Civil society meetings ahead of the 146th Session of the WHO Executive Board, 31 January and 1 February 2020

The traditional civil society meetings ahead of the governing body meetings of the WHO are convened and organized by G2H2 and its members. The meeting ahead of the 146th Session of the WHO Executive Board took place on 31 January and 1 February 2020.

Programme overview

Contact for general enquiries

Friday 31 January 2020, 14.00-17.30 hrs
Civil society workshop

Health heartbeats in the age of financial accumulation and digital technology

The Friday afternoon workshop and brainstorming meeting was organized by the Society for International Development (SID) and convened by the Geneva Global Health Hub (G2H2) as part of the civil society meeting ahead of the 146th Session of the WHO Executive Board. The programme was based on a call to G2H2 members to propose topics for a full or half day workshop.

The workshop referred to an agenda item of the 146h Session of the WHO Executive Board (Data and innovation: draft global strategy on digital health, item 20, document EB146/26), and linked it with a policy field neglected in the public debate: the overexpansion of the finance industry into the health sector.

The workshop was set up as a “brainstorming meeting”, and this implies that there was no clear distinction between “those who know” and “those who learn”. The workshop mainly intended to be a place for sharing analysis, approaches and positions, and for listening and mutual learning, laying the ground for a continued conversation among civil society actors, fostering synergies between different sectoral and intersectoral struggles and strategies.

Introduction (by Society for International Development)

The right to health is at a crossroad. The increasing pressure of financial arguments, financial actors and financial institutions in all aspects of the economy and society has produced a radical transformation in the way governments provide public services such as healthcare. Households have become increasingly reliant on financial products to meet their basic needs, in correlation with the varying withdrawal of state support in such domains as health, social security, pensions, education. While the stimulus to private financial capital into the healthcare sector is not new, healthcare markets are currently growing with very little concerns for their long-term effects on health and equity.

Biotechnology and data science are reconfiguring nearly all aspects of peoples’ lives, and health is no exception. Advances like big data and artificial intelligence are opening up new revolutionary pathways to managing people’s health, and healthcare service delivery. Precision medicine approaches have received new significant investments over the last decade, to create new therapies, learn more about disease processes and potentially prevent diseases before they arise. However, such major financial investments in biotechnology may come at the expense of existing public health measures that could have a greater impact on people’s health, especially when tackling burgeoning public health concerns like obesity, cancer, and other chronic diseases, as well as re-emergence of infectious pandemics. Moreover, there are fundamental ethical questions that are being raised around the potential use, when not outright exploitation, of the human body, in terms of its commodification for financial purposes and for political and social control. The age of cyborg has begun, and the consequences cannot be known.

Health digitalization may indeed be leveraged to improve the right to health among the most vulnerable populations. Socially responsible technologies may assist medical practice with cheaper and quick-fix solutions that help cater to the needs of populations in low and middle-income countries where workforce shortages and structural gaps of the national health systems constrain the access to and quality of care. Yet, challenges in developing and implementing digital applications remain largely unaddressed, including in the governance frameworks, so that is it not clear whether this type of innovation is in reality aligned with public health interest, on potentially in conflict with its goals.  How can the upcoming WHO strategy on digital health provide a window of opportunity to steer digital health toward the public health outcomes we want to see?

With this seminal workshop SID aims to

  • share the knowledge and stir the reflection with the civil society organizations involved in global health in the fields of health financialisation and digitalization, looking at the interconnections between the two political arenas, so decisive for the future of the right to health;
  • start a constructive interaction and engagement with the WHO, whose Digital Health Strategy will be discussed at the 146th Session of the Executive Board;
  • begin to forge new alliances in the matters, so that the role and knowledge of public interest organizations may become relevant in tackling the ethical and governance questions that both financialisation and digitalization trends entail, in health and other human rights domains

Programme

Session 1: Making health a bankable project
14.00 – 15.30 hrs

Presentation of the “Spotlight Report on Financial Justice”

Introductions by:

  • Nicoletta Dentico, Global Health Programme, Society for International Development
  • Anna Mariott, Public Services Policy Manager, Oxfam UK (via Skype)
  • Denise Namburete, Executive Director, N’weti, Moçambique (via Skype)

References, documentation

Session 2: All you need is a link!
15.30 – 17.30 hrs

Digital technologies and the politics of life

Introductions by:

  • Stefano Prato, Managing Director, Society for International Development
  • Parminder Jeet Singh,  Executive Director,  IT For Change
  • Sameer Pujari, Technical Officer, Digital Health and Innovation, World Health Organization

Followed by plenary discussion

References

  • Document for the 146th Session of the Executive Board: ” Data and innovation: draft global strategy on digital health. Report by the Director-General” Document EB146/26
  • Data Sharing Requires a Data Commons Framework Law. Parminder Jeet Singh and Anita Gurumurthy. DGN Policy Brief 02, January 2020

More about the workshop

Documentation, enquiries

Saturday 1 February 2020
Series of public briefings and dialogue sessions

Civil society perspectives on selected global health topics
146th session of the WHO Executive Board – and beyond

The Saturday programme of the civil society meeting ahead of the 146th Session of the WHO Executive Board followed the well-established pattern of providing a series of public sessions with civil society briefings and debates on selected health topics on the agenda of the WHO Executive Board and beyond the EB agenda. The programme was based on a call to G2H2 members to propose and introduce such topics.

All sessions were open for G2H2 members and civil society colleagues, but also for WHO staff and delegates of member states.

Programme and documentation

9.00-9.30 hrs Welcome and introduction

Session 1,  9.30 -11.00 hrs
Primary Health Care and Universal Health Coverage

Sub-topic 1:
PHM and UHC: How to “transform vision into action”?

The last two years, with the jubilee of the Alma-Ata Declaration (2018) and the UN High-Level Meeting on Universal Health Coverage (2019), brought Primary Health Care and health systems back to the top of the global health agenda. Now, as celebrations are over and declarations published, the EB agenda and the related documents (EB146/5, EB146/6 and EB146/38 Add.1 show that WHO and member states still struggle with the essentials of PHC and health equity, such as how to fully recognize and operationalize Primary Health Care as a policy guide to enlarge and transform all health systems to become really universal, comprehensive and egalitarian.

Good news is that the articulation of PHC in the DG’s Report EB146/5 goes further than the Astana Declaration: “a whole-of-government and whole-of-society approach to health that combines the following three components: multisectoral policy and action; empowered people and communities; and primary care and essential public health functions as the core of integrated health services. Primary health care-oriented health systems are health systems organized and operated so as to make the right to the highest attainable level of health the main goal, while maximizing equity and solidarity. They are composed of a core set of structural and functional elements that support achieving universal coverage and access to services that are acceptable to the population and that are equity enhancing.”

EB 146/5 then outlines the 14 levers of the draft operational framework “needed to translate the global commitments made in the Declaration of Astana into actions and interventions.”

Sub-topic 2:
Beyond the limits of proposed country categories for UHC implementation

In the proposed country categories for the UHC implementation (document EB146/6) there is a worrying absence of an equity approach to reduce the gap of access, accessibility, care quality and results among social classes, gender and races / ethnics at different territorial dimensions within countries and at the international borders.

Speakers and panellists for both sub-topics

  • Marta Jimenez Carrillo, People’s Health Movement
  • Armando De Negri Filho, World Social Forum on Health and Social Security
  • Moderator: Nicoletta Dentico, HIP / SID

Documentation

  • Introduction and overview: Session 1
  • David Sanders, People’s Health Movement
    Input at the Astana PHC Conference, 2018 (Video): Communication materials > Live streaming of the conference > Ministerial Parallel Sessions > Leaving no-one behind through PHC > Minutes 22.58 to 29.03
  • Marta Jiménez Carrillo, People’s Health Movement
    Primary Health Care & Universal Health Coverage – complementary but distinct. PPT as PDF
  • Armando de Negri Filho, WSFHSS
    Comment on 146 WHO EB agenda points 7.1 and 6. Video (YouTube) 
  • WHO EB documentation
    Primary health care. Draft operational framework – transforming vision into action. EB146/5
    Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues. Universal health coverage: moving together to build a healthier world. EB146/6

This session was dedicated to David Sanders (1945-2019)

Session 2, 11.15 -13.15 hrs
Access to Medicines and Vaccines

Sub-topic 1:
After the debates at the WHA: Perspectives of civil society advocacy

Access to medicines has become a “routine topic” of the civil society meetings ahead of the meetings of the WHO governing bodies. Civil society engagement in this thematic field has benefited a lot of a well-established, strong team of likeminded civil society institutions who have over many years successfully promoted the access agenda. However, after some turmoil at the last year’s 72nd World Health Assembly caused by outspoken civil society activism around a proposed WHA resolution on Transparent Drug Pricing, the environment for civil society advocacy might have become more hostile. Anyhow, the powerful economic interests remain the same, and the struggle for access to medicine is far from being over.

Speakers and panellists

  • Natalie Anne Rhodes, People’s Health Movement / UAEM
  • Thiru Balasubramaniam, KEI
  • Pauline Londeix, Transparency Observatory
  • Erika Dueñas Loayza, WHO Secretariat, Access to Medicines and Health Products
  • Moderator: Thomas Schwarz, MMI Network

Documentation

  • Introduction and overview: Session 2
  • Natalie Anne Rhodes, People’s Health Movement / UAEM:
    Access to medicines at EB146. PPT as PDF
  • Thiru Balasubramaniam, KEI
    WHO Transparency Resolution: WHA 72.8. PPT as PDF
  • Pauline Londeix, Transparency Observatory
    WHA72 transparency resolution, from its adoption to its implementation in France. PPT as PDF

Sub-topic 2:
Restore access to internationally controlled medicines for palliative care!

The struggle for adequate access to medicines includes internationally controlled essential medicines whose availability and affordability are conditioned by national and international “drug policy.” More than 65% of people in the world have low or no access to such essential medicines. This public health crisis affects primary health care in emergency medicine, trauma care, palliative care, chronic pain, dependence treatment etc. In May 2019, under US pressure, the WHO withdrew two key pain/palliative care guidelines member states used to improve access. Although the WHO Secretariat has committed to preparing replacement guidelines by the end of 2020, this normative and technical vacuum has a chilling effect on population health.

Speakers and panellists

  • Natalia Arias, IAHPC (also moderating this session)
  • Gilles Forte, WHO Secretariat
  • Francis Bwalya, Permanent Mission of the Republic of Zambia

Documentation

  • Introduction and overview: Session 2
  • Natalia Arias, IAHPC
    Global Health, palliative care & lack of access to internationally controlled essential medicines. PPT as PDF
  • Gilles Forte, WHO Secretariat
    Ensuring access to and safe use of controlled medicines. PPT as PDF
  • Francis Bwalya, Permanent Mission of the Republic of Zambia
    Policy Development for Universal Health Coverage in Cancer & Palliative Care: Lessons from Zambia. PPT as PDF

Session 3, 14.15-15.45 hrs
Public Health Emergencies

Sub-topic 1:
Discussing health emergencies in times of an imminent emergency

One of the ambitious tasks of the current WHO strategy (GPW13) is that “one billion more people are better protected from health emergencies”.  Item 15 of the EB agenda includes five subtopics related to health emergencies. But, for sure, this will not be just a “technical” agenda item of the upcoming EB session. The great attention given by national health authorities and the broad public to the emerging novel Coronavirus (2019-nCoV), and how the matter is dealt with by WHO, is another (unwanted) test case to see if the set of global/international policies, regulations, mechanisms and guidelines (some of them being dealt with by the EB) is fit for purpose, and if health systems in rich and poor countries are properly equipped for both health emergency preparedness and response.

While the Coronavirus case will be in the focus of the EB delegates’ attention within and beyond the EB agenda, there are other issues that deserve this attention, too. The report of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme (EB146/16) states that “WHO has made a great deal of progress in outbreak management”, but it also highlights some persisting challenges in dealing with health emergencies. And there are neglected root causes of health emergencies and, due to the lack of funding, the effectiveness and efficiency of the WHO Health Emergency programme remain limited.

Sub-topic 2:
Time for WHO to declare the climate crisis a public health emergency of international concern?

In a session at the civil society meeting in May, we asked “Who cares about/for Planetary Health?” Since then, the debate on the climate emergency has risen to international prominence. At the same time, and despite the adoption of a “WHO global strategy on health, environment and climate change”, the World Health Organization and its member states have yet to enact and implement policies that demonstrate concern for planetary health, with the urgency and dedication needed. Is it time for WHO to declare the climate crisis a public health emergency of international concern?

Speakers and panellists for both sub-topics

  • Michael Ryan, WHO Health Emergencies Programme
  • Jennifer Kay Lacy-Nichols, People’s Health Movement
  • Remco van de Pas, ITM Antwerp
  • Moderation: Thomas Schwarz, MMI Network

Documentation

  • Introduction and overview: Session 3
  • Jennifer Kay Lacy-Nichols, People’s Health Movement
    “One billion more people better protected from health emergencies”. PPT as PDF
  • Remco van de Pas, ITM Antwerp, et al.
    Time for WHO to declare climate change a public health emergency of international concern. PPT as PDF

This session was dedicated to Peter Salama (1969-2020)

Session 4, 16.00 -17.30 hrs
WHO and Global Health Governance

Defending the space of civil society at the WHO

The WHO Secretariat’s report and proposals on the “Involvement of non-State actors in WHO’s governing bodies” (agenda item 22.1, document EB146/33) have the potential to considerably change the terms of civil society involvement in the World Health Assembly and the sessions of the WHO Executive Board. The Secretariat proposals were assessed by G2H2 members in two strategy meetings in December 2019. After these meetings, we proposed to the WHO Secretariat to convene an informal dialogue session of both WHO Member States and non-state actors (in particular: civil society organizations) immediately ahead of EB146, on Sunday 2 February, moderated either by the Secretariat or by the EB chair. Unfortunately, this proposed dialogue session has not materialized.

For the EB session itself, civil society input on this agenda item will be mostly “technical” (and short!) and directly related to the secretariat proposals. However, the Secretariat proposals are not carved in stone, as interactions since their publication in November have shown. And, this is where we will start (and already started years ago): The process also needs to be positioned in the global political context (shrinking space of civil society, WHO and UN governance).

Speakers and panellists:

  • Thomas Schwarz, Medicus Mundi International Network
  • Other civil society speakers from the floor
  • Gaudenz Silberschmidt and Taina Nakari, WHO Secretariat
  • Moderator: Karoline Seitz, Global Policy Forum

Documentation

  • Introduction and overview: Session 4
  • Thomas Schwarz, Medicus Mundi International Network
    WHO and global health governance: Defending the space of civil society at the WHO. PPT as PDF
  • EB document: WHO reform – Involvement of non-State actors in WHO’s governing bodies. EB146/33
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