WHO: REPORT ON THE 124TH SESSION OF THE WORLD

UNCLAS GENEVA 000128 SIPDIS DEPT FOR IO/T, S/GAC, OES, G/AIAG, PRM, EAP USAID FOR DALE GIBB E.O. 12958: N/A TAGS: TBIO WHO SUBJECT: WHO: REPORT ON THE 124TH SESSION OF THE WORLD HEALTH ORGANIZATION EXECUTIVE BOARD REF: GENEVA 00060 ¶1. Summary. The 124th Session of the Executive Board (EB) of the World Health Organization (WHO) met from January 19-26, 2009, in Geneva. This cable reports on the significant outcomes from the Board (and its Program, Budget and Administration Committee, which met prior to the EB), including resolutions forwarded to the 62nd World Health Assembly for adoption in May. Discussions at the 124th EB were robust and substantive and, other than a voted-resolution on the health crisis in Gaza, the resolutions and decisions were approved by consensus. The debate and voted resolution on the health crisis in Gaza are reported reftel. Dr. Don Wright, Acting Assistant Secretary for Health at the Department of Health and Human Services (HHS),led the U.S. Delegation (USDel),which included officials from HHS, USAID, State (IO and PRM) and U.S. Mission Geneva. The EB began under one Administration and continued under the new Administration. USDel reflected, per guidance on select issues from the HHS Transition Team, the Administration's willingness to be more forward-leaning on issues such as the Millennium Development Goals, climate change and health and the WHO Commission on the Social Determinants of Health. End Summary. ¶2. WHO Director-General Margaret Chan, in the second year of her five-year term, was actively engaged throughout the EB, seeking specific Board guidance on issues, proposing ways to find consensus, and reminding Member States about WHO's core business as a technical health organization (as opposed to an IP or development agency). Her statement to the Board covered various humanitarian issues, such as the cholera outbreak in Zimbabwe and the health crisis in Gaza, in a non-political tone. She addressed issues before the EB such as primary health care, Chagas disease, the health-related Millennium Development Goals, health worker migration, counterfeit medical products, human organ and tissue transplantation, the report of the Commission on Social Determinants of Health, and the Proposed Program Budget for 2010-2011. She closed with reference to how, in these times of economic and financial crisis, the health sector manages risks, such as disease outbreaks; contributes to good global governance, such as its ability to inspire collaboration and good will; and motivates ethical behavior, leading to greater health equity. KEY OUTCOMES -------------- ¶3. UPDATE ON PANDEMIC-INFLUENZA PREPAREDNESS. The discussion focused on a progress report related to the December 2008 intergovernmental meeting (IGM) on pandemic influenza preparedness. USDel emphasized the need to reach consensus at the next IGM on all remaining issues related to sample-sharing/benefit sharing in time for the 62nd WHA in May 2009. Indonesia's Health Minister Supari, attending the first few days of the EB, said the IGM had agreed to the use of a standard materials transfer agreement for H5N1 viruses and to integrate benefit-sharing into such an agreement. (Comment: the IGM did not reach such agreements.) She urged countries to work cooperatively to resolve issues. WHO Assistant Director-General for Health Security and the Environment, David Heymann, commented on the ongoing threat of a pandemic, referred to WHO's work on assisting countries on vaccine production capacity, and spoke to the need for a broad spectrum vaccine as the "holy grail" that could mitigate or prevent a pandemic, although it remained a research issue with no such vaccines in clinical trials. ¶4. IMPLEMENTATION OF THE INTERNATIONAL HEALTH REGULATIONS. Delegations spoke to the many challenges in their countries to implementation of the IHRs and development of the core capacities required. USDel urged universal application of the IHRs and called on Member States to live up to their obligations, such as openly and transparently sharing information about disease outbreaks where the IHRs require reporting. ¶5. TAIWAN AND THE IHRs. As a positive development that occurred just prior to the EB, WHO sent a letter to Taiwan health authorities on January 2, 2009, proposing ways to include Taiwan in implementation of the IHRs, specifically: designation of a contact point, direct communications between Taiwan and WHO, provision of documents and information, measures related to a public health emergency of international concern, and inclusion of a public health expert from Taipei in the IHR expert roster. Taiwan's CDC responded on January 22, 2009, to accept the WHO offer. There was no public discussion of this matter at the EB. ¶6. PRIMARY HEALTH CARE. USDel expressed strong support for primary health care initiatives and encouraged countries to take active steps to expand primary care services in all communities. Japan and a group of WHO Member States from the Eastern Mediterranean Region, including Afghanistan, Oman and the United Arab Emirates, both tabled resolutions under this agenda item. (Comment: It appeared the EMRO text was actually a product of the WHO Secretariat.) The EB Chair asked a working group of Member States to meet informally, under the leadership of the Republic of Korea, to combine and deconflict the two texts. After six sessions of informal negotiations the working group reached consensus on a text that, inter alia, requested Member States to ensure political commitment at all levels to the values and principles of the Declaration of Alma-Ata, keep the issue of strengthening health systems based on the primary health care approach high on the international political agenda, and take advantage, as appropriate, of health-related partnerships and initiatives relating to this issue, particularly to support achievement of the Millennium Development Goals. ¶7. PRIMARY HEALTH CARE AND TRADITIONAL MEDICINE. The Board approved a PRC-sponsored resolution on Traditional Medicine under the primary health care agenda item. The resolution instructs WHO to update the WHO traditional medicine strategy based on countries' progress in disseminating traditional medicine and to update policy guidance to Member States. While the final text did not include a proposal to hold an annual Traditional Medicine Day, the PRC may revive that proposal at the WHA. ¶8. COMMISSION ON SOCIAL DETERMINANTS OF HEALTH. The discussion focused on the relevance of social determinants to the incidence of all diseases and, as such, the need to inform the design of and reforms to health systems. USDel welcomed the Commission's report, referring to President Obama having spoken about the need to address economic inequities and health disparities, and noted the Commission's report adds to existing data on the way social determinants, such as income disparity or lack of education, might lead to worse health. The resolution expressed appreciation for the work done by the Commission and called for a range of actions by all relevant players to reduce health inequities. The resolution also called on WHO to convene a "global event" to "highlight the developments, progress and renewed plans for addressing the alarming trends of health inequities and to increase global awareness on social determinants of health, including health equity." Brazil immediately offered to host a conference on social determinants of health in July 2010 and suggested it could also focus on achievement of the MDGs. ¶9. ACHIEVEMENT OF THE HEALTH-RELATED MILLENNIUM DEVELOPMENT GOALS. As agreed previously, the Board and WHA are to address the MDGs annually through 2015, the year the goals are to be achieved. Speaking for African countries, Malawi lamented that Africa was unlikely to achieve the health-related MDGs, and only six countries in the region were making real progress on them. South Africa noted it had gained no ground on maternal mortality rates in recent years. Some countries, particularly in Asia, did say they were on track to achieve the goals. USDel pointed to the importance of each of the MDGs and emphasized the need for reducing maternal mortality and improving mother and child health, including through better access to reproductive health services. The WHO Secretariat pointed to the need for both sustainable and accelerated approaches to achieve the MDGs. ¶10. CLIMATE CHANGE AND HEALTH. The EB approved a short resolution sponsored by the UK that endorsed the WHO Secretariat work plan on climate change and health and requested the DG to report annually on its implementation. USDel agreed that persuasive evidence exists regarding the impact of climate change on human health and urged WHO and Member States to take appropriate action. ¶11. WHO'S ROLE AND RESPONSIBILITIES IN HEALTH RESEARCH. The discussion focused on the proposed WHO Secretariat's strategy on research for health and the degree to which WHO is either engaged directly in research or in disseminating research findings. Some countries sought a much stronger role for WHO in direct health research. USDel cautioned that while WHO does engage in such research, for example at the International Agency for Research on Cancer (IARC) and in the Tropical Disease Research Program, WHO's primary role should be using research findings for technical guidance to Member States. The WHO Secretariat (Dr. Tim Evans) confirmed WHO's contributions related to the synthesis and translation of research into a useable form for policy processes in countries. Dr. Evans also noted the role of WHO's Advisory Committee on Health Research in the provision of best-evidence, and agreed to revise the research strategy to reflect that copyright and intellectual property rights are not barriers to access to health data, tools, materials and literature. ¶12. INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL: DRAFT GLOBAL CODE OF PRACTICE. The WHO Secretariat-drafted Code of Practice (COP) on the International Recruitment of Health Personnel was not agreed at the WHO Executive Board. Many Member States expressed diverse views on the Code and were particularly concerned that the Secretariat had not allowed for adequate consultations during the drafting process. The EB agreed to a schedule for further stakeholder consultation and Member State input, beginning with the fall meetings of WHO Regional Committees. Each Regional Committee will discuss the Code and then submit reports on their consultations to the Secretariat, which will prepare a synthesis report for consideration by the 2010 Executive Board. An open-ended meeting of Member States will then meet in Geneva to consider a revised draft Code, to be presented for consideration to the Health Assembly in 2010. Since discussions on the COP have been removed from the 2009 WHA agenda, the DG will include a brief statement regarding work completed to date in her report to the Assembly. ¶13. COUNTERFEIT MEDICAL PRODUCTS. The Executive Board was unable to reach consensus on this agenda item. Several Board members, including Brazil, Bangladesh, El Salvador, Paraguay and Sri Lanka, all spoke against the Board considering the agenda item and its accompanying resolution. India, Thailand and Egypt (not on the Board) also spoke against the Board considering it. The rationale used by these Member States was that matters pertaining to intellectual property rights were not appropriate to discuss at the WHO - the exact opposite position that this same group of Member States took in the context of the WHO Intergovernmental Working Group on Public Health, Innovation and Intellectual Property. (NOTE: The Brazilian Permanent Representative delivered remarks that attempted to link the agenda item to the seizure by Dutch authorities of a shipment of losartan (a diabetes drug) manufactured in India and en route to Brazil.) USDel, the European Union, Malawi and the European Commission all spoke in favor of the Board considering the item. As a way forward, the Board instructed the WHO Director-General to prepare a revised paper for the WHA in May that focuses on the public-health aspects of counterfeit medical products, with particular regard to adulterated/sub-standard medical products. The DG will also prepare a draft resolution to accompany the document. There is no guarantee the WHA will act on it. ¶14. PUBLIC HEALTH, INNOVATION AND INTELLECTUAL PROPERTY. The Board considered a progress-report related to the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property Rights. Although in informal discussions progress was made in reaching a compromise to settle the bracketed text that remained in the Plan of Action, the Board took no action, as adopting the compromise is the purview of the Health Assembly. USDel noted concerns about the estimated cost of implementing the Strategy and asked the WHO Secretariat to develop better indicators through which to measure progress. The Secretariat will present the revised indicators to the WHA in May. ¶15. ROLE OF THE PRIVATE SECTOR IN PROVIDING ESSENTIAL HEALTH CARE SERVICES. There was a robust discussion on this agenda item, proposed by Thailand. Countries had a variety of experiences ranging from a high percentage of health coverage from the private health sector in a number of countries to some countries where there was little or no activity of the private sector in providing health care. Most countries supported addressing issues related to appropriate regulation of private providers, the high cost of labor, and ways to increase access to quality care. There was an acknowledged lack of definition about the scope of the private sector, including both for-profit and not-for-profit provider, and whether private physicians, clinics, and pivate insurance companies were to be included. Several countries, namely Paraguay and Venezuela, opposed any resolution which did not acknowledge the government's role to ensure health care. The Board decided against forwarding a resolution to the WHA at this time. The Director-General agreed the Secretariat would provide a more fully-developed paper that reflected on the concerns of the Member States (such as the stewardship role of the public sector) and would lay out policy options for countries. At USDel's suggestion, WHO will propose a draft resolution with the document to be prepared for the WHA. ¶16. POLIO ERADICATION. Several countries spoke on this information item, focusing on the agenda in West Africa and other remaining pockets of the disease. The UK delegation, noting "we are tantalizingly close," reaffirmed its commitment to eradication in 2009. To that end, the UK had pledged an additional 100 million British Pounds to the effort. The UK also urged that the remaining endemic countries be invited to speak on this topic at the WHA. Dr. Chan said there was nothing more important to her than finishing the job on eradication. BUDGET AND ADMINISTRATIVE ISSUES (includes PBAC discussion) -------------- -------------- ¶17. WHO PROGRAM BUDGET FOR 2010-2011. WHO noted the budget was now broken out into three segments -- WHO programs, outbreak and crisis response, and partnerships and collaborative arrangements, in an effort to provide more transparency. Some Member States addressed the imbalance between assessed and voluntary contributions and concerns about the continuing high-level of earmarked resources and the relative imbalance among strategic objectives. Some were also concerned about WHO's ability to raise sufficient income and its capacity to expend the budget increase, especially given low implementation rates in the current biennium. USDel spoke to the issues of miscellaneous income, partnerships expenditures, the possibility of setting up a separate fund for emergencies, exchange rate adjustments, and the budget level and the need for budget discipline. ¶18. On miscellaneous income, the Secretariat is to provide in the revised budget submitted to the WHA a figure for what it prefers to call "additional" income into the budget appropriation (thus reducing assessments -- see also paras 23 and 24). On creation of a revolving fund for emergencies, the Director-General committed to keeping that under advisement, noting WHO can draw upon the harmonized UN fund for emergencies in New York - the CERF - and this is working adequately for WHO for now. WHO will include the most current exchange rate projections in the May budget. USDel was also told informally that the voluntary resource projections for 2010-11 will likely be reduced in the final budget proposed to the WHA. ¶19. WHO GLOBAL MANAGEMENT SYSTEM (GSM). WHO reviewed the status of implementation of the GSM and several countries, U.S. included, were concerned that based on anecdotal information received, the Secretariat was glossing over the significant difficulties in implementation. The Acting Assistant Director-General for General Management responded that WHO did not wish to gloss over the difficulties WHO has experienced and the significant workload, but he indicated problems on the financial side were progressively being resolved while big problems in the human resources module of GSM remained. More time was needed before the system would work as intended, although the new and better data being generated at Headquarters and the Western Pacific Regional Office (WPRO) was already providing benefits. Introduction of the system to the remaining WHO regions was postponed for now until the system is stable. ¶20. With regard to WHO's use of Satyam Computer Services, Ltd., as a main contractor, and its severe corporate problems, the Secretariat said WHO had been in contact with senior management of Satyam and there were no indications at present of disruptions to services to WHO, but contingency planning was under way to prepare for possible unfavorable developments. USDel was assured that additional costs were being met from existing funding for regional office implementation and system enhancements. Board members noted the GSM underpins the achievement of WHO's strategic objectives and the Organization should persevere to complete GSM's implementation. ¶21. PARTNERSHIPS. The Secretariat presented guidelines for WHO involvement with partnerships, which the EB endorsed. Denmark noted that many new actors are playing an increasing role in public health, which has an impact on the WHO budget, and cautioned this could lead to very complex processes. The Member States, nevertheless, need to be able to guide the Organization and the goals of partnerships that WHO engages with must be in line with WHO strategic objectives. USDel strongly agreed with this statement. For AFRO, Malawi observed that African countries want WHO to play a leading role on partnerships in view of the complex development landscape. While partnerships are helpful, there is a fragmentation of development that leads to high costs and reduces effectiveness. Malawi appealed for harmonizing country level interventions to reduce transaction costs and for more effective monitoring and evaluation. WHO, taking these observations into account, will work further on the partnership guidelines prior to the WHA. ¶22. ESTABLISHMENT OF AN AUDIT COMMITTEE. USDel was joined by a number of other Geneva Group countries speaking in favor of an Independent Expert Oversight Advisory Committee at the WHO, especially in view of WHO's projected $5.6 billion overall budget for 2010-11. Only China and Indonesia expressed mildly differing views. The EB agreed to the recommendation of the Program, Budget, and Administration Committee for the establishment of a committee that was both independent and expert in the relevant fields and separate from the PBAC. It was agreed Member States will work with the Secretariat between now and the May PBAC to prepare draft terms of reference and study issues related to lines of reporting, legal status, and costs. ¶23. AMENDMENTS TO FINANCIAL REGULATIONS AND RULES. USDel questioned three amendments to the financial regulations, in particular the insertion of a separate budget for capital expenditures and the deletion of miscellaneous income to be replaced by the concept of an income surplus. For the separate budget for capital expenses, the Secretariat agreed to delete the language, although it was noted the DG could submit spending proposals as the Secretariat chose, even though there should not be an expectation of a separate budget in the regulations. On the concept of miscellaneous income, after some discussion the Secretariat agreed that "surplus" may not be the best word, but opposed the term "miscellaneous," noting it did not exist in the International Public Sector Accounting Standards (IPSAS) that WHO was adopting. The compromise was the three main sources of extra income, including interest income plus "additional" income from regular budget sources, are now delineated explicitly. WHO stated this income is to be used for appropriations in the budget. The previously deleted section noted that in the case that estimated amounts fall short, the DG will adjust the budget. ¶24. The Secretariat noted an estimate for this additional income would most likely be reinserted into the next draft budget. Privately, the WHO Treasurer cautioned USDel not to expect this estimated number to be as high as previous years given the current zero interest rates in the US. It is expected to be in the range of $15 to $20 million rather than $30 million. ¶25. AMENDMENTS TO STAFF RULES AND REGULATIONS. USDel succeeded in deleting a proposed new staff rule to allow national professional officers a language allowance, since the UN and its Funds and Programs (UNHCR excepted) did not pay this allowance. USDel expressed concern the UN common system was undermined when different parts of the UN provided different employee benefits. WHO withdrew the proposal but indicated it would promote its support of a language allowance for national professional officers to the ICSC. ¶26. WORLD HEALTH ASSEMBLY PROVISIONAL AGENDA. The EB approved the provisional agenda for the 62nd WHA in May 2009 with the addition of four new items proposed by Board Members: Food safety (UAE),international chemicals management (Slovenia),MDR-XDR tuberculosis (PRC),and viral hepatitis (Brazil). Of note, when USDel raised concern about respecting the principle of the EB vetting issues before they go to the WHA, many Board Members agreed and sought to uphold the practice. After some debate, it was agreed these new items would be identified on the provisional agenda as not having been discussed at the EB. STORELLA