Hot debate over WHO governance

A major – perhaps the major – agenda item at this year’s World Health Assembly has been the future financing of the World Health Organisation (WHO). There is little doubt that WHO is in need of reform, as it is facing a financial crisis, but also one of identity and legitimacy.

Opening this debate about the WHO reform agenda has prompted a much wider debate about global health governance and the role of the WHO in this.

Wider stakeholders?

What kind of body do we need? Should we protect the mandate of the WHO as an organisation governed by Member States? Or should this be diversified to include wider stakeholders?

There is a fear that, de facto, power tends to follow money, not democratic authority. If the private sector and other institutions, with responsibility to different constituencies, were to be included in the governance structure of the WHO, this fear could be institutionalised.

Including them in the governance structure gives them the legitimacy to determine priorities in global health. Whilst I agree that the voices of other major actors have to be heard, I believe that this could be arranged in a formal and regulated way, whereby the power of decision is still reserved for Member States.

Responsibility of states

Health is a human right, a fundamental component of human development, and a global public good. As DG Chan said at the launch of the Accountability Commission’s report as part of the Global Strategy for Women and Children’s Health, delivering on the right to health for all is primarily the responsibility of governments.

It is the mandate of the WHO to oversee the realisation of this right, to translate evidence into normative guidance; guidance that is followed by all actors in global health.

Again, this comes down to the recurrent theme at this year’s Assembly: accountability.

Accountabilty paramount

As I noted in my blog on the Director General’s opening speech, accountability of Member States to their citizens must be remembered.

Similarly, there must be a way in which the Member States can hold global health actors accountable for their investments and actions, that these are consistent with the technical and policy guidance provided by the WHO, and contribute to the realisation of health for all.

Perhaps this will take place in the form of a convention, or a charter – this is yet to be figured out.

National control

But what remains clear to me is that the global health governance should be for the people, and by the people, through their representation by Member States (albeit sometimes imperfectly democratic).

The debate is contentious and unlikely to close at this year’s Assembly. From discussions in the corridors, I understand that a group of countries are coming together to defend the authority of Member States and keep the membership of the WHO’s governance exclusive to governments. This is reassuring.

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