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Balancing idealism with reality at the 69th World Health Assembly

By Radhika Arora
on May 26, 2016

This time, last year I logged on to WHO’s website to catch the proceedings of the 68th  World Health Assembly (WHA) online; I never in my wildest dream expected to find myself at the WHA69 in person! And yet, here I am, attending the WHA as an IHP Correspondent, navigating a calendar packed with more events and discussions than one can humanly attend. What’s more is that this isn’t any ordinary Assembly. It’s the assembly with the most number of delegates and the most number of items to be discussed (or “resolved”) on the agenda, ever! Luckily, I’m “shadowing” a WHA veteran, ITM researcher Remco Van De Pas.

Preparations for the visit began with a review of the documents which the WHO generously uploads in the weeks preceding the assembly. Unfortunately, no instruction manual comes with the documents. Help came in the form of ITM’s WHA regulars, and the people at the Graduate Institute Geneva, who conduct an introductory session to the WHA for new delegates the day before the Assembly. This critical session fortifies jet lagged participants with coffee and a thorough introduction to the WHA, supplemented by an overview of the main agenda(s) of the year – equipping us with some tools to tackle the week ahead!

Still, nothing quite prepares you for the first day of the WHA. Indeed, the first day at the WHO and UN buildings. This can be a moment in itself for first timers. A time to quietly reflect on the fact that it is, often, in these walls that decisions which affect the health and wellbeing of millions of people worldwide are taken; a place where power, politics and principle must coincide – sometimes they do anything but –  to balance the needs and interests of the various stakeholders in decision making processes on everything from health, security, aid and much, much more – often by people whose political, social and economic contexts are far removed from those on whose behalf these decisions are taken.

Returning to the Assembly itself, the WHA is not what I expected. Close on the heels of the Women Deliver conference in Copenhagen, with its walking turd, menstrual-cup chandeliers and social media, the WHA is one of gray suits and diplomatic discussions taking place in large soundless rooms. It struck me as odd, and made perfect sense that these discussions among member states on health agendas of critical importance take place in a room audibly silent, yet not. It also took me a moment to digest the fact that this is not a scientific conference with researchers coming together on a particular area of interest and study, with a sprinkling of policymakers. Indeed it’s quite the opposite – it’s a congregation of policy makers with a sprinkling of health workers, researchers, activists and others.

Day 3 at the WHA ended with a rainbow over “the Palais”; surely a cheerful note to end the day. By then, it had been three days of frantic diplomacy, closed door meetings (the Framework on Engagement with Non-State Actors (aka “FENSA”) is being discussed behind closed doors), lots of side-meetings, technical briefings and one sandwich too many perhaps. Seasoned WHA attendees or “watchers” might decide to use their time better by following discussions on a particular topic, area of interest or researcher. I had a more Dory-the-fish approach. From the plenaries, to the side-meetings, technical briefings and country discussions – trying to cram in the latest on adolescent and women’s health, urban health, SDGs and health systems. Discussions on these will follow in subsequent blog posts.

In the wake of the Ebola crisis, and more recently Zika and Yellow fever outbreaks/crises, the WHO role in responding to health emergencies, as well as developing country capacities to respond to global health emergencies was high on the agenda. Margaret Chan’s severe warning against untreatable gonorrhea provided comic relief to an audience presented repeatedly with the terrifying possibility of a world without usable medicines, the threat of Anti-microbial Resistance (AMR), another “hot topic” at the Assembly.  A lot is going on. Maybe too much; almost everyone has remarked on the packed agenda – some appreciate it, whilst others (including China) expressed the need to limit the items for discussion on the Executive Board and WHA menu. Anyway, against the backdrop we know, global health security and the implementation of the International Health Regulations (IHR) have emerged as a priority.  The issues of UHC, global health security and health system strengthening towards achieving the SDGs, and of course in the context of health security are some of the leading themes under discussion. In addition, almost all discussions, whether it’s on improved emergency response, or improving the health of women, children and adolescents highlight the need to invest in human resources (Committee B this year). With the need for an estimated 40 million health workers by 2030 this is certainly a pressing issue and one that has been stressed upon, as Dr. Marie-Paule Kieny, Assistant Director-General – Health Systems and Innovation, emphasized: “there is no health security without health workers”. Discussions on the migration of health workers, looking for better economic prospects have been highlighted in technical sessions and other discussions; however committee proceedings on human resources for health are not yet over.

Over to some of the (usually packed) technical briefings then.

Health in the 2030 Agenda for Sustainable Development: Intersectoral Action was the first technical briefing of the week. The session focused on partnerships, intersectoral action and health system strengthening towards achieving the SDGs. Gender and the role of women towards achieving the SDGs, as well as using the goals in the SDGs, particularly on health workforce strengthening was emphasized as an opportunity to increase the participation of women in the workforce. David Sanders from the University of Western Cape brought attention to the issue of health worker migration, articulating a need to potentially compensate countries for “brain robbery”, in other works, the migrant health workers trained in source countries. The second technical briefing, Survive, Thrive, Transform: implementing the Global Strategy for Women’s, Children’s and Adolescents’ Health summarised the Global Strategy and called for country leadership to provide the necessary stewardship and financing towards improving the health of women, children and adolescents – the next generation. Dr. Chan emphasized the need to engage men in the discourse on women and adolescent health, emphasizing that “It’s not either/or. We need to work together”.



It was interesting to note that almost all discussions stressed on the need to focus on the health workforce; the need for partnerships not just for implementation, but financial stability – of programs, institutions and overall health sector development at the national and global levels. Interestingly the private sector received much attention and emphasis across sessions. Throughout, the need to increase and generate funding at the national level and reduce dependence on overseas development assistance was emphasized. Of course, this would also imply strengthening links between the ministries and getting cozy to the ministry of finance, and learning their language. As was said during a session on the High-Level Commission on Health Employment and Economic Growth, “If you want to sell a message to a hard-nosed finance minister, equity isn’t going to cut it, efficiency is”. Women were almost in a calculative way equally represented at all panels which was interesting (Twitter didn’t seem to agree, though). Anyway, it is extremely heartening to see a large number of female participants, some of whom can be seen with their infant children. I do think the WHA needs to make a conscious effort to engage with and bring across young researchers from less wealthy countries. I noticed a number of young people and medical students from North America and Europe – but few (at least none that I spoke with) – from developing countries.

A focused summary on the various subjects tackled during the last three days will require dedicated blog posts (keep an eye out!). I do think it’s necessary to prepare and be ready for any health emergencies, but also feel that we must not lose our focus on strengthening health systems, especially in low resource settings – this I believe will ensure a far more sustainable and consistent readiness in times of national and global health crisis. Many global health people make this connection, clearly, but ‘hard-nosed’ ministers of Finance and their bosses sometimes don’t.

Time at the WHA is flying by faster than expected; as a newbie you can jump right in, or ease into it as I did. However, it is going to be a while before I can comfortable cue into what transpires behind the words, and become proficient in “Geneva-nese.”  Do watch out for my book on ‘The WHA for Dummies”.  For the moment, in the words of Dr. Chan, I’m going to “roll-a-skate”!

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