January 2019: Civil society meeting ahead of WHO EB 144: WHO Governance

23 January 2019: Civil society meeting ahead of the 144th session of the WHO Executive Board

The 144th Session of the WHO Executive Board was scheduled from Thursday 24 January to Friday 1 February 2019, with one day break in-between, on Sunday 27 January. The EB documentation can be found here.

The preparatory civil society meeting organized and hosted by G2H2 and its working groups and members took place on Wednesday 23 January 2019, with a public session (“Selected items on the EB agenda”) in the morning and a closed civil society session on WHO governance in the afternoon as main elements.

The Geneva Global Health Hub (G2H2) set up in 2016 intends to contribute to longer-term strategic thinking and coherent and sustained action by civil society entities involved in global health advocacy. The civil society meeting was kindly hosted by the World Council of Churches at the Ecumenical Centre.

Programme and schedule:

8.30 hrs	Coffee and croissants
9.00-12.00	Open session for civil society and EB participants: Selected items on the EB agenda
	9.15 Universal Health Coverage (agenda item 5.5) 10.15 Health, environment and climate change (agenda item 5.6) 11.00 Medicines, vaccines and health products (agenda item 5.7)
12.00	Lunch
13.00-16.45	Closed civil society session: WHO governance
17.00-18.30	Closed civil society session: Briefing on G2H2 positioning and planning process
18.30	Reception

Meeting documentation

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Morning: Selected items on the WHO EB agenda

The January civil society meeting was dedicated to Amit Sengupta (1958-2018)

In the open morning session, and based on a call among G2H2 members to propose topics, three selected items on the agenda of EB144 were introduced by representatives of the People’s Health Movement’s WHO Watch team, followed by an open discussion. The session benefited a lot from the participation of some senior representatives of the WHO secretariat. It provided a space to debate and “test” selected civil society analysis and proposals.

Moderator of the morning session: Mariska Meurs, Wemos

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Universal Health Coverage (agenda item 5.5)

The debate focused the the sub-item “Primary health care towards universal health coverage”. After the disappointingly vague declaration of the Alma-Ata jubilee conference (Astana Declaration, October 2018), the WHO/UNICEF document on Primary Health Care (“A vision for PHC in the 21st Century”) to which the WHO Secretariat’s report (EB144/12) mainly refers, rightly frames PHC as a pre-requisite for achieving access to health and the health-related SDGs – not just as a means to achieve Universal Health Coverage.

The debate also included an update on the preparation of the UN High-Level Meeting on UHC in autumn 2019 and related negotiations (see EB 144/14).

Initial input by Giulia Loffreda, PHM WHO Watch: PPT as PDF
Guest: Dr Naoko Yamamoto, WHO ADG for UHC and Health Systems Cluster
Civil society statements at EB 144 (temporary collection): EB website

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Health, environment and climate change (agenda item 5.6)

This agenda item includes two framing documents, a Draft Global Strategy for the WHO on health, environment and climate change (EB144/15), and a Draft Global Plan of Action on the same in Small Islands and Developing States (SIDS) (EB144/16). These aim to provide directions for governments to develop concrete policies at the national and international level.

The first document presents a comprehensive strategy for the health sector with regard to climate change, based on 6 axes of intervention namely primary prevention; cross-sectoral action; a strengthened health sector; building support; enhanced evidence and communication; and monitoring. It is an excellent strategy but could still be strengthened before consideration at WHA72.

The second document proposes practical measures to progress the ‘special initiative’ launched at the Bonn Conference of Parties (COP) in October 2015. It is a weaker document that requires greater clarity with regard to its structure and language.

Initial input by Alexandre Gajardo, PHM WHO Watch: PPT as PDF
Civil society statements at EB 144 (temporary collection): EB website

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Medicines, vaccines and health products (agenda item 5.7)

This agenda item covers a draft road map outlining WHO’s work on access to medicines, vaccines and health products in general (EB144/17) and the executive summary of a technical report on pricing, availability and affordability of cancer medicines (EB144/18).

The Draft Road Map is the result of a strong demand led by key developing countries to continue the discussion on the outcomes of the UN Secretary General’s High Level Panel on Access to Medicines. The draft road map elaborates activities, actions and deliverables for the period 2019−2023. The draft roadmap is sensibly structured and, despite some unfortunate omissions, brings together in a coherent way a wide range of programs and commitments which have previously been progressed separately. It is likely that the Secretariat will be asked to provide budget estimates, targets and indicators before submitting it to WHA 72 in May 2019.

The executive summary of the report on cancer medicines describes two broad set of approaches to price-setting: producer (industry) approaches and payer (government or insurance) approaches. It provides a framework to engage with long standing discussions with regard to the linkages between pricing, research and development, availability and affordability. Despite the many policy options listed, the report does not consider the broader governance capabilities at the national and international levels which would enable the implementation of these options, nor does it describe possible implementation models as they might operate at the national and international levels.

Initial input by Sarai Keestra, UAEM, PHM WHO Watch: PPT as PDF
Guests: Dr Mariângela Batista Galvão Simão, WHO ADG Access to Medicines, Vaccines and Pharmaceuticals, and Dr Suzanne Hill, WHO Director Essential Medicines and Health Products
Civil society statements at EB 144 (temporary collection): EB website

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Afternoon: WHO Governance

The engagement of many civil society organizations as “friends of the WHO” and the need for sharing assessments, for joint strategizing and for coordinated interventions regarding the WHO financing and governance crisis was one of the roots of the Geneva Global Health Hub in 2015-2016.

Over the last years, civil society advocates have focused their advocacy related to WHO governance on issues such as:

Protecting WHO’s constitutional mandate
Critical assessment of actors, power, interests (incl. Member States)
Addressing the shrinking space for civil society (global, national)
WHO financing as part o financing global public goods
Defending WHO’s leading role in global health governance
WHO leadership and management: WHO’s capacity to fulfil its mandate

The afternoon session was set up as a closed (civil society only) brainstorming and strategy meeting. In this session, the G2H2 working group on “WHO governance and financing” (launched in December 2018) provided an overview of current governance issues and processes at WHO that need civil society attention.

After the initial discussion, the debate was structured along three focal topics addressed by the WHO EB in its January session, with short inputs followed by a discussion among all participants in view of assessing which issues need particular civil society attention and shall be further dealt with by the G2H2 working group, beyond the EB session.

Moderator of the afternoon session: Karolin Seitz, Global Policy Forum

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Introduction and overview

Under the leadership of the new WHO DG Tedros and his team, WHO governance has become even more complicated and confusing than before. There are new dynamics, processes and actors that deserve civil society attention – and probably action. Processes highlighted in the introduction:

“WHO reform and transformation agenda” launched by the new leadership under DG Dr Tedros with an impressive amount off activism and new strategies, structures and teams reported to the EB, but still unclear perspectives and consequences for the management and governance of the organization. – See document EB144/31.
Interaction of the new WHO leadership with various “civil society” teams (such as a “WHO-CSO Task Team” that delivered its report and recommendations on 7 December 2018, a “WHO Civil Society Working Group on the third High-level Meeting of the UN General Assembly on NCDs” or the “CSO advocacy advisory group” on the WHO “Investment case” launched in autumn 2018) and related governance issues.
WHO financing and the WHO “Investment case” (see recent blog by Remco van de Pas)

Introduction and overview by Thomas Schwarz, Medicus Mundi International Network: PPT as PDF
Guest: Dr Gaudenz Silberschmidt, Director, WHO Partnerships and Non-State Actors.
Civil society statements at EB 144 (temporary collection): EB website

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Reform of WHO Governing Bodies and perspectives of a further shrinking space for civil society

Initial input by Thomas Schwarz, Medicus Mundi International Network PPT as PDF
See document EB144/34 and a recent blog by Thomas Schwarz
Civil society statements at EB 144 (temporary collection): EB website

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WHO Engagement with non-State actors: Initial evaluation of the implementation of FENSA (2019, in preparation) and new plans for a “WHO Strategy on Engagement with non-State actors”

Initial input by KM Gopakumar, Third World Network: to be published here
See article by KM Gopakumar and Shirin Syed, in: The Wire, 29 January 2019
See documents EB144/36 and EB144/37
Civil society statements at EB 144 (temporary collection): EB website

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Preparation of a “Global Action Plan for healthy lives and well-being for all” and related governance issues, including civil society representation
Initial input by Mariska Meurs, Wemos, and Daniel Gulati, German Institute for International and Security Affairs: PPT as PDF
See document EB144/11 Rev.1, page 9f.
Civil society statements at EB 144 (temporary collection): EB website