WHO Gears Up For Reform Driven By Financial Shortfall

The Executive Board session of the World Health Organization ended early on Monday after a week of discussions that settled some issues but left some others for the next governing meeting of the organisation in May, with much to do until then. The WHO is facing a significant gap in its budget and a programme of reforms is brewing.

The 128th Executive Board session took place from 17-24 January. The WHO secretariat was asked by the Board to provide reports to the annual May World Health Assembly (WHA) on a number of subjects, such as counterfeit medicines, a programme of reforms, next election of the director general, and research and development financing, and time seems short.

Margaret Chan, WHO director general, told the opening of the Board meeting that the agency is under-funded, and according to the implementation of the programme budget 2010-2011 [pdf], “the best-case scenario presents a US$ 200 million difference between projected income and expenditure, a worst-case scenario presents an equally possible shortfall of up to US$ 600 million.”

The budget summary shows concern about distribution of funds across WHO programmes, with many funds earmarked for specific activities. Donor countries have increasingly targeted their spending toward results in their own interest, leaving some basic public interest needs wanting.

According to the draft proposed programme budget for 2012-2013 [pdf] to be approved at the WHA [clarification: after revisions asked by members], US$ 4.8 billion is needed to run all the activities covered by the organisation, showing an increase of US$ 264 million compared with the approved budget for 2010-2011 due to “adjusting the Special programmes and collaborative arrangements and outbreak and crisis response budgets to the realities of their funding and implementation.” The WHO fiscal year is aligned with the calendar year.

In a summary of Chan’s concluding remarks [pdf] on the future of financing of WHO dated 22 January, she said discussions on the subject had “provided an outline of our collective vision for the future of WHO.” She recalled WHO’s role as the “directing and coordinating authority on international health work.”

This vision, she said, “must be worked out practically, through a programme of reform that I will present to the WHA in May 2011.”

Chan described three elements of the reform programme. The first one is a plan for strengthening WHO’s central role in global health governance, including a multi-stakeholder forum. Second is a systematic objective priority-setting, with “a financing model that ensures the core functions are adequately funded.” The third one is a “detailed plan for managerial reform in WHO,” including a results-based planning framework, a roadmap for implementation, and a plan of action for “enhancing accountability and transparency” with a mechanism for independent evaluation.

The vision also included a revised human resources strategy “facilitating recruitment of high quality, competent, experienced staff to provide high quality service to member states.” Chan said she would present plans to the upcoming WHA after an “extensive process of consultation with member states, staff and other partners.”

Election Process for Future DG

The upcoming election of the WHO director general in 2012 brought on the subject of geographical rotation favoured by some countries. Previous directors have come from only three of the six regions of the WHO. Burundi, on behalf of the African region, submitted a draft resolution on the principle of geographical rotation but this principle was described by some countries as posing a danger of overriding more important selection criteria such as expertise and experience. A drafting group was set up to try to find consensus and a draft a resolution before the end of the Board session (IPW, WHO, 18 January 2011).

On the last day of the Board meeting, the chair of the working group, A.J. Mohamed of Oman, reported that a consensus had been found. The draft resolution [pdf] approved by the Board recognised that “due regard should be paid to the importance of recruiting future Directors-General on as wide a geographical basis a possible from Member States of the six regions of the WHO.” It was decided to establish a working group on the process and methods of the election of the DG of the WHO, open to all member states.

Burundi on behalf of the African region said that the draft resolution “was not perfect” but was an opening for a methodological analysis of this issue. The European Union and China said they welcomed a balanced resolution. Most countries which took the floor, such as the United States, Canada, Yemen, Barbados, and Burundi said they wished to take part in the working group, which should submit an interim report at the WHA in May, and a final report, including recommendations at the 130th session of the Executive Board in January 2012.

First Global Ministerial Conference on Non-Communicable Diseases

Delegates also discussed the prevention and control of non-communicable diseases and Barbados submitted a draft resolution [pdf] cosponsored by New Zealand, Norway, the Russian Federation and Trinidad and Tobago on 24 January to which Bangladesh added some text.

According to sources, some delegations said the text was submitted too late to be adequately discussed and the issue was left to be addressed at the WHA. Bangladesh’s additions were mainly about access to affordable diagnostic tools and medical products, and to “develop and implement legal and policy tools, as appropriate, to ensure access to affordable care and treatment.”

Russia will be co-organising with the WHO the first global ministerial conference on non-communicable diseases and healthy lifestyles in Moscow on 28-29 April.

Patents at Heart of WHO-WIPO-WTO Symposium

On 18 February, a joint technical symposium will be organised by the WHO, World Intellectual Property Organization and World Trade Organization, hosted at the WHO.

The focus of this second joint symposium will be the importance of patent information for public health related to research priorities and strategies, medicines procurement, and technology transfer to improve access to medicines.

The event will congregate speakers from the three agencies, institutions, and panellists from the generics industry, the research-based industry, procurement agencies, and patent offices. The symposium aims to identify information gaps, highlight the importance of patent information access for access to medicines, and “show how patent information can be used in determining the freedom to operate for improving access to medicines.”