IP-Watch – The first agreement on how to manage relationships between a United Nations organisation and non-governmental actors, such as industry, philanthropic organisations and public interest groups, was adopted on 28 May by the World Health Assembly. The framework, which had been discussed for several years, was hailed as historic by many countries, but met a mixed reaction from those primarily concerned.
The chair of the drafting group, Julio Mercado, a minister in the mission of Argentina, who headed the difficult discussions leading to the agreement on the framework, was unanimously complimented and got a standing ovation at the close of annual Assembly for his management of the negotiations (IPW, Public Health, 27 May 2016). The 69th WHA took place from 23-28 May.
The Framework of Engagement with Non-State Actors (FENSA) is meant to prevent undue influence by outside actors on the work of the World Health Organization, and to prevent conflicts of interest.
“The timely historical conclusion of FENSA is critical for WHO’s leadership in global health,” WHO Director General Margaret Chan, said of the resolution before its adoption by the full WHO membership on the last day of the assembly.
“Without this framework, we could not move forward to support member states in the 2030 agenda for sustainable development,” she said.
Register, Rules on Secondments, Review
The adopted resolution [pdf] requests in particular the WHO secretariat to expedite the establishment of a register of non-state actors in time for the next WHA, in May 2017. The text of the FENSA is included in the resolution.
It says that the WHO Executive Board includes a standing agenda item for reporting on the implementation of the framework. In 2019, the implementation of the framework and its impact on the work of WHO will be evaluated. The results of this evaluation should be submitted together with any proposals for revision at the Executive Board in January 2020.
The decision also requests that the WHO, in consultation with member states, develop a set of criteria and principles for secondments (staff on loan) from non-governmental organisations, philanthropic foundations and academic institutions, and that those criteria and principles be submitted to the next WHA. The Framework states that “WHO does not accept secondments from private sector entities.”
In particular, secondments from non-state actors should be referenced in the annual report on engagement with non-state actors, “including justification behind secondments,” the decision says.
The 70th WHA is expected to review progress on the implementation of the framework at the three levels of the WHO (headquarters, regions, and countries), the decision concludes, “with a view to taking any decisions necessary to enable the full, coherent and consistent implementation of the Framework of Engagement with non-State actors.”
Countries Hail Success
The agreement on FENSA was unanimously praised by delegates.
Algeria on behalf of the 47 member states of the African region said the historically important decision sets out an innovative framework, which is the first of its kind in the United Nations system. The framework will allow WHO to strengthen its efficiency and achieve better results in protecting public health, although the implementation of the framework may not be an easy task, he said.
South Africa remarked that with the framework WHO is “once again” showing leadership in the UN family.
The Netherlands, for the European Union, applauding the success of the negotiations said in order to ensure global leadership in public health, WHO has to be able to engage with a large variety of different actors. Risk of conflict of interest has to be managed in an appropriate manner, the delegate said, adding that the framework cannot prevent WHO from performing its duty of protection and promotion of health including in emergency situations.
India said FENSA is not about encouraging or discouraging engagement with different non-state actors but about creating a robust framework insuring transparency, accountability, and consistency on how WHO engages with different non-state actors and how effectively conflict of interest is managed.
Non-State Actors: Too Much, Too Little
FENSA is meant to frame the way WHO engages with non-state actors, whether they are industry groups, professional groups, public interest groups, philanthropic organisations, or academia.
Although widely applauded by WHO member states, some non-state actors seemed more doubtful about the results. It is interesting to note that statements delivered on FENSA were submitted to WHO, as is the rule, before the opening of the WHA, well before the conclusion of the negotiations, and still applied after the framework was adopted, seemingly indicating that concerns of those actors are still there.
The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said in its statement that it “welcomes continued efforts to design a framework allowing WHO to fulfill its leadership role in global health and its mandate by engaging with a varied set of actors.”
However, the IFPMA said, “while we believe that FENSA should ensure interactions continue to grow, the current draft framework still appears to be restrictive in a number of areas that could hamper non-State actors in their ability to fully contribute to global health outcomes.”
“We believe that a strong focus should be put on equitable application of the provisions of this framework across different categories of non-state actors. Where conflicts of interest may arise, whether commercial or not, it is appropriate that these are managed in a robust, clear, transparent and equitable manner with all non-state actors.”
In its statement, the International Baby Food Action Network (IBFAN) said the FENSA draft and the resolution “do not strengthen voices of public interest actors. On the contrary, they open channels for undue influences by the corporate and venture philanthropic sector,” the representative said.
“FENSA, in its overarching section puts private sector entities on an equal footing with other NSAs [non-state actors], failing to recognize their profoundly different nature and roles,” they said. “The principle of ‘inclusiveness’, when applied to transnational corporations, business associations and philanthropic foundations reinforces the framing of public health problems and solutions that favour their interests and agendas.”
“FENSA allows business interest groups to obtain ‘Official Relations’ under the label of Non State Actors. This will, once and for all, legitimize lobbying by business associations and philanthropies at WHO governing bodies, normalising their inclusion into public health decision-making,” the group said.
Stichting Health Action International (HAI), in its statement, said, “the distinction between NGOs that have public interest goals and private sector entities with commercial objectives is appropriate, particularly since the WHO is expected to provide norm-setting and guidelines that are intended to regulate commercial entities when in conflict with health priorities.”
However, HAI warned, “The approach to Philanthropic foundations deserves more attention, because the WHO has become extraordinarily dependent upon and influenced by perhaps two very large Philanthropic Foundations.”
“Both inside and outside the WHO, the largest global philanthropic donor is now perceived to wield extraordinary influence over the institution, with inadequate transparency and oversight of this relationship,” HAI said.
It was unclear at press time which two foundations, HAI was referring to, but the largest philanthropic donor to WHO is the Bill and Melinda Gates Foundation – in the top three donors overall to WHO.
Medicus Mundi International, Third World Network, and the People’s Health Movement, in ajoint statement, said it is “fundamental that WHO keep full control over activities that are subject to contributions from the private sector and that salaries of WHO staff are not drawn from private sector resources.”
They said they remained “deeply concerned about the retention of the possibility for WHO to engage with PS [private sector] through technical collaborations in the field of capacity building, which is an important channel for the exercise of undue influence.”