TWN Info Service on Health Issues (Apr16/05)
21 April 2016
Third World Network

WHO: Developed countries turning against non-State actor engagement framework

Geneva 21 April (K M Gopakumar) – Developed countries are turning against the World Health Organization’s framework of engagement with non-State actors (FENSA). 

Many European countries are putting conditions for the adoption of FENSA, as negotiations enter into the last stage when the Open-Ended Intergovernmental Meeting on the draft FENSA meets on 25-27 April at the WHO headquarters in Geneva.

Member States from the European Region are citing three issues to block the adoption of FENSA. First, the adoption of FENSA is possible only when there is a clear understanding on the implications of its implementation, especially financial and human resource implications. Secondly, these countries also warn that the Secretariat should be given flexibility to suspend FENSA norms while engaging with non-State actors to respond to emergencies. In other words, FENSA could be suspended to engage with non-State actors while dealing with an emergency. Thirdly, these countries also want the implementation of FENSA at all three levels of WHO viz. head quarters, regional and national.

Responding to the demand of analysing the implications of FENSA implementation, the 138th meeting of the Executive Board (EB) took a decision based on the recommendation of the Program and Budget Advisory Committee  (PBAC). This decision requested the WHO Director-General to “present an objective and balanced report on the implications for WHO of the implementation of the framework, well in advance of the final session”.  The External Auditor prepared the report titled  ‘Implications for the World Health Organisation of the implementation of the framework of engagement with Non-State actors’.

The Report concurs with the Secretariat’s non-paper circulated in October 2015 and states that, “the adoption and implementation of FENSA will involve considerable costs from a policy, financial and human resources perspective, at all levels of the organization.” However, it refuses to make an estimation of the cost and states:  “… the financial and human resource implications cannot be estimated with sufficient degree of accuracy to provide a solid figure, but will be monitored as FENSA is progressively implemented.”

Further, the Report states that “FENSA as an overarching framework can already stand on its own and can be considered for adoption.” However the Report favours implementation in a phased manner rather than a full and complete implementation of both the framework and the operational procedures at the same time.

Disappointed at the absence of any reference to the exact cost implications of implementation of FENSA, a few Member States from the European Region have jointly written to the WHO Secretariat expressing concerns on the external auditor’s report.  The letter from the Czech Republic, Finland, Germany, the Netherlands, Norway, Sweden, Switzerland and the United Kingdom states, “We understood a key purpose of the current document to be to substantiate and document those claims. It does not appear to do so”.

The letter seeks information on the following areas: (a) an estimated figure or figure range for the current volume of engagements annually; (b) an estimated figure or figure range for the cost of implementing FENSA as it currently stands; (c) an estimated figure or figure range for the number of additional staff expressed as work years that implementation would require, as well as for the additional overall workload on existing staff in technical and other units not primarily tasked with operating the mechanisms FENSA would establish.

According to a developing country delegate, the request for additional information is an indirect way of putting conditions to block the adoption of FENSA even after the conclusion of negotiations.

Another developing country delegate who attended the Secretariat’s briefing on 18 April said that during the briefing Switzerland stated that FENSA could not be adopted at this stage without information on resource implications.

Many delegates view the letter as a digressive move during the Secretariat’s briefing, and as a strategy to prevent further strengthening of safeguards against undue influence especially from the private sector.

It is noteworthy that on 18 February, six US industry associations (Biotechnology Innovation Organisation, National Association of Manufactures, National Foreign Trade Council, Pharmaceutical Research and Manufactures of America, US Chamber of Commerce and United States Council of International Business) wrote to Senator Orrin Hatch, chairman of the U.S. Senate Finance Committee, expressing concerns mainly on the UN High Level Panel on Access to Medicines which could “degrade the global ecosystems of innovation ”. The letter further states that, “This is not, however, the only example of UN institution constraining business involvement to the detriment of innovation. Similar exercises are currently underway in the World Health Organisation (WHO) with its ‘Framework for Engagement with Non-State Actors’ (FENSA) …”
Interestingly most Member States who are now opposing FENSA had earlier supported the adoption of the FENSA text drafted by the Secretariat during the 134th and 136th Executive Baard meetings.  The cold feet developed only when the drafting process shifted from the Secretariat to a Member State-driven process of the Open Ended Intergovernmental Committee. The interventions of some of these Member States are quoted below from the Summary of Records of the two sessions in January 2014 ( and January 2015 ( ).

Norway at the 134th Executive Board meeting “expressed support for the objectives, overarching principles and boundaries described in the report and for the proposed next steps set out in paragraph 28. He welcomed the proposal to hold further informal consultations during which the various elements to be included in policies and operational procedures for different types of non-State actors could be examined.”

Switzerland at the same meeting stressed that “WHO needed to adapt to the changing cast of actors in the global health sphere and that it should continue to play its unique normative role. She welcomed the overarching principles outlined in the report, that any engagement should respect the intergovernmental nature of WHO, demonstrate a clear benefit for public health, be conducted on the basis of transparency and prevent conflicts of interest. In order to put those principles into practice, it would be necessary to regulate the Organization’s engagement with non-State actors using clear and precise procedures. That was an essential condition for maintaining the reputation of WHO and respect for its mandate”.

The UK stated that, “The development of a code of conduct, rules of engagement or a general policy that was applicable to all non-State actors would ensure a shared understanding and hence avoid extensive discussions on conflicts of interest during each negotiation. Such a document could be used to identify the purpose and scope of any engagement and whether there were any real or perceived conflicts of interest”.

At the 136th Executive Board meeting “Lithuania speaking on behalf of Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway and Sweden, commended the clear structure of the revised draft framework which took into account Member States’ concerns. It established uniform rules and clear expectations for non-State actors, facilitating interaction while managing risks and protecting WHO’s reputation. … He recommended adoption of the framework by the Sixty-eighth World Health Assembly, and noted the possibility of evaluation and review after two years to address the lessons learnt from implementation”.

At the same meeting, Germany said that, “non-State actors made a significant contribution to shaping global health and could provide valuable support to help WHO to play its global health leadership role. Germany did not consider that adoption of the draft framework would infringe on the independence of WHO activities or on the decision-making power of Member States, but was willing to refine further the draft framework during the current Executive Board session”.