activists, are argued to fly in face of the SADC treaty which calls upon its 14 members to uphold human rights and the rule of law and promote common political values through democratic, legitimate and effective institutions. The article cites examples from countries in the region, including from Zimbabwe, Malawi, Swaziland, Angola, DRC and South Africa.
According to CIVICUS, in 2011, the existing institutions of global governance failed to provide people-centred responses to the current global economic, social, political and environmental crises. Too often in key multilateral meetings and processes, the narrow national interests of states prevailed. The Durban climate change summit of 2011 (COP17) fell short of the decisive action required, as did the 2011 G20 meeting of the world’s most powerful economies. On the positive side was the launch of the new United Nations body, UN Women, as well as the Busan High-Level Forum on Aid Effectiveness, and many of the stances adopted by the UN Human Rights Council in Geneva, particularly during the Universal Periodic Review, its peer-reviewed assessment of human rights in UN member states. In Busan and in Geneva, the space guaranteed to civil society enhanced the credibility and quality of the process, and these procedures should be regarded as minimal standards that should be extended to other arenas. A predicament for both states and civil society alike is the fact that disconnected summits purport to address intertwined issues such as economic growth, development effectiveness, climate change and human rights in silos. Civil society organisations must combine to advocate for a multilateral system that has the reach and ambition to tackle connected challenges and the imagination to put global interests first.
In December 2011, the Global Health Security Initiative (GHSI) celebrated its 10th anniversary with a ministerial meeting in Paris, France. This article chronicles the achievements of the Initiative in global health security, namely the development of globally common methods for the assessment of global health threats and risks, such as the H1N1 flu virus, and the mainstreaming of a multidisciplinary approach on health security. The Initiative has been involved in: setting up information-sharing networks, such as a contact emergency network for communication among health officials; the establishment of general guidelines for risk communications; the design of a ‘risk incident scale’ for global health emergencies; and the development of evidence-based research for policy making related to human decontamination. Although the Initiative is limited to only the eight countries, the network is working with the World Health Organisation to share the best practices with the broader global health community.
The aim of this paper is to support all stakeholders who are developing or researching universal health care (UHC) reforms and who wish to conduct stakeholder analysis to support evidence-informed pro-poor health policy development. It presents practical lessons and ideas drawn from experience conducting stakeholder analysis around UHC reforms in South Africa and Tanzania, revealing that differences in context and in reform proposals generate differences in the particular interests of stakeholders and their likely positioning on reform proposals, as well as in their relative balance of power. It is, therefore, difficult to draw cross-national policy comparisons around these specific issues, the authors caution. Nonetheless, they argue that cross-national policy learning is possible with regard to choosing approaches to policy analysis and management of policy processes, but stakeholders should avoid generalisations when comparing UHC reform packages and should rather focus on how to manage the reform process within a particular context. The authors emphasise that stakeholder analyses can be used both to think through the political viability of new policy proposals and to develop broader political management strategies to support policy change.
In response to the announcement that World Bank President Robert Zoellick will step down at the end of his term on 30 June 2012, a global coalition of campaigners has called for an open and merit-based process to elect the next World Bank leader, and for developing countries to determine the selection. The campaigners, including many major development organisations, have also asked the United States to announce that it will no longer seek to monopolise the Presidential position. A “gentlemen’s agreement” between Europe and the US dating back to World War II has so far ensured that the President of the World Bank is always an American, and the International Monetary Fund’s Managing Director is European. In this open letter, the campaigners demand that the new President is selected by a majority of World Bank member countries, not just a majority of voting shares, as most members are low- and middle-income countries. They also demand that the selection process be opened to anyone to apply, with interviews held in public and with open voting procedures. A clear job description and necessary qualifications should be set out, requiring candidates to have a strong understanding and experience of the particular problems facing developing countries.