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A “make or break year” for WHO and its new leadership – Discussion on the 13th General Programme of Work at the 142nd session of WHO’s Executive Board

By on January 26, 2018

Manager Quality Improvement and Quality of Life (MNCH & NCD), at the Karnataka Health Promotion Trust, Bangalore, India

Over the past few days, I’ve been fortunate to attend the first half of the 142nd session of WHO’s Executive Board meeting in Geneva, after a couple of  preparatory civil society meetings  hosted by the Geneva Global Health Hub (G2H2). The EB meeting provides a fresh start to the new (global health) year, and the hope is of course that for WHO a similar fresh start is in the making, under Dr. Tedros’ leadership. Speaking of the new WHO DG, after a special EB meeting in November last year (EBSS4), this “normal” EB meeting is considered by many global health observers as the first ‘real’ test for Dr Tedros and his team. In this short viewpoint, I’ll mostly focus on how the 13th General Programme of Work has been received at WHO’s headquarters, without aiming to be exhaustive, obviously.

As expected, at the start of the Board meeting, member states agreed to discuss all items on the agenda, including the  13th General Programme of Work (13GPW).  Ahead of the EB meeting, a lot of analysis and critical reflection on the ambitious 13GPW and its budget implementation plan had already taken place (see here and here for example), which clearly suggests the focus of the global health community on WHO at  this important point in time, and the high expectations towards the new DG in many corners.

DG Tedros, also known as “the people’s DG”, was quite emotional in his speech on the opening day as he cited the (very recent) murder of two polio healthcare workers (a mother and her 18-year-old daughter) in Pakistan and expressed his utter sadness over the issue of violence against health workers. Tedros then laid out his vision on the future of WHO, in the form of the (now revised) 13GPW, and how changes like a greater focus and prioritization (of UHC & people-centred care, a healthier population, health emergencies), a more detailed implementation plan, and clarification of WHO’s position on its normative role (vs a more operational one) have taken place since the last EBSS in November. He then emphasized that WHO is committed to transformative change: strategic priorities are being set, resource mobilisation revamped, and Tedros himself aims to set an example by having a dynamic leadership structure at the highest level, including – as you know – many women. All in all, he said, 2018 will be a “year that will determine what WHO looks like in the future”. Put differently, this will be a “make or break” year (or 18 months) for WHO, both in terms of structure & functioning. The GPW, the transformation, resource mobilization and strong leadership all need to go together, Tedros emphasized. But of course, real commitment from the member states will also be required if Dr Tedros and team are to pull off this ambitious agenda in the coming years. As he mentioned in November, “It takes two to tango”.

In the discussion on the GPW and its implementation plan this week in Geneva, the multi-stakeholder approach and financing of this ambitious agenda were some of the main matters of concern.

On partnerships and multi-stakeholder participation the new DG used fairly strong words, saying that a truly dedicated multi-stakeholder partnership (comprising member states, the private sector, and civil society) would only build a united force for a common goal. He responded to conflict of interest concerns raised by some civil society speakers who claimed that there’s a big risk that more explicit involvement of the private health sector might lead to undue commercial influence in the programme of work, distorting progress towards health equity (thereby impeding progress towards UHC and other health SDG targets), and norm-and standards setting. Tedros addressed their concerns in a quite emotional and open manner, as is becoming his trademark. He told the audience that, with greater faith in 13GPW, it is possible for all to join hands while keeping conflicts of interest close to zero. Tedros was perhaps overdoing it a bit, here, as it was rather obvious from their interventions that some countries (like the US, Italy) were keen on a (far) more prominent role for the private sector. And as you know, the Americans are still a big WHO funder, at least for now. Conflict of interest risks will probably remain an issue till long after Tedros has moved on. Anyhow,  the DG called on everybody to work together and rise above individual egos and pet priorities. There was not much discussion on the implementation of the Framework of Engagement with Non-State Actors (FENSA), in the light of the GPW assumption that multi-stakeholder participation can be the model while remaining an independent and transparent global health body.

Resource mobilisation for the GPW was another major point of discussion under the specific agenda item. Days before the EB meeting, the Programme, Budget and Administrative (PBAC) committee got together. The committee estimates in its report that a total of 10.8 billion USD will be needed for the implementation of the GPW over the next five years for the base segment of the budget. Based on the already approved programme budget 2018–2019, this represents a US$ 2 billion increase over the five-year period, or an increase of about US$ 400 million per year. Keeping the GPW in mind, a programme budget with two segments was proposed, namely: a base segment and scalable operations. As per the PBAC report, the scalable operations segment would include emergency response, the remaining activities of the Global Polio Eradication Initiative and special projects – special projects are typically unforeseen negotiated projects at the country level, which are essential in implementing the strategic priorities of GPW 13. However, the budget discussion was postponed at this EB meeting. It will be discussed at EB143 and the World Health Assembly in May, to be then finally adopted/approved at the WHA 2019. But the Secretariat will work on “transformative resource mobilization”, it was assured. PBAC made it clear that adoption of the GPW did not imply adoption of the budget estimated for it. Like in November, the DG called upon member states to provide more un-earmarked funding and move from just quantity of funding to better quality of funds. With more flexible (un-earmarked) funding, there will be greater scope for prioritizing, Tedros argued. However, in the EB there was not much of discussion on how to increase the assessed contributions, signalling a kind of (weary?) acceptance of the fact that most of the budget will still primarily come from earmarked funding. There was hardly any discussion on chronically under-funded areas like NCDs and access to medicines.

To conclude: it is high time now to see the implementation of the GPW on the ground (which will only start in 2020, though, according to the plan) and move from words to action, in line with the “Move the caravan on the road” jibe by the Turkish spokesperson.  A  revised (final) draft of the GPW is already out, incorporating some of the comments and feedback received from member states. If all goes well, this GPW will be agreed upon and approved in the EB meeting in May 2018 (143rd EB) and the World Health Assembly.

And then the real work can start.

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