Info Service on Health Issues (Apr19/06)
WHO: Restructuring fails to address conflict of interest in FENSA Implementation
New Delhi, 24 April (K M Gopakumar): The recent restructuring of the World Health Organization (WHO) hierarchy fails to address conflict of interest in the implementation of the Framework of Engagement with Non-State actors (FENSA).
WHO announced its new structure on 6 March 2019 that has four pillars viz. Universal Health Coverage (UHC), Emergencies, External Relations and Governance and Business Operations. These four pillars will be supplemented by the Division of the Chief Scientist.
According to WHO’s press release the Chief Scientist is to “strengthen WHO’s core scientific work and ensure the quality and consistency of WHO’s norms and standards”. The press release quotes Dr Tedros Adhanom Ghebreyesus, WHO Director-General: “The changes we are announcing today are about so much more than new structures, they’re about changing the DNA of the organization to deliver a measurable impact in the lives of the people we serve”.
The department in charge of FENSA implementation is responsible for Health and Multilateral Partnerships. Prior to the restructuring the name of the department was Partnerships and Non-State Actors.
As the name suggests, the division in charge of FENSA implementation also has the responsibility of promoting and entering into partnerships. This means the department’s mission is to promote engagements with non-State actors (NSAs). This creates potential conflict of interest between the two functions. This would create potential risk of compromising the implementation of FENSA especially with regard to due diligence.
During the 142nd Executive Board (EB) Meeting in January 2018 India had raised concern on the conflicting roles of the department of Partnerships and Non-State Actors. The Official Record of the Board meeting paraphrases India’s statements as follows: “Implementation of the Framework of Engagement should be the responsibility of the Office of the Legal Counsel, not of the departments in charge of implementation and resource mobilization, as there could be conflict between those two functions.”
Prior to India’s statement during the EB meeting, Geneva-based civil society platform G2 H2 (Geneva Global Health Hub) raised similar concerns in a memorandum submitted to the WHO Director-General on 20th November 2017. The memorandum states: “Currently, the official in charge of FENSA implementation also has the responsibility of partnerships and resource mobilization. Independent of the skills and integrity of this official, the institutional arrangement of combining responsibilities for both tasks in one person risks compromising WHO’s stand on FENSA. The responsibility of FENSA implementation should be rather moved to the Office of Legal Counsel.”
There was expectation among WHO observers that the FENSA implementation team currently reporting to the Director of Health and Multilateral Partnerships would be shifted to either the Office of the Legal Counsel or Office of Compliance, Risk Management and Ethics as part of the restructuring process.
Further, the implementation of FENSA is slow and the Secretariat has not implemented crucial provisions. For instance, according to Paragraph 13 of FENSA “WHO will determine through its due diligence if a non-State actor is subject to the influence of private sector entities to the extent that the non-State actor has to be considered itself a private sector entity”.
To date there is no such determination made. Such a determination is critical for finalising the nature of engagements, especially the collaborative work plan that is a prerequisite for an entity to enter into official relation with the WHO. A mapping of entities that sought renewal of official relation status shows that out of 71 NSAs, 46 (66.2%) disclosed income from the private sector.
Another very critical element for the effectiveness of FENSA is the implementation of a comprehensive policy on conflict of interests covering both individual and institutional conflict of interest in the context of engagement with NSAs.
Para 25 of FENSA states: “In actively managing institutional conflict of interest and the other risks of engagement mentioned in paragraph 7 above, WHO aims to avoid allowing the conflicting interests of a non-State actor to exert, or be reasonably perceived to exert, undue influence over the Organization’s decision-making process or to prevail over its interests”.
However, to date there is silence on how to address institutional conflict of interest. Even the Guide for Staff on Engagement of NSAs is silent on this issue. Recommendation No. 1 of the UN Joint Inspection Unit Report on conflict of interests states: “Executive heads of the United Nations system organizations should direct their officials entrusted with the ethics function to map the most common occurrences and register the risks of situations exposing their respective organizations to organizational conflicts of interest, no later than December 2019.” There is no information available in the public domain with regard to WHO’s policy to address institutional conflict of interest.
The WHO Director-General has expressed several times his reservation about FENSA including at the opening of the World Health Assembly in 2018 and the EB. In response to his repeated remarks on FENSA, Medicine Mundi International, Peoples’ Health Movement and TWN in their statement at the 144th EB session said: “We would like to express our concerns about the repeated statement from the [Director-General] that FENSA is not a fence and that WHO is moving from risk aversion to risk management”.+