World Health Assembly to discuss reforms

Health activists push for funds with no strings attached

By Vibha Varshney
Published: Thursday 24 May 2012

Health activists push for funds with no strings attached

As Margaret Chan takes charge of her next stint as the Director-General of the World Health Organization (WHO), one of the first tasks she has to attend to is that of reforms. The cash-strapped organisation has to figure out fast where to get funds from if it hopes to continue providing a suitable direction to global health. The UN agency gets funds from member states and philanthropists to meet its running cost.

The WHO reform process was initiated in 2009. Initially the focus was just on funds, which has been decreasing; the flow has become unreliable since the 2008 financial crisis. But then it was realised that governance of the organisation needs to be looked at holistically.

The World Health Assembly meets today in Geneva to discuss three aspects of the reforms: programmes and priority setting, governance and management. Under the management head is the issue of a financing mechanism that respects agreed priorities. The reforms are consolidated in a document prepared by WHO. This covers 16 points that need to be discussed.

The discussions are crucial for WHO, which is often blamed for selling itself to private funders. Around three-fourth of the funds required for running WHO comes from member countries. Though most of the funds are voluntary, when governments and philanthropists provide money, they sometime earmark it to specific programmes. This creates a conflict of interest. For example, in May 2011, Bill and Melinda Gates Foundation, which provided around 4 per cent of WHO's overall budget, provided US $1,691,774 for training African professionals in health logistics. The focus of the funding was on vaccine logistics and supply chain management. Gates Foundation has an interest in the vaccine industry. It promotes extending the use of under-utlilised vaccines such as that for Haemophilus influenzae B and rotavirus. A study in PLoS Medicine last year showed that the Gates Foundation has indirect interest in Berkshire Hathaway, a conglomerate of many companies, including banks, railroads and candy producers. Berkshire also has shares in Sanofi-Aventis and GlaxoSmithKline (GSK). Sanofi makes the vaccine for Haemophilus influenzae B while GSK has one for rotavirus.  Interestingly, the Gates Foundation is funding part of the reform process.

Health activists across the world are also pushing to incorporate the reform which allows contributions with no strings attached.

WHO's reform plans went through an external assessment by the Office of the Comptroller and Auditor General of India. The assessment suggested that the issue of financing has been dealt with adequately in the reform proposal.

In its reform document, WHO suggests that it understands the need to tackle the conflict of interest. A policy is being developed which would provide the principles and best practices that WHO needs to incorporate. This document would be prepared by January 2013 and would be discussed at the Executive Board meeting.


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