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All human beings should receive the health services they need without suffering financial hardship, such is the definition of universal health coverage, a key point of discussion at the World Health Organization Executive Board meeting this week. New WHO Director General Tedros Adhanom Ghebreyesus (Dr Tedros) opened the event by presenting his vision for the future, and the collective work to accomplish necessary changes to the UN health agency. The European Union and United States warned against politicisation of the WHO.

The 142^nd WHO Executive Board (EB) meeting is taking place from 22-27 January. According to a WHO spokesperson, some 1,115 delegates have registered for the Executive Board meeting so far.

Dr Tedros, in his statement this morning, described 2018 as a year of opportunities for WHO, setting a new future for the global health organisation.

He underlined universal health coverage (UHC) as essential, as at least half the world population lacks access to essential health services, and almost 100 million people pushed into extreme poverty due to “out-of-pocket health spending.”

UHC will be the theme of the upcoming World Health Assembly (WHA) in May, he said, announcing at the same time the launch of a Global Challenge on UHC. The global challenge asks for countries to take at least three concrete steps towards UHC. Countries will be invited to make commitment towards the challenge at the May WHA.

Intensive Work to Change WHO

“WHO has to change,” Dr Tedros said, adding “we have an intensive 18 months of change in front of us to become the WHO that you want, and that the world needs.” A main focus is to agree Dr Tedros’ proposed Global Programme of Work (GPW) in that time.

In order to change how the WHO operates, he called for flexible and un-earmarked funding, and said there is a need to align budget and priorities.

“I know the trust deficit we have between WHO and the member states,” Dr Tedros said, adding, “We will do everything to address” this trust deficit, and requesting member states’ help.

He asked for support on three fronts: first, that member states commit to concrete action towards UHC; second, that member states commit personnel and resources, and finance their deployment in response to emergencies; and third, to commit to un-earmarked funding, which he said more member states are supporting.

He reported on a number of initiatives launched since his election last May, including the new High-Level Commission on NCDs (non-communicable diseases), new agreements with organisations such as the World Bank, and the United Nations Framework Convention on Climate Change. He also said the WHO has started a new process of engaging with civil society organisations to “amplify our collective voices.” “It’s the collective voice that is more potent than the fragmented one,” he said.

Reform Discussions Pushed to the Next EB

The Board chair, Assad Hafeez of Pakistan, suggested that discussions on two agenda items, both on WHO reform, be postponed until the January 2019 Executive Board meeting. That proposal was met with a united front from EB members.

Hafeez suggested that documents 142/5 [pdf] (Reform), and 142/6 [pdf] (Prioritization of proposals for additional items on the provisional agenda of the Executive Board) be postponed until the 144^th session of the EB. The main reason for the postponement is a new pilot system for prioritising EB agenda items, which was intended to be tested before its discussion by the Board.

Some countries underlined the late submission of Board documents for this session, such as Malta on behalf of the European Union countries, who said the practice of producing documents late is “a serious governance issue.”

Brazil said the approach of testing ideas before discussing them was setting a dangerous precedent and was not prone to building confidence.

That proposal was challenged by several countries, such as Malta for the EU, who insisted that discussion on reform should not be postponed by a year. The Netherlands, Thailand, Canada, Iraq, Bahrain, the Philippines, and Congo also asked that discussions on reform take place at the EB in May.

The Board approved the decision to postpone the reform discussion on those two agenda items to its next meeting in May, right after the annual Health Assembly.

EU, US Warn against Politicisation; US Pushes Industry

As a new way to approach communication with member states, Dr Tedros called member states to engage in a dialogue on his statement.

Malta for the EU said it is imperative that the WHO delivers evidence-based knowledge and not allow its normative function to become politicised. Malta also asked how the WHO was going to guarantee that staff recruitment is more transparent and competitive.

WHO will have more meaningful impact when it focuses on its core priorities of pandemic preparedness, health emergencies, and being the world’s best evidence-based norm-setting body, the United States delegate said.

The US government aspires to increase access to healthcare, he said, and added that countries should do so by reducing costs and expanding health care choices. Each country should develop its own system according to its own cultural, economic, political, and structural context, he said.

According to the US delegate, in many countries the private sector serves as an important health provider, investor, stakeholder and employer. WHO’s technical and evidence-based public health voice must remain neutral, he said, adding that the WHO advocacy role should be undertaken within its core mandate, and “grounded in proven science.”

To strengthen WHO’s normative function, it must improve the process of getting outside technical expertise by diversifying the range of experts, improving transparency, and avoiding trying to advance certain ideology and agenda, he said. The WHO should focus on inclusive partnerships with the private sector, which should be included in public health policy discussions, he said.

During a recent US industry event in Washington DC which gathered IP attachés posted around the world, a Geneva-based attaché said the US has been opposing any support or acknowledgement of the 2016 UN Secretary-General High-Level Panel on Access to Medicines (IPW, Health & IP, 22 January 2018).

In today’s Board meeting, some countries – such as Sweden and Brazil – underlined the need for access to healthcare for all.