Editorial – Reforms at WHO

Reforms at WHO

At the 2011 World Health Assembly, the director-general of the WHO presented “The future of financing for WHO” proposing an agenda for reform, focusing on the organization’s financing and a better alignment between objectives and resources. This first report eventually evolved towards a proposal for more essential reforms of the organization, as outlined in “WHO reforms for a healthy future”, which was presented to a special session of the Executive Board (EBSS) in November 2011.

The document outlines the three main pillars of the proposed reforms: 1) programmatic work and priority setting, 2) governance and 3) management reforms. The EBSS did not approve the proposal as such and requested additional analysis. The reforms are again on the agenda of the Executive Board meeting next week (16-23 January 2012).

The planned WHO reforms are extensive, and (potentially) of great importance for global health. Many comments and opinions already circulate, which we do not wish to repeat. However, following an internal discussion at ITM, there are still three issues worth highlighting:

• The importance of an appropriate consideration of civil society. The progressive empowerment of civil society in the past decade should be seen as an opportunity. Active and regular dialogue will support WHO in its pursuit to adequately respond to the true priorities in global health. Even if the Member States keep the final decision power, the implication of civil society at local, national, regional and international level provides an essential contribution.
• The link between finances and influence. Prioritisation should be at the centre of determining resource implementation, instead of the earmarking of voluntary contributions. Strong oversight is needed to ensure efficient use of resources and maintain (or build again?) trust in the organization. In return, more financial flexibility will also better allow WHO to play its leadership role in global health.
• Clarity on WHO’s role. It needs to be recognised that WHO’s normative powers in health cannot be translated in the same manner in every single country, nor should they. Its role might thus vary depending on the development of health services and systems on (sub-) national level. Allowing the organization the flexibility it needs in implementing its programme priorities, adapted to the different contexts, will increase its operational efficiency.

The Executive Board meeting next week is expected to provide a final proposal to the World Health Assembly which takes place in May. Considering the little time foreseen for the reforms on the Board’s agenda and the delayed feedback to the comments of the EBSS, it is likely that discussions will continue in the coming months. A few months from now, Belgium will become a member of the executive board (for a three-year period). Obviously we will continue to contribute to these discussions.

Evelyn Depoortere (ITM)