By Ayushi Parvathaneni Pathipati, Policy and Advocacy Consultant
The World Health Organization Executive Board (WHO EB) annual session serves as an opportunity for 194 member-states to agree upon a health agenda ahead of World Health Assembly meetings, which determines resolutions, action plans, finances, proposed budgets and policies that govern WHO. This year, amidst the backdrop of the COVID-19 global emergency and its fallout on health systems, the January 2021 EB’s focus was once again on pandemic response and helping guide the world out of this health crisis.
Through EB148, governments supported and discussed key agenda items, such as:
- The UN High-Level Meeting on non-communicable diseases (NCDs)
- Public health emergencies preparedness and response
- Resolution on the social determinants of health
While conversations focused on COVID-19 and vaccine distribution, another pressing issue caught our attention: The on-going role of civil society in global WHO proceedings. At the EB meetings, WHO’s reform document, which outlines the rules and methods of engagement alarmed civil society groups, as it not only highlights the historical issues with participation, but proposes limiting future engagement – including technical consultations and official side-events. At WHO, technical consultations produce suggestions and comments of credible experts from civil society organizations which support and strengthen action plans envisioned by Member States and WHO. Official side-events provide the rare opportunity for informal engagement between civil society organizations and Member States on topics of mutual interest and enable the exchange of ideas and knowledge.
While the reform document captures the dissatisfaction of both Member States and civil society, as an explanation for the motivation behind the reform the report points out that:
“When a large number of non-State actors speak one-by-one at the end of a discussion, their interventions have little impact on the content or direction of the debate.” – WHO Reform Report by the Director General
Civil society, particularly international NGOs, serve a unique role in outlining and achieving health targets, holding governments accountable, providing technical expertise, and representing diverse communities. But these proposed changes could radically alter the quality of input from civil society groups, a vital constituency that is committed to improving global health and well-being.
In a pre-pandemic world, civil society organizations had an active role during EB meetings; they were at the forefront of grass-roots mobilization, disseminating technical guidelines, advocating for groups and issues long neglected, contributing to much needed knowledge generation and presenting key evidence. The importance of getting the pandemic under control prompted a break in civil society’s participation. The UN and WHO had to adapt to pandemic imposed restrictions that limited in-person meetings, and quickly devised a virtual format that excluded civil society participation. Civil society was not heard on the virtual floor during last year’s World Health Assembly or at the UN General Assembly, both of which focused on COVID-19.
Now there is concern that this disengagement might continue beyond any immediate crisis. WHO and the EB now suggest civil society organizations regroup their statements with other organizations, including the private sector and philanthropic foundations, further restricting their already limited input. Civil society organizations, including Vital Strategies, are concerned this move could make it difficult for groups with competing interests to come to a consensus.
The new proposals are set to be tested during the 74th World Health Assembly (WHA74) in May of this year. Proposals call for informal civil society events weeks or even months before the meetings, creating a separate, parallel process that does not allow civil society to weight in or run events at the same meetings heads of state and other officials attend. Events in the margins of the WHA are organized outside of formal sessions and provide a valuable opportunity for Member States and civil society to discuss perspectives on a range of issues. It is important to note that even before these new proposed arrangements, official civil society statements on the floor at critical global health meetings were limited or often left towards the end of the program; time limitations meant that sometimes statements were never read.
During recent meetings, agenda items were also shared with civil society groups only days before discussions among Member States began, making it difficult for organizations to review content and provide meaningful input.
Most recently, the WHO Executive Board agreed that a virtual informal meeting for non-state actors (including civil society groups) should be organized before WHA on a trial basis. The meeting will take place on April 20-22 and will invite feedback from civil society groups in official relations with WHO.
Even with this announcement, doubts remain whether key reports for issues including COVID-19 response and health emergencies will be available to civil society groups before the World Health Assembly meeting in May.
While a proposal on reform is welcome, the uncertainty around how WHO and Member States will proceed, which organizations are invited to the table to contribute, and how conflicts of interest will be managed is of great concern to civil society.
We ask Member States to strongly consider:
- Ensuring civil society’s early access to technical documents to encourage effective responses and the development of strong action plans.
- Distinguishing between civil society groups and unhealthy commodities industries, such as tobacco and alcohol; they should not be treated as groups with similar interests for the formation of constituency statements.
- Guaranteeing that informal meetings do not take the place of or coincide with formal preparatory meetings.
- Maintaining transparency about proposed informal discussions, mechanisms and resources to be tested at WHA74.
Without civil society engagement, the global health community risks losing crucial expertise and data, sound evidence and much-needed emphasis that laws and policies must protect people, save lives and create a healthier world for all.