TWN Info Service on Health Issues (Feb23/03)
6 February 2023
Third World Network

WHO:  Continued derailment of  the implementation of FENSA

Geneva, 6^th February (K M Gopakumar) – The current leadership of WHO continues to derail  the implementation of the organization’s Framework on Engagement with Non-State actors (FENSA).

FENSA sets out the norms and standards for WHO’s engagements with non-State actors (NSAs) viz. academic institutions, non-governmental organisations (NGO), philanthropic foundations and the private sector.

WHO Director-General (DG) Dr. Tedros Adhanom Ghebreyesus seems to have taken a sceptical view on the implementation of FENSA, and instead follows an approach to promote engagement with NSAs including the private sector, risking the undermining of WHO’s integrity, independence, credibility and reputation.

Further, the Secretariat is not implementing the key provisions of  FENSA and thus facilitates the continuation of risky engagements.  One such recent engagement is the decision to partner with the Fédération internationale de football association (FIFA) or International Association Football Federation in English.

The DG’s report to the WHO Executive Board (EB)  states: “our partnership with Qatar and the International Association Football Federation enabled us to reach billions of people globally with messages about physical activity and more during the 2022 World Cup. And that was the first time. We learned a lot. It was a success”. The DG was referring to WHO’s partnership that started in 2019. However, he did not mention the reputational risk involved in the partnership with FIFA that has been plagued with controversy.

Current FIFA partners include soft drink company Coca-Cola and the 2022 World Cup sponsors include alcohol manufacturer Budweiser as well as junk food chain McDonalds. The business activities of these companies bear high health risks and the decision on WHO partnering with FIFA normalises the engagement with the business of alcohol, soft drinks and junk food. Paragraph 7 (f) of FENSA identities such risks  as “the whitewashing of a non-State actor’s image through an engagement with WHO”.

The memorandum of association (MoU) with FIFA was originally signed in 2019. The four areas of collaboration are:

• Advocacy to promote a healthy lifestyle through football.
• Policy alignment to ensure tobacco-free environments at FIFA events; to encourage national football federations to adopt tobacco-free policies, including at stadiums; and to enable WHO to provide technical advice to FIFA on health matters.
• Building on FIFA events to institute lasting improvements in health and safety.
• Joint programmes and initiatives to increase participation in physical activity through football, in line with WHO guidance, as well as working with national associations and networks of WHO goodwill ambassadors, football players, coaches and volunteers to increase physical activity through football.

It is also important to note that the high reputational risk of FIFA following the criminal investigations on corruption charges. The MoU and recent partnership not only helped whitewash FIFA’s reputation, but the private sector involved is marketing products of health risks.

Non-implementation of key FENSA provisions

Engagements during emergencies: The Secretariat’s report states that, “Building on the lessons learned from the coronavirus disease (COVID-19) pandemic response, WHO has continued leveraging stronger collaboration and coordination at all levels with non-State actors to respond effectively to the needs of Member States. In 2022, the Secretariat released the revised Strategic Preparedness, Readiness and Response Plan to End the Global COVID-19 Emergency in 2022,1 setting the collective goal of ending the pandemic and strengthening linkages between WHO, health authorities and non-State actors to support the response of local governance mechanisms”.

However, the Report selectively provides information on certain engagements without providing information on the nature and details of such engagements. The report maintains a stoic silence on whether there was waiver of any due diligence on such engagements.

Paragraph 73 provides flexibility to the DG “to engage with NSAs during emergencies. However, the “The Director-General will inform Member States through appropriate means, including in particular written communication, without undue delay when such a response requires exercise of flexibility, and include summary information with justification on the use of such flexibility in the annual report on engagement with non-State actors”. There was no such notification to date.

According to an observer, this allows the Secretariat to continue these engagements away from Member States’ scrutiny.

Accreditation of NGOs:  FENSA provides two routes for the accreditation of NSAs in official relation with the WHO. Only NGOs, international business associations and philanthropic foundations are allowed to enter into official relations. The first route is available to all NSAs after a systematic engagement with WHO for nearly two years, following which the NSAs need to enter into a collaborative work program for 3 years.

The second route is available only to NGOs under Paragraph 53 of FENSA. This states: “For nongovernmental organizations working on global health issues, sustained and systematic engagement could include research and active advocacy around WHO meetings and WHO’s policies, norms and standards. Official relations may be considered for such nongovernmental organizations based on at least three years of their activities and future work plan on research and advocacy on global public health issues”.

This means NGOs working on global health issues can seek official relations without any prior collaborative work program. Further, sustained and systematic engagement could include research and active advocacy around WHO meetings. This means that these NGOs need not enter into an MoU to prove systematic engagement; rather their  work speaks for the systematic engagement. However, the Secretariat has not implemented this paragraph and to date has not allowed any NGOs to seek official relations though the Paragrapgh 53 pathway.

Institutional Conflict of Interest: Paragraph 26 of FENSA states: “For WHO, the potential risk of institutional conflicts of interest could be the highest in situations where the interest of non-State actors, in particular economic, commercial or financial, are
in conflict with WHO’s public health policies, constitutional mandate and interests, in particular the Organization’s independence and impartiality in setting policies, norms and standards”.

However, there is no institutional conflict of interest policy for WHO in the public domain. Insiders in WHO confirm that there is no such policy existing within the organization.

Classification of NSAs: 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. Such influence can be exerted through financing, participation in decision making or otherwise. Provided that the decision-making processes and bodies of a non-State actor remain independent of undue influence from the private sector, WHO can decide to consider the entity as a nongovernmental organization, a philanthropic foundation or an academic institution, but may apply relevant provisions of the WHO’s policy and operational procedures on engagement with private sector entities, such as not accepting financial and in-kind contributions for
use in the normative work”.

To date, the Secretariat has not carried out any such classification of NSAs and in fact allows many NGOs receiving substantial funding from the private sector to continue to participate as “NGOs”.+