Privilege or Participation

Privilege or ParticipationAlthough the World Health Organization (WHO) has failed over the last 70 years at its charter mission to realise the right of everyone to enjoy the highest attainable standards of health, it has succeeded in assuring that the WHO itself enjoys the highest attainable standards of privilege, well hidden from public view by its lack of transparency. A recent article in the Washington Post (see below) revealed that the annual travel budget of the WHO was in excess of $200 million each year, more than the total amount they spend on HIV/AIDS, hepatitis, tuberculosis and malaria combined.

The WHO is mandated to serve first and foremost those that are the most vulnerable, the billions of poor or marginalised, and people struggling to survive life-threatening diseases or life-changing disabilities. Instead, it seems to first make sure that it serves its own interest and those of the 193 governments (Member States) that have complete control over the governance of the WHO. As the oversight of the WHO is in the hands of these Member States, including hundreds of governments with long histories of high-level corruption, a culture of  institutional impunity is allowed to go unchecked, while transparency is limited. Five star hotels and first class travel are just some of the many privileges and perks provided to long term staff, as well as substantial tax-free salaries. Meetings are held in luxury settings around the world, with a mix of the international and national elite in attendance to declare that these important gatherings are essential to improve the health and well-being of the world.

Those that the WHO should prioritise, the people most affect by health inequities and most in need of their right to health, are excluded from participating in the governance of the WHO. Their community organisations also have no say in how the WHO manages its programmes or spends its funds, which mostly come from governments through taxation of the public. As seen at other UN entities such as UNAIDS, the inclusion of representatives from these most affected communities ‘at the table’ contributes to increasing the accountability of the institution. Without the participation of the most affected communities, it’s almost impossible to fully monitor programmes or ‘follow the money’ to see what the WHO is doing on the ground, or in the air.

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Fix FENSA and Inform INGOs

FENSAThe WHO’s decision-making body, the World Health Assembly (WHA), has just concluded its 70th annual meeting in Geneva. Among the dozens of items on the Agenda was the Framework Engagement with non-State actors (FENSA),  an agreement on how to manage relationships with organisations representing industry, philanthropic and academic institutions and international NGOs with WHO ‘Official Relations’ status. FENSA was agreed and adopted in May 2016 by the 69th WHA, and at this year’s meeting, certain clarifications and updates were made.

More than a billion poor people around the world depend mostly on public health systems for their health and well-being, and so are directly affected by the decisions and policies of WHO, which guides national programmes.  If you can not afford private health care, qualified specialists, advanced treatments or most medicines, the public health services are your only hope when serious illness or injury arrives. WHO plays an important role in leading governments to improve their health systems, and is responsible for pushing them forward so that one day, hopefully, everyone will enjoy their right to health, not just those with money.

FENSA is essential as it defines how civil society, including the private sector, academic institutions and NGOs, can interact with the WHO. Yet for those most impacted by WHO policies, FENSA is an obstacle to participation and institutionalises our exclusion. The agreement makes no provisions for enabling those from affected communities that lack the resources to develop an international NGO (INGO) needed to be in Official Relations with the WHO, nor provides for any means of seeing if the few ‘official’ big INGOs that claim to represent marginalised communities actually do. As WHO resolutions, such as FENSA, are very hard to alter or change, our efforts to develop meaningful participation and the accountable representation of those most in need has been made more difficult.

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