Executive Board Meeting Ends with Concerns about WHO’s Sustainability and Board´s Ability to Govern Efficiently Analysis 30/01/2022 • Paul Adepoju & Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Dr Patrick Amoth, Chair of the Executive Board, As the 150th Executive Board Meeting of the WHO closed Saturday, attention focused on the inability of the WHO governing board to reach consensus on critical issues that it had debated – including a more sustainable financing framework as well as a clear way forward on a proposed new pandemic legal accord, reforms of global pandemic response and related WHO emergency operations. Despite six days of hours-long discussions, EB agreement to increase WHO member states´ assessed contributions to 50% of the budget by 2028-29, remained elusive. Nor could EB members even agree on a way forward for changing the format for voluntary contributions – using newer, and more innovative fundraising models, such as the ¨replenishment drives¨ that have made other non-profit global health organizations like Gavi and The Global Fund even more financially robust than WHO. Decision to extend mandate of Sustainable Finance working group keeps hopes alive WHO Director General Dr Tedros Adhanom Ghebreyesus on Saturday, the closing day of the EB´s 150th session In his closing remarks, Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, noted that while a conclusion on funding for WHO, which is a crucial issue, could not be reached at the meeting, the decision to extend the mandate of the working group on sustainable financing until the World Health Assembly demonstrated optimism. “I sincerely hope that by working together, we can make substantive progress on this issue,” the DG said. In advance of this year’s World Health Assembly, Tedros said that the WHO Secretariat also will further develop proposals, in consultation with Member States, on strengthening the global health architecture for emergency preparedness, response and resilience. “In doing so, we will take into consideration the preliminary findings of the Working Group on strengthening WHO Preparedness and Response to Health Emergencies, and recommendations of recent review panels and committees,” he said. However, that Working Group, as well, failed to reach agreement on key reforms, such as bolstering WHO´s mandate to make visits early on to sites of suspected pathogen outbreaks. Long, unwieldy agenda proves frustrating Dr Clemens Martin Auer, Austria´s EB representative and vice-chair Before officially declaring the meeting closed, Dr Patrick Amoth, Chair of the Executive Board, also stressed the need for discussions on how to improve the efficiency of WHO’s Executive Board meetings, and other member state fora, in order to ensure that member states can help WHO to perform more effectively. In all, the board reviewed over 55 agenda items and sub items. That, Amoth admitted, was ambitious, given the number of days available. “This resulted in longer sessions than we anticipated,” the chair added. While he also described the sessions as ´rich and engaging´ other member states were more blunt about the fruits of hours, upon hours of rhetorical statements by member states – which obscured real debate and discussions about key decision points. EB Vice Chair, Dr Clemens Martin Auer, Austria´s Special Envoy for Health, said that the Executive Board´s inability to come to any real conclusions not only harms WHO´s ability to perform, but leaves it in a ¨critical¨ situation. “We have reached the situation where we still don’t act accordingly to what we are supposed to do. We are still not living up to what we have to do, colleagues. We have to be aware that we haven’t concluded on anything and that we are leaving this organization in a critical situation,” he said. Auer warned that failure of governance, not by the WHO Secretariat, but by member states failing to get their act together on how to implement better governance — could make the organization progressively less relevant – and create a vacuum into which other global actors such as the G-20 would step. “We are contributing to further fragmentation when it comes to global health issues and also emergency issues and we pay the price of non-inclusivity and that’s a high price. Don’t talk, act. Don’t say, show. Don’t promise proof,” Auer told member states. Hours and hours talking Last June, a G-20 High Level Panel proposed the creation of a ¨Global Health Threats Board¨ including health and finance representatives of the world´s major economies, working in conjuction with the WHO and another proposed body, a Global Health Threats Council, that would be overseen by the UN Secretary General´s office. During the EB, a US State Department spokesperson said that President Joe Biden wants to support the creation of such a new financing mechanism, housed at the World Bank, to ensure a reliable source of investments for helping countries increase their own global health emergency preparedness – rather than remaining so dependent on donor aid. The US and other supporters have stressed that such initiatives should not detract from the central role of WHO´s global health support to countries and emergency response. And indeed, as if to underline the central role the WHO will continue to play, US Secretary of State Anthony Blinken also announced an additional $280 million more in fuding to the agency in late December. If that funding were to be added to the $ 365 million annually Washington provided last year, it might even put the US ahead of Germany once again as the WHO´s top donor for 2022. That, despite a statement by WHO Director General Tedros, on the opening day of last week´s EB session, to the effect that Germany is now WHO´s biggest donor. Greater efficiences a challenge both inside WHO and within its governing board But money aside, the struggle for greater efficiencies remains a challenge – both inside WHO and among the member states’ own governing board. Dr Ahmed Mohammed Al Saidi, Oman’s Minister of Health corroborated Auer´s call on the board members to actively seek more efficient ways of doing things in order to achieve desired results. “We need to find a more efficient way of doing things and implementing them. We spent hours and hours talking, but let’s find a way where we can do things more efficiently. It can be by limiting the interventions and making it easier for the Executive Board members via retreats during which we have free time to talk about issues that matter to health care, not in our countries, but worldwide,” he concluded. Other EB members also complained that even certain tactical procedures, such as the bundling together of numerous reports, action plans, and updates into the same EB document, made it more difficult to wade through the various background documents. In an age in which written presentations to busy executive boards typically rely heavily on indexing, infographics, bullet points, graphics and other visual aids, EB documents continue to be drafted like the text-heavy academic theses of the mid-20th century style – which makes it almost impossible to quickly read and seize key messages, issues of debate, decision and action points. Similarly, EB member state statements remain heavy on rhetorical flourish – but lacking slides, visuals or even, in many cases, a written text, to support better understanding. The old-fashioned, and very indirect, style of the deliberations certainly also serves certain diplomatic goals – allowing countries to voice criticism in nuanced, coded language that is inscrutable for most outsiders, preserves decorum and avoids out-and-out conflict. Still, the formulas of presentation are often as obscure as the countries´ commentaries on them. Notably, some items, such as the NCD agenda, covered over a dozen different issues, from healthy foods to mental health, wrapped up into one long run-on document followed by annexes – with nary even a table of contents. As the US EB representative Loyce Pace observed at one point such bundling together of so many action plans and statements into one document, made it all the more difficult for EB members to weed through, and consider all of the important issues being raised. 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