Day Four at the 64th WHA

Highlights from the fourth day of the 64^th World Health Assembly

Geneva, 19.05.11

Technical briefing: Commission on Information and Accountability for Women’s and Children’s Health
A technical briefing to discuss the advance report of the Commission on Information and Accountability for Women’s and Children’s Health was convened. It was chaired by the state representative of Tanzania and co-chaired by the Minister of Health of Senegal and the General Secretary of YWCA. The objective of this briefing was to provide an overview of the framework developed by the Commission of in order to empower both donor and recipient countries to monitor resources and facilitate the gathering of the best evidence on the effectiveness of programmes to improve the lives of women and children. The Commission, established by the Director General of  WHO, follows on the launch of the UN’s Global Strategy for Women’s and Children’s Health. The Commission was chaired by H.E. Jakaya Kikwete, President of Tanzania, and Mr. Stephen Harper, Prime Minister of Canada; with the DG of WHO and Secretary General of International Telecommunication Unit (ITU) as vice-chairs. With them, the Commission included 30 other commissioners, including Novartis Foundation, the World Bank, and the Gates Foundation. The Commission first met in January 2011, and held a final meeting in May 2011 to finalise their draft report. The work of the commission was informed by two Working Group – on Results and Resources – and numerous technical inputs from a wide range of stakeholders as well as public consultations.  Introductory remarks by the chairpersons addressed the challenge to implement the Commission’s recommendations in order to make more accelerated progress on MDGs 4 and 5. In this context, the need to enhance health information systems was stressed. Next, Dr. Margaret Chan and Dr. Toure (Secretary General of ITU) presented an overview of the Commission’s report, with its 10 recommendations, grouped in 3 major items: better information for better results (highlighting the importance of having reliable vital statistics, appropriate indicators and integrated use of information and communication technologies), better tracking of resources for women’s and children’s health (resource tracking, country compacts, and reaching women and children), better oversight of results and resources: nationally and globally (national oversight, transparency, reporting aid for women’s and children’s health, and global oversight). The Commission’s advance report is available here. This overview was followed by a Panel Discussion with questions and comments from the floor. The NGO Corporate Accountability initiative questioned the involvement of private for profit organizations and the need to ensure minimization of conflicts of interest .It called for a distinction between NGOs that are working to promote public interest and those working for profits. She called on WHO not to legitimize such organizations. These issues were inadequately handled by the panelists, starting with Dr. Toure who tried to compare private sector participation in the telecom sector with that in health. He said that the private sector will make profit, which is normal as long as they follow the rules of engagement and create jobs for the people (!!!). Dr. Klaus Leisinger (from Novartis Foundation) advised to judge private companies individually, it’s not true that all of them are this distortive. His company, for example, is not in the food business, so he advises not to make a judgment of the private sector as a whole. The panelists and chairs made signs of agreement. On her part, Dr. Chan said there were good and bad private sector organizations, and WHO will pick the good ones and run with them. In the end, the work of the Commission was strongly praised, with strong support from Health Four Plus (H4+) [WHO, UNICEF, UNFPA, WB and UNAIDS]. More information on the Commission can be found at: http://www.everywomaneverychild.org.

Side meeting: Meeting the Millenium Development Goals by improving global health governance
This meeting, organised by World Vision International and The Graduate Institute, Geneva Global Health Programme, was in some ways a "follow up" of the gathering held in Delhi at the beginning of May, where a group of NGOs and associations got together to discuss the perspectives of global health governance (GHG) in the light of the announced WHO reform.
The meeting was chaired by Richard Horton, chief editor of The Lancet, who introduced the seminar stating that the current GHG situation is a "chaotic mess". However, he showed optimism for the unprecedented level of spending in GH, even in a period of economic crisis, as well as for the developments of science. Referring to the promising results of trials on the preventive use of antiretrovirals (ARVs), he then predicted a sharp increase in ARVs demand across the world, and more generally a scaling up of health needs that will require increased spending, coherence and efficacy of interventions. While GH initiatives and private donors are expanding their role and impact, WHO is contracting. Referring to Bill Gates and the role his Foundation is playing, he expressed some criticism and concern on the fact that a single man - thanks to his wealth - is actually shaping the GH agenda across the world, way above any democratic and legitimate institution.
He then gave the word to the former Ministry of Health of Hungary, and current president of the WHO Executive Board, Mihály Kökény, who stated that the riform is mainly needed in order to make WHO "fit-for-purpose" in today's world. The financial issues are but an accelerating factor. According to him, an intergovernmental body can not be in the leading position in a landscape in which many other actors, including NGOs and the private sector, are increasingly playing relevant roles in global health. He added that, from the consultations held with member states, a possible solution would be the creation of a "small forum" as a pilot project for three years, that should coordinate with WHO governing bodies and work at the development of a "global health charter", described in terms of "soft law".
The second panellist to speak was Gaudenz Silberschmidt (Head of International Affairs, Swiss Federal Office of Public Health), who stated that member countries have the main responsibility for the present financial crisis of WHO. He proposed to think mainly in terms of "GH topics" and "GH roles and functions" in order to identify WHO core business in areas where there are no other actors who can accomplish them. According to him, WHO should not be a financing agency nor an implementing agency, but it should rather play a technical and normative role. Concerning the forum, he strongly advised not to reject a proposal that "is only half cooked", and suggested that there is room for discussion as "nobody - not even the DG - knows how this beast will look like".
The word was then given to civil society. Anita Manuykan from World Vision International referred to case studies from India to illustrate the challenges of having to deal with very fragmented GH interventions. WVI proposal for addressing this challenge is to create a GH "council", with around 30 elected members representing all WHO regions. However, it is not clear who could participate in such a process, and how.
Finally, Nicoletta Dentico spoke on behalf of the group of NGOs and networks that met in Delhi and released the so-called "Delhi statment", which addresses some of the key issues of GHG from the perspective of public interest groups (the term "civil society" has been carefully avoided as it is often used to refer also to the corporate sector). In her speech, Nicoletta Dentico set the right to health as the focal point of attention, and stated that it is the result of the promotion and protection of all human rights. Health is an inherently political issue, she said. Therefore, we should speak about, and work for, a "global governance" of the right to health, and not just about "global health governance". According to her, the current crisis could also be an opportunity, however WHO needs to be strengthened and in this sense member states play a huge role. She added that global governance starts at the national level, mentioning the examples of Thailand and Brazil, two countries that are actively participating in the debates during this WHA also because they are implementing strong health and social programmes at home, increasing community participation and promoting health and social rights. Finally, she said that the lack of resources is a relative one, as it comes from unequal distribution. "The world not flat", she said, therefore power relations have to be carefully taken into account when proposing a World Health Forum. Without safeguards and guarantees, no such body will enable to address the unbearable fact that - as it is today - "the power of money, and not the voice of needs, is heard".

Side event: WHO HIV strategy - Implementing Treatment 2.0
Treatment 2.0 is an initiative convened by WHO and UNAIDS as a global initiative to achieve and sustain universal access to treatment and maximise its preventive benefits.  It works towards a target product profile: one pill per day fixed dose combination, minimal toxicities, and potent, high barrier to drug resistance, minimal drug interactions etc. Five priority work streams were identified for this: a) Optimise regimens b) Provide access to point of care c) Reduce costs d)  Adapt delivery systems e) Mobilise communities.
What is needed to meet the scale up challenge? There is the need for simple drug treatments, innovation, efficiency gains, equity and affordability, leadership, willingness and resources to invest. Treatment 2.0 priorities include:
1) Moving from evidence to timely normative guidance (eg treatment eligibility)
2) Improve on drug dosing and regimen.
Countries should also set policies to optimise treatment and care programs including simplified diagnostics for adults and paediatrics and also to shape domestic market dynamics. WHO global HIV health sector strategy reaffirms global goals and targets defines health sector role within a multisectoral response. It also embeds HIV in the broader global health and development agenda while building on progress/ evidence and drives innovation. There has been a big scale up of treatments; however there is still a current gap of approximately 10 million people. We can also help to reduce costs by using generic names, increase use of TRIPS flexibilities etc. It is worthy of note that Malawi has increased its number of ART sites have increased from 9 in 2003 to 417 in December 2010.

• See also Official Summary Report of the Day in Journal No 4 (from page 7)