WHO executive board met in Geneva
Dr Luisa Pettigrew, Wonca Council representative for the United Kingdom took the opportunity to attend the World Health Organisation (WHO) 130th Executive Board meeting, in Geneva, from January 16–23, whilst undertaking an internship at WHO headquarters. Following are excerpts of her report to Wonca leaders on this meeting and her personal perspectives on the meeting and its issues.
As my first attendance at a WHO Executive Board meeting, it was a real challenge to fully embrace the overwhelming range of terms and acronyms used as well as to understand the exact role of member-states and observers present. However by the end of the week I had started to get a grasp of proceedings.
For readers who, like me, may be novices to the world of WHO meetings I will share with you some background information (for those already familiar feel free to move on!):
An introduction to WHO meetings
The WHO assembly is currently made up of 194 member states. This is the WHO's decision making body. It meets annually at the World Health Assembly (WHA) in May.The WHO Executive Board (EB) is made up of 34 member states, each serve a three year term and are elected by the WHA. WHO EB meetings take place twice a year, these guide and follow-up on the WHA agenda.
Both WHA & EB meetings are attended by all member-states, although at EB meetings EB members speak first and ultimately decisions to pass resolutions lies with them. In addition, a range of different categories of observers are invited. These include: non-member states (e.g. the Holy See), observers (e.g. Global Fund), observers invited under special resolution (e.g. Palestine), representatives of the United Nations and Related Organisations (e.g. World Trade Organisation), specialised agencies (e.g. World IntellectualProperty Organisation), other intergovernmental organisations (e.g. European Union), and Non- Governmental Organisations (NGOs) in official relations with the WHO.
Wonca is recognised as a non- governmental organisation (NGO), which has been approved to be in ‘official relations’ with the WHO. Other organisations under this umbrella term include; patient interest groups, religious organisations, pharmaceutical organisations, food industry organisations, humanitarian and development organisations and other health professional organisations.Throughout the course of the EB behind the scenes work takes place where informal country and observer coalitions form to propose changes to reports and draft resolutions. Prolonged discussions between groups of countries over what could be perceived as minor word changes, but could potentially have a significant impact, are a frequent occurrence at WHO meetings.
To speak on an agenda item, otherwise known as making an 'intervention', as an observer you must submit your statement 24 hours before the agenda item is discussed. If it is felt to be factually correct and relevant to the discussion by the WHO secretariat you will be granted an opportunity to speak.This year for the first time a traffic light system was introduced to limit interventions by both member states and observers to three minutes. This seemed to be very welcomed by most!
In the spirit of collaboration, on even the most controversial of matters, the EB worked to reach a consensus and avoid resorting to a vote. It was interesting to hear the WHO's legal advisor indicate that he could remember few times when￼ the EB had not be able to reach consensus.
An overview of the 130th WHO EB meeting
It is truly hard to do justice to the depth and breadth of discussions which took place over the course of a week within a couple of pages. Below I have only been able to highlight a handful of discussions and comments from countries, however all the agenda reports and resolutions for this EB meeting, which provide a wealth of information on the topics covered, can be accessed on the WHO website: http://apps.who.int/gb/e/e_eb130. html
Director General's Report: our lop- sided world
The observers' balcony and overflow balcony for member states were packed as Dr Margaret Chan, Director General of the WHO, gave her annual report. She indicated that "our world is in very bad shape", noting that 2010/11 had brought an unprecedented number of natural disasters including floods, drought, starvation in the horn of Africa, a tsunami and the ensuing nuclear disaster. Also, she noted that it had been a year of economic crisis, protests and uprisings which were, as she described, a result of "social malaise". This had highlighted the need to pay greater attention to inequalities in terms of both income and opportunities, particularly for young people in the world today. Drawing attention to the fact that GDP is steadily rising in many countries whilst at the same time more people are falling below the poverty line she described a pressing "need to introduce greater balance in our lopsided world" where good policies that focus on equity, fairness and social justice are urgently needed.
She observed that we now have a much better understanding what works in public health and offered examples of positive indicators, such as the fact that that mortality in children under five years old in Sub- Saharan Africa is falling at double the rate that it was between 1990 - 2000, and that the HIV epidemic appears to have stabilised. The polio eradication programme is on track, however she warned that the WHO must stay the course otherwise it may be one of public health's most expensive failures.
Dr Margaret Chan emphasised the pressing need to address the new challenge of Non-Communicable Diseases (NCDs) with the need to shift from a focus on acute care and treatment, towards long-term care and prevention. She acknowledged that the first wave of NCDs was already upon us, and warned that the second wave was yet to come which would be "much more horrific" if the root causes were not addressed now.
￼￼￼WHO 130th EB meeting Jan 2012 - observations from the upper circle!
Changing actors within the global health arena and financial ￼challenges have resulted in new breeds of research and development partnerships. These, Dr Margaret Chan indicated, need to continue to be developed alongside new methods of securing transparent funding.
Finally there was no escaping the fact that the WHO has embarked on a major reform process as a result of its own internal financial crisis and that there is mounting pressure for it to improve transparency (in particular with regards to stakeholder relationships), improve planning and prioritisation of work, as well as address issues in its human resource management.
With only one candidate it was of limited surprise that Dr Margaret Chan was elected for her second five year term. The board also elected Dr Ala Alwan as Regional Director for the Eastern Mediterranean Region. The outgoing Regional Director, Dr Hussein Gezairy, will become the WHO envoy for polio and primary health care.
Monitoring the achievements of the health-related millennium Develop- ment Goals (MDGs)
As the 2015 MDG deadline draws closer it was noted that although statistics indicate that the death rate due to HIV is falling and despite progress being made in some countries, worldwide MDGs regarding child mortality and maternal health are the furthest away from being achieved.
Numerous countries highlighted the need for greater integration of health into wider global and political agendas, strengthening of multisectoral cooperation and strengthening of health systems. The more potentially politically 'controversial' comments came from the NGO observers such as Médecins
Sans Frontières, that highlighted the Global Fund's unprecedented decision to cancel new funding for this year, asking the WHO to urge countries who had not met their pledges to do so.
What new goals would be set after 2015 was a matter of concern. Many commented that ‘good indicators’ were needed alongside the recognition that targets were useful to monitor progress. Some countries indicated that new goals should reflect a changing global context where “action beyond aid” should be encouraged. It was also highlighted that the terms ‘developed’ and ‘developing’ country were outdated. There was general recognition of the need to address challenges that were relevant to all societies such as climate change, NCDs and financial crises.
It seems that the jury is still out on the UN's next set of development goals; however Dr Margaret Chan made it clear that both polio and health systems strengthening would be amongst her priorities.
Prevention and Control of NCDs
The observers' balcony was packed for this session reflecting the momentum this subject has gained over recent years. Following the United Nations high-level meeting of the General Assembly last year, the WHO has been given the responsibility of implementing the Global strategy for the prevention and control of NCDs and action plan. This action plan has six objectives in relation to NCDs: including raising their priority level, strengthening policies for their prevention and control, promoting interventions to reduced modifiable risk factors, promoting research, promoting partnerships, and monitoring and evaluating progress at all levels.
There was widespread support for this matter. Japan highlighted how NCDs had become a major issue due to ageing populations. India amongst several others highlighted the need to address the role that the alcohol and tobacco industries have. Brazil, with reference to the right to access medicines, urged here and at numerous other points during the meeting for there to be greater flexibility to intellectual property agreements.
There was frequent reference to the need to regulate the private sector and their involvement in influencing health policy and in their ‘official relations’ with the WHO. Opinions seemed to vary between countries on the subject of differentiating between types of NGOs. Some countries requested clearer definitions on what was civil society, whereas others suggested that all NGOs had vested interests and attempts to formally distinguish between them would be difficult.
Global Burden of mental Disorders
A resolution was brought forward by India, USA & Switzerland on the 'Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level’. Most countries were in favour of this resolution, although it was highlighted that the document lacked recognition of the need for wider social policies to strengthen preventive strategies. There was also debate on whether neurological disorders and substance abuse should be included in the resolution. After numerous modifications the resolution was accepted. This can be found on the WHO website.
Poliomyelitis: intensification of the global eradication initiative
India was congratulated after reporting being free of polio for one year, but concerns were raised about ￼outbreaks earlier this year in Pakistan and Nigeria. Dr Margaret Chan gave a passionate speech about the need to continue to strive to eradicate polio. The budget for 2013–2018 is estimated at USD1,896 Million.
Global Vaccine action plan: update
This item raised questions about the role of introducing new antigens in national immunisation campaigns, as many countries highlighted the document lacked clarity on this. Proposals were made to hold 'World Immunisation Week' again. The event is planned to take place around late April this year.
There were further resolutions passed on promoting active aging; schistosomiasis; 2011 world conference, held in Rio, on the social determinants of health; substandard / spurious / falsely-labelled / falsified / counterfeit medical products (although not on a definition of these yet!); the WHO’s role in humanitarian emergencies; and numerous other progress reports were noted by the EB. Details of these are on the WHO website.
A personal perspective
From a family doctor's perspective the moment seems ripe for primary health care to be pushed forward again, to the frontline and into the core of health systems worldwide. The increasing awareness of the burden of NCDs and mental health, of the need to strengthen health systems, of the role of the social determinants of health, of the need to move away from purely vertical programmes, of the rising cost of health care and a general desire to revisit the objectives of the 1978 Alma Ata declaration all indicate, as the 2008 WHO report has done, that primary health care is really needed now more than ever.
The term 'primary health care' was frequently used. Although some reference can be found within the text of reports and resolutions, as an outsider observing discussions for the first time, I felt that there was limited debate amongst member- states around what was actually needed to have an effective primary care system. Such WHO meetings seem an extremely valuable forum to raise awareness of the need to invest in appropriately trained, equipped, empowered and motivated community health workers, nurses and family doctors; to work together to address the ongoing "brain- drain" of health workers worldwide; to find practical ways that health workers can be supported to help address the social determinants of health and stimulate inter-sectorial collaboration at all levels; to prioritise work which moves health systems closer to universal coverage; and of course, for the political will to implement policies to support all of the above.
Further collaboration with other professional and patient interest NGOs, as well as increased dialogue between all Wonca representatives and their respective WHO delegations will help inform interventions that member state and observers make so that the primary care voice is heard loud and clear in the WHO.