Info Service on Health Issues (Feb20/01)
Geneva, 4 February (TWN) – The WHO Secretariat’s report for the consideration of the 146th Meeting of the Executive Board (EB) proposes to curtail the participation of CSOs in the governing body meetings such as the World Health Assembly (WHA) and EB.
The 146th EB of WHO is meeting at its head quarters in Geneva from 3 to 8 February.
The document titled “Involvement of non-State actors in WHO’s governing bodies” (EB 146/34) makes several proposals to reform the participation of non-State actors (NSAs) in WHO governing body meetings.
First, there would be an informal meeting between Member States and NSAs in official relations (with the WHO), before each WHA session. This informal meeting would contain side events and a forum.
Secondly, an opportunity would be given to NSAs to make 5 joint statements early in the debate and the opportunity to make the statement would be at the discretion of the Chair. Once the NSAs agreed to make joint statements the NSAs cannot make oral individual statements. In the absence of joint NSA statements “a maximum of seven individual statements on a first-come-first-served basis at the end of the debate”.
Thirdly, the number of individual statements an NSA can make in one session of the EB and WHA is limited to three.
Fourthly, the number of delegations of NSA in official relations would be limited to a maximum of 25 delegates.
The EB is invited to take a decision on whether the proposals can be implemented "tested during the 73rd WHA in May 2020 or at 147th session of EB and continue at the 74th WHA.
There is a question of legality with regard to this proposal to the EB i.e. whether the EB can overrule the decision of WHA. Resolution WHA 69.10 adopted the Framework of Engagement with Non-State Actors (FENSA), which regulates NSAs’ participation in the governing body.
Paragraph 55 of FENSA states: “Entities in official relations are invited to participate in sessions of WHO’s governing bodies. This privilege shall include: (a) the possibility to appoint a representative to participate, without right of vote, in meetings of WHO’s governing bodies or in meetings of the committees and conferences convened under its authority; (b) the possibility to make a statement if the Chairman of the meeting (i) invites them to do so or (ii) accedes to their request when an item in which the related entity is particularly interested is being discussed; (c) the possibility to submit the statement referred to in subparagraph (b) above in advance of the debate for the Secretariat to post on a dedicated website”.
Thus it is clear that every NSA in official relations has a right to speak if the Chairman of the meeting invites them to make a statement or accedes to an NSA request when an item in which the related entity is particularly interested is being discussed. This has been conferred by Resolution WHA 69.10 and the EB cannot take any decision to limit or cancel a privilege granted to NSAs through the WHA resolution.
The first proposal to hold a separate meeting prior to the WHA is viewed as creating a multi-stakeholder platform in the name of governance reform. Though other international organisations such as UNCTAD, WTO, Human Rights Council etc. organises forums for NGOs and other NSAs to deliberate on issues of concern there is no link between such forums and the governing body meetings of those organisations.
In fact, the idea of such a forum is an old idea of setting up a Committee C, similar to Committee A and Committee B at WHA. In an article published in Lancet in 2008 titled “Creating Committee C of the World Health Assembly” the idea of creating such a committee was mooted. The objective of Committee C is to provide a forum for various actors of global health to discuss and coordinate. The lead author of the article was Dr.Gaudenz Silberschmidt, then a staffer of Switzerland’s Federal Department of Home Affairs, Federal Office of Public Health. During those days Dr. Silberschmidt was part of Switzerland's delegation to attend WHO governing body meetings. Interestingly Dr. Silberschmidt is now one of the WHO staffers leading the governance reform. Another co-author of the article, Ilona Kickbusch, was in the transition team of the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus.
The idea of creating a Global Health Forum also came up in 2011 as part of the WHO reform but it was rejected by the Member States. In 2011 the WHO Secretariat even organised a Global Health Forum in Moscow. This was not pursued as a result of opposition from the Member States.
According to observers, such a forum would be captured by the resource-rich NSAs, especially those backed by business, and lead to the marginalisation of CSOs. Currently out of 217 NSAs in official relations, 72% have declared financial relationships with the private sector. Private sector contribution to 38% of these NSAs consitutes 30% or more of their financial resources.
Further, the forum could also lead to the under-representation of CSO from the South. Then, the solution would be to facilitate financial assistance for attending such meetings. That would lead to donor-driven participation. Among the 217 NSAs in official relations, less than 9 NSAs are based in developing countries. Further, the majority of WHO Member States themselves do not have enough financial and human resources to attend the WHO meetings and therefore would not be attending the proposed forum. The forum is proposed to be held in parallel with the meeting of the Program and Budget Committee of WHO.
Till 2008 NGOs in official relations could organize side events during WHA. This was curtailed by reducing the number of side events and the Secretariat also asked CSOs to co-organize side events. The strict selection process of side events during WHA resulted in the drastic reduction of the number of NSA side events. For instance, in 2018 out of 20 NSA applications, only 8 side events were selected. The shrinking space for the participation of NSAs is mostly related to CSO-organized side events because the cash-rich NSAs such as international business associations, industry-funded NGOs and philanthropic foundations find alternative ways such as organizing events outside the WHA venue or organizing breakfast meetings or evening cocktails.
The proposal for collective statements during governing body meetings by different NSA constituencies ignores the diversity among NSAs, especially among NGOs. Currently, nongovernmental organizations, international business associations and philanthropic foundations are eligible for official relations. The NGO constituency is not a monolithic entity and consist of various types of organizations. These include patients' organizations, disease advocacy groups, faith-based organizations, professional organizations, trade unions, and CSOs. This diversity also reflects their approach to issues and it would be difficult to reach a consensus on issues.
Further, many health issues are interconnected and therefore NSAs especially CSOs have a legitimate interest to intervene in these cross-cutting issues. For instance, the 146th EB is discussing tuberculosis, cervical cancer and neglected tropical diseases, Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, Epilepsy, Global Vaccine Plan, etc. An NSA working on access to health products would be interested to make statements in all these agenda items. If the proposal to limit the number of individual NSA statements to 3 is accepted then NSAs would be prevented from making statements on all the relevant agenda items.
The proposal to limit the number of NSA statements to 7 on every agenda item, and the maximum number of 3 statements for one NSA during the governing body meetings, violate the principles of the right to participation recommendation laid down by the UN High Commissioner on Human Rights.
In the annual report submitted to the 38th Session of the Human Rights Council the High Commissioner stated: "The effective functioning of international and regional organizations is inexorably linked to civil society participation.” According to the report "International human rights law requires States and other duty bearers to create and support a safe and enabling environment that allows civil society to exercise fully the rights and freedoms that are indispensable for them to fulfil their essential role of bringing the voices of all parts of society to the table". It recommends: "The right to access to information underpins the participation of civil society in regional and international organizations and therefore should not be unnecessarily or disproportionately restricted."
Though there are 217 NSAs in official relations all these organisations are not attending WHA. For instance, in 2019 only 127 registered for attending WHA. In 2018 too only 127 NSAs registered for attending WHA. This does not mean that all the NSAs registered are making statements on every technical matter discussed at the Committee A or B. In 2018 the number of NSA statements was 236. In 2019 the number of statements in Committee A was around189. The total number of NSA statements on each agenda item varies. In 2019 discussions on primary health acre attracted the maximum number of interventions i.e. 23. In 2018 one agenda item had 36 NSA statements.
As per the rules of the procedure, the possibility to make the statement is entirely with the Chair of the meeting. There is no existing guideline to direct the discretion of the Chair of the Committees concerning NSA statements. As a result, there is no clarity with regard to duration and occasion of NSA statements. Generally, NSAs are allowed to read out 300-word statements after the completion of the intervention of the Member States and Intergovernmental Organisations. As mentioned above depending on the number of interventions form the Member States the duration of NSA statements gets reduced. Normally the Chair gives 2 minutes to a NSA to make a statement and many times the Chair reduces the time to 1 minute.
Often NSA statements were allowed only after the conclusion of the work of the drafting group i.e. the finalization of the decision/resolution and this makes the NSA statements redundant. Even though the censoring of NSA statements is no more applied but NSAs are asked to submit their statements at 8 am on the day of agenda item listed. As a result, NSAs are not in a position to express their views when certain issues come up in the Member States intervention.
The reform discussion does not address these practical problems and the solutions like allowing NSAs to make statements during the initial part of the discussion or allowing NSAs to post detailed comments on the agenda item in advance with a word limit of 700 to 800 words.
Prior to the 142nd EB the Geneva Global Health Hub (G2H2) in a Memorandum to the Director-General of WHO pointed out this issue. The Memo states: “Following an earlier 48 hours rule, NSA statements currently need to be submitted by email before 8 AM of the day when a particular agenda item is scheduled, and they are strictly limited to 300 words. Such a rigid mechanism does not allow proper interaction (reacting to the development of the discourse) and risks to be an alibi exercise. We encourage WHO to assess the respective modalities in other UN organizations where civil society can intervene during any debate, with representatives present in the same room and without having to submit a written statement hours before”. (http://g2h2.org/wp-content/uploads/2017/11/G2H2-Tedros-2017-4-Transparency-and-inclusiveness.pdf )
Apparently, in reply to this Memo the WHO eceretraita sent a letter to all NSAs in official relations dated 16th May justifiying the 8 am submission rule set by the Secretariat. The latter states: “For logistical and organisational purpose, Non-State Actors wishing to have their name placed on the list of speakers for the purpose of making statements should notify the Secretariat at latest by 08.00 am of the day of the meeting in question”. However the letter did not explain the logistical and organisational reasons mentioned in the letter. (http://www.who.int/about/collaborations/non-state-actors/Letter-on-participation-of-non-State-actors-at-WHO-meetings-and-other-engagement.pdf )
The proposals to limit the number of the delegate to 25 also would limit CSO participation. Many NGO delegations have a huge number of delegates, sometimes up to 117. This is primarily due to the faulty restrictions placed on CSO participation in WHO Governing Body meetings. As mentioned only three categories of NSAs are allowed to enter into official relations. Only those who meet the requirement “Entities in official relations are international in membership and /or scope" are allowed to enter into official relations. The second important condition is “of official relations” is a plan for collaboration between WHO and the entity with agreed objectives and outlining activities for the coming three-year period structured in accordance with the General Programme of Work and Programme budget. Therefore CSOs are left out of official relations. Many CSOs thus participate in WHO governing body meetings through a partner organization.
Though FENSA allows the accreditation for certain types of NGOs without a plan of collaboration the Secretariat has not initiated any steps to provide such accreditation. The current proposal would drastically reduce CSO participation.
The proposal in the name of enhancing the participation of NSAs is effectively curtailing the participation of CSOs in WHO governing body meetings.+