4. Next Steps

In May 2011, WHO launched a reform with a document on ‘Future Financing of WHO’.  Six months - and many discussions and consultations - later, the Special Session of the Executive Board on the reform resulted in decisions going much further than financing. The financial troubles of the Organization led to a rethinking of the governance and management of the organization and its place in the crowded global health landscape.

The background document (referred to as the ‘consolidated document’ ) to the EBSS introduced three areas of reform: one in programming & priority setting, one in governance and a managerial reform. During the discussions on Next Steps it soon became clear that Member States didn’t want to rush, but rather to have different timelines for the three areas of reform. Brasil and India in particular urged caution for moving too quickly, because some seemingly innocent decisions could have “serious consequences”; while the US emphasized that immediate action could already be taken in certain areas, especially for the managerial reform.

The discussion on next steps was build on draft decisions in each area of the reform, prepared by the Secretariat. The draft decisions contained references to specific paragraphs from the consolidated document. Because of varying agreement on the details in these paragraphs, Member States requested to take out the references in the draft decisions. Brasil was against too much detail in general, while the US and the EU supported to take the references out because of problems with certain proposals.

The final decisions reflect the varying amount of agreement and specific timelines for the different proposals made by the Secretariat in the consolidated document. The EB “welcomed” or “agreed on” certain proposals, giving the Secretariat a green light to take them forward (although sometimes “recognizing that further work is needed”); “urged cautions” for others or “requested further detail from the Secretariat”. For some they requested a detailed proposal by the Jan EB, others have to be prepared for the WHA in May and some were even postponed further.

For priority setting, there wasn’t much discussion on the draft decision. On Tuesday it was already clear that Member States did not want to set priorities, but rather define a method to do this. The only thing agreed upon at this EB was that the process for developing the priority-setting-method should be Member State driven. The Secretariat was asked to provide detail on how priorities are currently set and resources allocated and to propose a Member State driven process by the EB in Jan; so the EB could “provide recommendations on methods for programme and priority setting, for the consideration of the Sixty-fifth World Health Assembly in May 2012”.

As for governance, EB Members in general welcomed the Secretariat’s proposals on reforming internal governance structures. They emphasized the importance of intergovernmental decision-making processes and the need to strengthen existing WHO structures, mechanisms and fora, rather than developing new ones. Sessions of the Executive Board and the Programme, Budget and Administration Committee (PBAC) will be optimised or extended, rather than holding additional sessions of the EB - which would have significant cost implications. The role of PBAC will also be extended in terms of monitoring and evaluation functions.

The decision acknowledges the importance of strengthening the linkages and alignment between Regional Committees, the EB and the WHA. This need was repeatedly expressed by Member States during the EB deliberations.

As for the role of WHO in Global Health Governance, the role of WHO as coordinating authority on health matters, as established in the Constitution [1], was reaffirmed. The management of partnerships at the WHO was a rather divisive issue. The draft decision contained a paragraph on expanding the mandate of the Standing Committee on Nongovernmental Organisations to include providing guidance on WHO’s work with partnerships. This proposal was objected to by several EB Members who preferred not to mix partnerships with matters concerning nongovernmental organisations. India and Brasil stated it was “premature” to hand partnerships to the Standing Committee on NGOs, preferring to deal with them individually. In the final text, the EB requests the Secretariat to prepare a “further analysis on modalities to improve Member State involvement with and oversight of partnerships including the possible expansion of the mandate of the Standing Committee on Nongovernmental Organizations in this regard”

In the area of management reform finally, much of the proposals made by the Secretariat were welcomed by the EB and will thus be taken forward, although it was recognized that further detail should be provided. In this document you can see the changes made to the draft document after the discussions. Member States urged caution for implementing strategic relocation and introducing an annual budget re-costing mechanism. Further detail was asked on: mechanisms to increase flexibility and predictability of financing, the proposed contingency fund for health emergencies, a possible new resource allocation mechanism and ways to strengthen resource mobilization at country level. There was much debate on the proposals regarding the two-staged independent evaluation. Eventually it was decided that the Director General will identify the appropriate entity for the first stage and to “further develop in consultation with the UN Joint Inspection Unit, the External Auditor and the External Oversight Committee (IEOAC) an approach to the two-stage evaluation, in consultation with Member States”. The result of this consultation will be presented to the EB in Jan for consideration.

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[1] Article 2 WHO Constitution
In order to achieve its objective, the functions of the Organization shall be:
  (a) to act as the directing and co-ordinating authority on international health work;
  (b) to establish and maintain effective colration with the United Nations, specialized agencies, governmental health    
        administrations, professional groups and such other organizations as may be deemed appropriate;

See Media Release by Secretariat Nov 4, 2011 on Outcomes of SSEB

Return to SSEB, Nov 1-3, 2011