WHO's prob­lem

As most de­vel­oped coun­tries shy away from in­creas­ing their con­tri­bu­tion, a cash-strapped World Health Or­ga­ni­za­tion is forced to rely on pri­vate sec­tor funds. Civil so­ci­ety groups warn of con­flict of in­ter­est


THE 68TH World Health Assem­bly (wha), the an­nual meet­ing place for pol­i­cy­mak­ers from the 192 mem­ber states of the World Health Or­ga­ni­za­tion (who), was held be­tween May 18 and 26.The mem­bers de­cided on poli­cies that will guide global health in the com­ing years.But they failed to reach a con­sen­sus on the cru­cial Frame­work of En­gage­ment with Non-State Ac­tors (fensa), a process to de­ter­mine the rules of en­gage­ment be­tween who and non-state ac­tors, a moniker used for academia, non-gov­ern­men­tal or­gan­i­sa­tions, phil­an­thropic foun­da­tions, and the pri­vate sec­tor.

fensa was in­cluded in the on­go­ing who re­form process in 2013 af­ter civil so­ci­ety groups and mem­ber states raised the is­sue of in­dus­try bod­ies try­ing to in­flu­ence health poli­cies at the Assem­bly by pro­vid­ing funds for spe­cific projects that suited their agenda.

Just prior to the re­cent Assem­bly, an in­ter­gov­ern­men­tal meet­ing took place in Geneva to look into fensa.The meet­ing was in­con­clu­sive. Then on the first day of the wha, a com­mit­tee was set up dis­cuss the is­sue fur­ther. Af­ter nine for­mal and three in­for­mal ses­sions, the com­mit­tee sub­mit­ted its re­port that said more work needed to be done be­fore fensa res­o­lu­tion could be adopted. The com­mit­tee sug­gested that another in­ter­gov­ern­men­tal meet­ing should be con­vened by Oc­to­ber so that a de­ci­sion is ready to be dis­cussed in the ex­ec­u­tive board meet­ing be­fore the 2016 wha.

Cor­po­rate in­flu­ence

The grow­ing rep­re­sen­ta­tion of the cor­po­rate sec­tor at this year’s Assem­bly was alarm­ing. wha per­mit­ted more than 100 del­e­gates from the Global Health Coun­cil (ghc), a group of stake­hold­ers from in­dus­try, academia and oth­ers in­volved in the health sec­tor. ghc charges a hefty fee from its mem­bers, which is af­ford­able only to rich in­dus­trial groups.

One of ghc del­e­gates was Scott Ratzen, vice-pres­i­dent, Global Cor­po­rate of global brewer An­heuser-Busch InBev.He at­tended the Assem­bly as the editor-in-chief of the Jour­nal of Health Com­mu­ni­ca­tion with­out any

men­tion of his in­dus­try af­fil­i­a­tion. Mem­bers of in­dus­try body In­ter­na­tional Food and Bev­er­age Al­liance (ifba) were also in­vited by who to at­tend the Assem­bly. ifba rep­re­sents mem­bers from the food in­dus­try such as Nes­tle, Fer­rero, Coca Cola, Mars, McDon­alds and Pep­siCo.

What is even more wor­ry­ing is that in­dus­try lob­bies are us­ing del­e­gates of mem­ber states to voice their con­cerns. This was seen at the ex­ec­u­tive board meet­ing of who in Jan­uary this year where the Ital­ian del­e­ga­tion seemed to speak on be­half of the sugar lobby. The del­e­ga­tion ve­he­mently op­posed a 2014 who draft guide­line that rec­om­mended daily energy in­take for a per­son from sugar should be re­duced from 10 per cent to 5 per cent.

Vito De Filippo, un­der-sec­re­tary for health from Italy, said “sugar is an es­sen­tial nu­tri­ent” and ar­gued that re­duc­ing sugar in­take was “overly re­stric­tive”. What he did not men­tion was that Italy is a ma­jor sugar pro­ducer and the coun­try is host to the world’s largest cho­co­late pro­ducer, Fer­rero, owned by Italy’s rich­est man.

Cash crunch

Short­age of funds to run pro­grammes is one of the main rea­sons who is in­ter­sted in pri­vate funds.And fensa will guide the UN body on how to deal with the pri­vate play­ers. who gets two types of con­tri­bu­tion to run its pro­grammes. All mem­ber states pay an an­nual mem­ber­ship fee called as­sessed con­tri­bu­tion, which is cal­cu­lated on the ba­sis of the coun­try’s wealth and pop­u­la­tion. As­sessed con­tri­bu­tion ac­counts for just 20 per cent of who’s to­tal bud­get. The re­main­ing 80 per cent is funded through vol­un­tary con­tri­bu­tions made by coun­tries, foun­da­tions, cor­po­ra­tions and phi­lan­thropies. The prob­lem is that 93 per cent of the vol­un­tary funds is given for spe­cific pro­grammes. As a re­sult, who is un­able to im­ple­ment or sup­port many pro­grams that are de­cided each year at the wha.In fact this was the rea­son who gave for its fail­ure to swiftly act dur­ing the re­cent Ebola out­break.

To in­crease the avail­able funds, who di­rec­tor gen­eral Mar­garet Chan had re­cently asked for a 5 per cent in­crease in the as­sessed funds but al­most all de­vel­oped coun­tries shot down the pro­posal. In­stead, they agreed to an in­crease in vol­un­tary con­tri­bu­tions by 8 per cent. “Ear­marked funds pro­vide more ac­count­abil­ity to the tax pay­ers,” says Lour­des Chamorro, who was part of the Euro­pean Union del­e­ga­tion at wha.

Mem­ber states are gen­er­ally not will­ing to pro­vide funds that are not ear­marked as they feel that who does not pro­vide them with data on how this money is used. At the Assem­bly, most coun­tries asked for more ac­count­abil­ity and trans­parency at who.

“The re­fusal to in­crease the as­sessed con­tri­bu­tion is the tech­nique de­ployed to force who to be open for cor­po­rate in­flu­ence,” says David Legge of the Peo­ple’s Health Move­ment. A day be­fore the wha, Gau­denz Sil­ber­schmidt, di­rec­tor for part­ner­ships and non-state ac­tors at the di­rec­tor gen­eral’s of­fice, who, said in a public meet­ing that fensa was un­likely to be adopted at the re­cent Assem­bly. He also pointed out that with­out the in­dus­try funds, a cash-strapped who would have to cut down on its projects.

Con­sen­sus over noth­ing

The big­gest prob­lem civil so­ci­ety sees in the ex­ist­ing fensa draft is that it glosses over the is­sue of con­flict of in­ter­est. A state­ment by the global ac­tivists’ group In­ter­na­tional Baby Food Ac­tion Net­work states the ex­ist­ing draft gives false im­pres­sion that risks of in­ter­ac­tions with cor­po­ra­tions and phi­lan­thropies, in­clud­ing con­flicts of in­ter­est, are ad­e­quately ad­dressed. De­vel­op­ing coun­tries, es­pe­cially in Africa, had pointed this out. Male­bona Pre­cious Mat­soso, di­rec­tor gen­eral (na­tional health), South Africa, told Down To Earth that the is­sue of con­flict of in­ter­est needs to be re­solved soon.In a draft cir­cu­lated in March 2015, Zim­babwe, on be­half of African group, said, “The cur­rent in­for­ma­tion is not clearly re­flect­ing a de­fin­i­tive pol­icy on con­flict of in­ter­est.”

Ex­perts point out a va­ri­ety of ways of im­prov­ing the frame­work. Stichting Health Ac­tion In­ter­na­tional, a dutch non-gov­ern­men­tal or­gan­i­sa­tion sug­gests a ceil­ing on non-state ac­tors’con­tri­bu­tions, above which money would go to the core vol­un­tary fund. Adam Kam­radt-Scott, se­nior lec­turer at Univer­sity of Syd­ney, says who should learn from ex­ist­ing public-pri­vate part­ner­ship mod­els that work rea­son­ably well.

But amidst a bat­tery of de­lib­er­a­tions, the real rea­son be­hind fensa is get­ting lost. “The pol­icy is now so de­tailed, com­plex and long that it is no longer prac­ti­cal. Ba­sic com­mon sense and good judge­ment should have been enough in­stead,” Legge says.

Food and drug in­dus­tries are push­ing their agenda into WHO by in­flu­enc­ing mem­ber states, academia, and non-gov­ern­men­tal or­gan­i­sa­tions

In­dus­try bod­ies tried to in­flu­ence health poli­cies at the Assem­bly by pro­vid­ing funds for spe­cific projects that suited their agenda

WHO blames fund crunch for its fail­ure to act swiftly dur­ing the re­cent Ebola out­break

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