WHO Reforms

MAY 19

Mains   > International relations   >   International Institutions   >   Health

IN NEWS:

  • Recently, Prime Minister Narendra Modi, during his address at the second global Covid virtual summit, said that the World Health Organisation (WHO) must be reformed and strengthened to build a more resilient global health security architecture.

WORLD HEALTH ORGANIZATION:

  • World Health Organization (WHO) is a specialized agency of the United Nations (UN) established in 1948 to further international cooperation for improved public health conditions.
  • WHO’s work remains firmly rooted in the basic principles of the right to health and well-being for all people, as outlined in its 1948 Constitution.
  • The headquarters of the World Health Organisation is in Geneva, Switzerland.
  • Membership:
    • As of January 2021, the WHO has 194 member states.
      • All member states of the United Nations except for Liechtenstein (192 countries), plus the Cook Islands and Niue.
  • Governance:
    • The World Health Assembly:
      • The Health Assembly is the supreme decision-making body of WHO.
      • The World Health Assembly's mandate is to approve the biennial programme budget, and decide on major policy matters.
      • The World Health Assembly is held usually in Geneva, in May each year, and is attended by delegations from all Member States.
    • Executive Board:
      • The Executive Board is composed of 34 individuals technically qualified in the field of health, each one designated by a Member State elected to do so by the World Health Assembly.
      • It oversees the implementation of World Health Assembly’s decisions.
    • The Secretariat:
      • The Secretariat of WHO is staffed by some 8000 health and other experts and support staff on fixed-term appointments, working at headquarters, in the six regional offices, and in countries.
      • The Organization is headed by the Director-General, who is appointed by the Health Assembly on the nomination of the Executive Board.
  • Funding:
    • WHO gets its funding from two main sources:
      • Assessed contributions:
        • Assessed contributions are the dues countries pay in order to be a member of the Organization.
        • The amount each Member State must pay is calculated relative to the country's wealth and population.
        • They cover less than 20% of the total budget.
      • Voluntary contributions:
        • Voluntary contributions come from Member States (in addition to their assessed contribution) or from other partners.
        • In recent years, voluntary contributions have accounted for more than three quarters of the Organization’s financing.
        • Voluntary contributions (VC) are further categorized in to the following categories based on the degree of flexibility WHO has in deciding how to spend these funds:
          • Core voluntary contributions (CVC):These contributions are fully unconditional (flexible).
          • Thematic and strategic engagement funds (partially flexible): They provide a certain degree of flexibility in their allocation.
          • Specified voluntary contributions: Specified voluntary contributions represent 88% of all voluntary contributions. They are tightly earmarked to specific programmatic areas and/or geographical locations and must be spent within a specified timeframe.

ACHIEVEMENTS AND CONTRIBUTIONS OF WHO:

  • Eradication of infectious diseases:
    • The WHO’s most celebrated achievement was eradicating smallpox in 1980.
    • Today, the WHO and its partners are on the verge of eradicating wild-type polio, now confined to Afghanistan and Pakistan.
    • After eliminating malaria from more than 2 dozen countries during the 1950s, the organization now aims to reduce 90% of malaria cases and related deaths by 2030.
  • Response to public health emergencies:
    • The WHO has responded to public health emergencies of international concern, authorized under the International Health Regulations (IHR) in 2005, including the 2009 pandemic influenza A(H1N1) virus, polio in 2014, Zika in 2014, Ebola in 2014 and 2018, and COVID-19 in 2020.
    • After the West African Ebola epidemic, the agency revamped its response capacity, forming a Health Emergencies Program and launching a health emergencies fund.
  • Other initiatives:
    • Beyond infectious diseases, the WHO monitors global health trends, conducts research, sets standards, and provides technical support.
    • The agency’s work ranges from noncommunicable diseases, nutrition and obesity, to mental health, road safety, and antimicrobial resistance.
    • Importantly, the WHO provides relief for the hundreds of millions who suffer from extreme poverty.
  • “Triple billion” strategic plan:
    • Responding to the UN’s Sustainable Development Goals, the WHO devised a 5-year(2019-2023) “triple billion” strategic plan.
    • The triple billion targets are to ensure by 2023:
      • 1 billion more people benefitting from universal health coverage.
      • 1 billion more people protected from health emergencies.
      • 1 billion more people with improved overall health.

WHY REFORMS NEEDED:

  • Responsibility with little power:
    • Unlike international bodies such as the World Trade Organization, the WHO, which is a specialised body of the UN, has no ability to bind or sanction its members.
    • The agency needs more powers to demand that member states comply with the norms and to alert WHO in case of disease outbreaks that could cause global harm.
      • Under the legally binding International Health Regulations (IHR), member states are expected to have in place core capacities to identify, report and respond to public health emergencies.
      •  Ironically, member states do not face penalties for non-compliance.
      • This has to change for any meaningful protection from future disease outbreaks.
  • Limited funding:
    • Most of the financing for WHO comes from extra budgetary contributions, which though voluntary in nature, are normally earmarked.
    • The WHO enjoys very little flexibility in use of these funds.
    • Assessed contributions comprise less than one-fifth of the WHO's Budget.
    • Even the Health Emergencies Programme is not fully funded from the regular budget.
  • Dual mandate:
    • A dual mandate of being both a technical agency with health expertise and a political body where states debate and negotiate on sometimes divisive health issues.
  • Political Independence:
    • The WHO relies on governments for funding and support, which affects the political independence of the organization.
    • It relies on member state cooperation, including access to a member state’s territory to get the WHO’s experts on the ground.
    • The WHO director-general must have freedom to act in the best interest of public health and science without political interference.
  • Criticisms during COVID-19:
    • Many member states have criticized WHO for its handling of the COVID-19 response and called for further reforms to the organization even as they have recognized the continuing importance of WHO in the global health system.
  • Dilemma Between Regulations and Humanitarian Aid:
    • The dilemma between a standard-setting body responsible for the formulation and creation of standards and instruments for the administration of international health regulations, versus an agency responsible for providing humanitarian assistance in cases of health emergencies, thereby competing with and duplicating the efforts of other agencies such as the Global Fund, Gavi (including the COVAX facility), Unitaid, other UN agencies such as UNICEF, UNAIDS or UNDP, and large NGOs such as MSF.
  • A cumbersome, decentralized, and bureaucratic governance structure.

REFORMS SUGGESTED BY INDIA:

  • Strengthen Public Health Emergency of International Concern (PHEIC) declaration process:
    • Devise objective criteria with clear parameters for declaring PHEIC.
    • The director general should be empowered to declare a Public Health Emergency of International Concern (PHEIC), instead of going in for a consensus approach involving member states.
      • Currently the decision making is primarily on the recommendation of International Health Regulations (IHR) Emergency Committee.

 

International Health Regulations

  • The International Health Regulations (2005), or IHR (2005), represents a binding international legal agreement involving 196 countries across the globe, including all the Member States of WHO. Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.

Public Health Emergency of International Concern (PHEIC)

  • A PHEIC is defined in the IHR (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”.
  • PHEICs were declared in six instances: H1N1 in 2009, Poliovirus in 2014, West Africa Ebola Virus Disease (EVD) outbreak in 2014, Zika outbreak in 2016, the 10th Democratic Republic of the Congo (DRC) EVD outbreak in North Kivu and Ituri provinces in 2019, and the ongoing COVID-19 outbreak

 

  • Funding:
    • There is a need to ensure that extra budgetary or voluntary contributions are unearmarked to ensure that the WHO has necessary flexibility for its usage in areas where they are required the most.
    • There is also a need to increase the regular budget of the WHO so that most of the core activities of the WHO are financed from it.
  • Improvement of the WHO's governance structure:
    • A proper review of the format & functioning of Executive Board(EB) & World Health Assembly should(WHA) be taken up for them to be an effective engagement tools with the Member States instead of the present set up where in the format of Executive Board & World Health Assembly are repetitive.
    • There must be an accountability mechanism to indicate what follow up action on the interventions of member states in EB and WHA has been initiated by WHO Head Quarter, Regional Office and Country Office.
  • IHR Implementation:
    • Though the Member States have a self-reporting obligation under IHR 2005 the review of IHR implementation is voluntary.
    • So the WHO should be given necessary tools to ensure compliance with the IHR.
  • Access to therapeutics, vaccines and diagnostics:
    • It has been felt that the TRIPS flexibilities provided for public health, under Doha Declaration, may not be sufficient to deal with crises such as COVID 19 pandemic.
    • So it is important to ensure fair, affordable, and equitable access to all tools for combating pandemics like COVID 19 and, therefore, the need to build a framework for their allocation.
  • Creation of Global Framework for Management of Infectious Diseases & Pandemics:
    • Enhancement of capacities of countries in preparation for and response to infectious diseases of pandemic potential, including guidance on effective public health and economic measures for health emergencies by leveraging a multidisciplinary approach which includes social science alongside health and natural sciences.
  • Enhancement of the response capacities of the WHO and Member States:
    • The programmatic activities carried out by the WHO, under its General Programme of Work, should focus on building and strengthening capacities in member states as required under IHR 2005, which are found lacking or deficient on the basis of the self-reporting on IHR 2005 done by the Member States.
    • WHO may support creation of IHR technical and core competencies in each country so as to facilitate broad uniformity in country responses.
  • Transparency of funding mechanism and accountability framework:
    • There is an urgent need for effective involvement of Member States in discussions on budget implementation and spending.
    • Establishing strong and robust financial accountability frameworks will enable maintaining integrity in financial flows.
  • Role of Hosted Partnerships in pandemic management:
    • To improve capacity for global pandemic prevention, preparedness, and response, and strengthening our ability to fight back any such pandemic in future, besides the existing Department or Division approach there is a need for initiating Hosted Partnerships on this key agenda of Pandemic Management.

PRACTICE QUESTION:

Q. “There is urgent need for major reforms in WHO”. Discuss the need for reforms in WHO with special reference to the reforms suggested by India.