{"id":41105,"date":"2018-01-16T15:51:31","date_gmt":"2018-01-16T14:51:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41105"},"modified":"2018-01-23T09:45:47","modified_gmt":"2018-01-23T08:45:47","slug":"charles-clift-tedros-is-refreshingly-honest-about-the-deficiencies-in-who-governance-and-financing-will-member-states-respond","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/01\/16\/charles-clift-tedros-is-refreshingly-honest-about-the-deficiencies-in-who-governance-and-financing-will-member-states-respond\/","title":{"rendered":"Charles Clift: Tedros is refreshingly honest about the deficiencies in WHO governance and financing"},"content":{"rendered":"<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-41113\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/charles_clift-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/charles_clift-150x150.jpg 150w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/charles_clift.jpg 160w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/span><em>Will member states respond?<\/em><\/p>\n<p><span style=\"font-weight: 400\">The executive board of the World Health Organization (WHO) will meet on 22-29 January. A key agenda item will be <\/span><a href=\"http:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/EB142\/B142_3-en.pdf\"><span style=\"font-weight: 400\">the latest draft of WHO\u2019s 13<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> General Programme of Work (GPW)<\/span><\/a><span style=\"font-weight: 400\"> for the period 2019-2023. WHO\u2019s constitution obliges the executive board to submit a GPW periodically for approval by the World Health Assembly (WHA). <\/span><\/p>\n<p><span style=\"font-weight: 400\">WHO\u2019s ambitious plan is centred on three strategic priorities linked to the Sustainable Development Goals\u2014one billion more people with health coverage, one billion made safer from health emergencies, and one billion lives improved by targeting four priority interventions. It also envisages a country focus, an expanded operational role for WHO, and an impact framework so that WHO can demonstrate results as well as organisational change. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dr Tedros, WHO\u2019s Director-General since July 2017, has accelerated the procedures for approving a new GPW because he wants it to encapsulate his vision for the WHO and its role in the global health arena. At a <\/span><a href=\"http:\/\/apps.who.int\/gb\/e\/e_ebss4.html\"><span style=\"font-weight: 400\">special session of the executive board,\u00a0<\/span><\/a><span style=\"font-weight: 400\">convened in November 2017, to discuss the draft GPW, <\/span><a href=\"http:\/\/www.who.int\/dg\/speeches\/2017\/special-session-executive-board\/en\/\"><span style=\"font-weight: 400\">he said<\/span><\/a><span style=\"font-weight: 400\"> that, in order to address current global health challenges, \u201cwe cannot do business as usual. We need a paradigm shift, a radical change in approach\u2026This GPW is not just about transforming WHO. It\u2019s about transforming global health, and ultimately transforming human lives\u201d. <\/span><\/p>\n<p><span style=\"font-weight: 400\">At the November meeting, member states had a generally positive reaction to the draft strategy. For the main donor countries, the focus on impact and results was music to their ears. On the other hand, there was some scepticism about WHO\u2019s proposed operational role and many questions about how WHO, as one of many players, could measure its impact. Inevitably many member states contributed to a long list of issues that should have been given higher priority\u2014a common headache for WHO in attempting to prioritise. The main funders wanted to know how much this would cost before agreeing to a final GPW.\u00a0 \u00a0 \u00a0 <\/span><\/p>\n<p><span style=\"font-weight: 400\">What was entirely refreshing about the meeting was <\/span><a href=\"http:\/\/www.who.int\/mediacentre\/events\/2017\/webstreaming\/ebss4\/en\/\"><span style=\"font-weight: 400\">Dr Tedros\u2019 closing remarks<\/span><\/a><span style=\"font-weight: 400\"> which went much further than the GPW in discussing WHO\u2019s governance and financing problems. He began by telling the executive board that &#8220;<\/span><i><span style=\"font-weight: 400\">it was not a board<\/span><\/i><span style=\"font-weight: 400\">, <\/span><i><span style=\"font-weight: 400\">WHO had no board<\/span><\/i><span style=\"font-weight: 400\">.&#8221; By this he meant that, because all 194 member states, not just 32 board members, were allowed to participate, it was no different from the World Health Assembly (WHA). In effect WHO had three assemblies each year (two executive boards and the WHA) consisting mainly of prepared statements by member states on each agenda item. There was no real dialogue or debate and there was no real strategic governance happening. He attributed this state of affairs to the fact that member states did not trust each other, which is why they insisted on universal participation. A real executive board would have a bureau consisting of regional representatives, trusted by regional member states, who would be able to interact much more intensively with WHO management and provide a proper link between the organs of WHO governance and the secretariat. This was how he understood most other organisations arranged things.<\/span><\/p>\n<p><span style=\"font-weight: 400\">He was equally blunt with member states on the subject of financing, focussing on the fact that 80% of WHO\u2019s money is provided as voluntary contributions earmarked for particular purposes favoured by funders. Only 20% comes through member state assessed contributions that WHO is free to allocate in accordance with its priorities. He said this made proper prioritisation of activities impossible because individual funders, not member states collectively, determined how 80% of the budget was spent. It was also extremely inefficient\u2014WHO had over 3000 separate grants annually which was an impossible burden on its administrative and management capacity. If this situation persisted, <\/span><i><span style=\"font-weight: 400\">then change could not happen<\/span><\/i><span style=\"font-weight: 400\">. He repeated twice: \u201cit takes two to tango\u201d. He made member states an offer: WHO <\/span><i><span style=\"font-weight: 400\">did not need more money overall\u2014<\/span><\/i><span style=\"font-weight: 400\">what was required was the same amount as \u201cquality money\u201d that could be allocated efficiently and effectively to WHO priorities. Only then could WHO demonstrate what it could do. <\/span><\/p>\n<p><span style=\"font-weight: 400\">This was a remarkably candid performance. The themes were not entirely new, although few have been so explicit about the deficiencies in WHO governance. But Dr Tedros\u2019 willingness to lay it on the line for member states is refreshing. His predecessors have generally been extremely cautious in biting the hands that feed them. For that very reason the strategy is a high risk one. If member states fail to respond in any substantial way, then this leaves Dr Tedros in charge of an organisation he considers is not fit for purpose. Yet his boldness can only be admired. <\/span><\/p>\n<p><em><strong>Charles Clift<\/strong> is a senior consulting Fellow at the Centre on Global Health Security at Chatham House. He works as an independent consultant in the field of global health, including for the WHO, and is the author of publications on the role of the WHO in the international system.<\/em><\/p>\n<p><strong>Competing interests<\/strong>: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Will member states respond? The executive board of the World Health Organization (WHO) will meet on 22-29 January. A key agenda item will be the latest draft of WHO\u2019s 13th [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/01\/16\/charles-clift-tedros-is-refreshingly-honest-about-the-deficiencies-in-who-governance-and-financing-will-member-states-respond\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":40126,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-41105","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Charles Clift: Tedros is refreshingly honest about the deficiencies in WHO governance and financing - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/01\/16\/charles-clift-tedros-is-refreshingly-honest-about-the-deficiencies-in-who-governance-and-financing-will-member-states-respond\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Charles Clift: Tedros is refreshingly honest about the deficiencies in WHO governance and financing - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Will member states respond? 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