As part of WHO’s Reform process, Member States of WHO have been for over 4 years discussing a policy for engagement with external actors. To protect the agency’s integrity, independence and credibility, the 2014 World Health Assembly (WHA) called for an ‘appropriate framework’ to address ‘conflicts of interest and relations with the private sector.’
The latest draft policy, the WHO’s Framework of Engagement with Non-State Actors (FENSA), was presented to the 2015 WHA and Member States engaged in extensive drafting sessions. Yet, the policy has not been finalized and is being discussed once more by Member States in Geneva on 9-10 July .
FENSA has a critically important role to play in protecting WHO from undue influences and ensuring its integrity, independence, trust-worthiness, its accountability towards the world’s people and primary constitutional mandate: ‘Health for All’.
But first of all surely Member States must have the fundamental political discussion about FENSA’s role in the future direction of WHO. A discussion that has still not been had. Is FENSA a safeguard or a fund raiser?
Unfortunately, the draft policy in its current form is inadequate to play this role. The document lacks in coherency, and rather legitimizes old channels of industry influence while opening new once.
The discussions revealed a stark difference of opinion between rich and poor countries. The UK, the US and other rich countries, keen to increase WHO’s collaboration with and funding from corporations and philanthropies, have been pushing the speedy adoption of FENSA with a ‘try it out and see what happens’ approach. In contrast, developing countries have stressed that ‘WHO should proceed with caution..’ and have specifically called for a ‘clear policy on how WHO will manage its conflicts of Interest.’
Some of the problems:
The term Non State Actor (NSA) is applied equally to transnational corporations (TNCs), large philanthropies and public interest groups, blurring the distinction between these very different entities.
FENSA refers to ‘transparency, openness, inclusiveness, accountability, integrity and mutual respect’ – terms that are totally inappropriate when applied to TNCs, whose overriding fiduciary duty is to maximise profits.
FENSA uses an incorrect conflict of interest concept, conflating Conflicts of Interest that lie within a person or institution – with conflicts or divergences between actors and their mandates.
FENSA ignores the fact that WHO’s need for extra funding (its secondary interest) is conflicting with its constitutional duty to protect health for all (its primary interest) and legitimises increased funding from the Private Sector. This will diminish at a stroke the chances that WHO will strengthen its ‘due diligence’ procedures. WHO would have to bite the hand that feeds it and will probably come under pressure to refer to indices such as the FSTE4Good or GAIN’s Access to Nutrition that use weak criteria and rely on what companies SAY they do rather than what they ACTUALLY do.
At the heart of this issue is the freeze on Member States assessed contributions that was pushed by the US in the 1990s. WHO’s budget is now less than one third of the Atlanta-based Centre for Disease Control. Voluntary donor funds account for 80% of WHO’s budget, with 93% tightly earmarked – effectively preventing WHO from implementing programmes that donors don’t like – even those decided by the WHA. In May the UK and Belgium opposed the unfreezing of WHO’s budget, even though it would have been a fraction of the costs caused by the delayed response to the Ebola outbreak.
The WHA Participants List includes 115 delegates from the Global Health Council (GHC) a PPP in Official Relations with WHO. Along with four Nestlé delegates, Scott Ratzen, was listed as “Editor in Chief of the Journal of Health Communication.” No mention that Ratzen is Vice President of Anheuser-Busch InBev, one of the world’s leading alcohol producers. So much for transparency.
A leaked memo from the International Food and Beverage Alliance (IFBA) (Nestlé, Coca Cola, PepsiCo etc) showed how IFBA was lobbying Member States for access to WHO.