The 1948 Constitution of the World Health Organization positions the WHO as the ‘guardian’ of everyone’s right to health, which makes the forthcoming election of its next Director General to be of great importance to those who strive for human rights and health justice. This is why we have been closely following the election process, and studying the final three Candidate’s positions. As the WHO process is nearing its conclusion, we are deeply dismayed by the weak words on rights and shallow slogans coming from the next Director General of WHO.
In a few weeks, a new Director General (DG) of the World Health Organization (WHO) will be elected by the representatives of the 193 governments, known as Member States, that govern this UN agency. Although we believe that a human rights-based approach (HRBA) should be the framework of all of the World Health Organization (WHO) policies and programmes, many of the Member States do not share this view on rights. This may explain why after 70 years of the WHO’s mandate to progressively realize the right to health, it has failed to do so. It also may explain why the candidates will not risk losing the potential support of these regressive Member States by proposing real actions and reforms that would advance the right to health, including steps that would make the WHO more accountable to those they serve, the folks on the ground waiting for health justice.
Unfortunately, the billions of people that are most impacted by the policies of the WHO do not have any say in this election process. Only Member States have a vote on the candidates, as well as on every other aspect of WHO policies.
A key element of the human rights-based approach is the participation of affected communities and their civil society organizations in decisions on policies, which would enable the public to be more equal partners in public health development. The WHO is missing this crucial element, and after 70 years, must change.
We believe that the WHO must urgently reform its constitution and make its governance more democratic, accountable, transparent, and inclusive. For this to happen, the next Director General should dynamically lead this process of reform, with action not slogans. Sadly, their weak words on rights don’t give us much hope that this will happen in the near future.
Below is an extract from the Health & Human Rights Journal with the three Candidate’s answers to a key question: How do you see the right to health and rights-based approaches guiding WHO’s work with national governments and civil society?
Extracted from Health Human Rights Journal :
At this year’s World Health Assembly (May 22–31, 2017), member states will vote for a new Director-General to lead the World Health Organization (WHO) over the next five years. At this critically important time in global health—as the world looks to WHO for leadership in the face of globalized pandemics, health insecurity, mass population displacement and protracted humanitarian crises, climate change, and the looming threat of anti-microbial resistance—we asked each of the three Director-General candidates how they view the role of human rights in global health governance.
The candidates are
• David Nabarro, from the UK, sustainable development adviser to United Nations Secretary-General Ban Ki-moon
• Sania Nishtar, Pakistan’s former health minister
• Tedros Adhanom Ghebreyesus, Ethiopia’s foreign minister and former health minister
HHRJ: How do you see the right to health and rights-based approaches guiding WHO’s work with national governments and civil society?
Dr. Nabarro: I anticipate that WHO will continue to reflect the directives of its governing bodies and support the use of human rights-based approaches in planning and programming across everything the organization seeks to achieve. Disaggregated data on health trends provide an important measure through which to identify persons and population groups who are at greatest risk (in terms of health outcomes) and tend to be excluded from responses. This group tends to include refugees, migrants, and around 10 million people (of whom 3 million are children) who are stateless in their own country or liable to be forcibly displaced. But more specific information is needed for effective tracking of who is being left behind and the measures being taken to address the situation.
Civil society organizations that can provide additional insights (for example, on inequities and discrimination) have important contributions to make. Under my leadership, WHO will encourage accurate and impartial reporting of all health data. The information will be made available to human rights treaty bodies as they conduct individual country reviews.
Dr. Nishtar: The 2030 Agenda and Sustainable Development Goals reaffirm the responsibility of member states to “respect, protect and promote human rights, without distinction of any kind as to race, colour, sex, language, religion, political or other opinions, national and social origin, property, birth, disability or other status,” signaling a renewed commitment to human rights. In line with this, WHO has developed a roadmap to integrate equity, gender, human rights, and social determinants into ongoing activities—a welcome step. I will build further on that.
In terms of engagement with national governments, it must be appreciated that WHO has a dual role. It is a member-state-governed organization and, as such, must execute policy set by member states. But on the other hand, it is also the global guardian of health, and therefore there are situations in which it must stand firm to promote a rights-based approach to health.
As for civil society, WHO has an explicit mandate to engage as agreed by member states through the Framework of Engagement with Non-State Actors. Civil society has a comparative advantage in relation to advocacy and accountability, which is where strategic engagement with civil society can help promote a rights-based approach to health.
I come from a civil society background and have been a longstanding and strong promoter of the rights-based approach to health. The dedication of my last book, Choked Pipes, epitomizes my commitment: “Dedicated to the silent and unjustified suffering of millions of individuals for whom the right to health remains unrealized—and whose lives I strive and aspire to touch.” Choked Pipes provides a blueprint for how low- and middle-income countries can move toward universal health coverage from a mixed health system. In aspiring to lead WHO, I aspire to lead an organization that positions health as a wider reflection of a broad social policy vision and a universal right rather than a commodity.
Throughout my work as a doctor, in government, in civil society, in academia, and with international agencies, I have always based my work on the rights-based foundation. It was this strong grounding that led me to set up an innovative financing facility in Pakistan that helps the poorest and most marginalized communities avoid catastrophic expenses when accessing health. I will continue to walk the talk on the right to health as Director-General of WHO.
Dr. Tedros: Every year, hundreds of millions of people go without essential health care or fall into poverty trying to pay for it. That is a violation of the human right to health that demands our full attention and urgent action. All of us—national government leaders, members of civil society, health workers, patients and families, and religious and community leaders—have critical roles to drive progress on universal health coverage. Developing technical policies to ensure universal health coverage is an important start, but policies alone will not be sufficient. Implementation of those policies is much more difficult and requires collaboration and partnership across stakeholders.
That approach guided Ethiopia’s pursuit of equitable health access when I was minister of health. We maintained a firm commitment to the principle that health is a basic human right by dramatically expanding coverage of primary health care services. We achieved success by (1) directing new domestic investments in primary health care to people in areas where the need was greatest, including rural and pastoralist areas; (2) engaging communities as partners in local health governance; and (3) building political commitment and promoting accountability at all levels and across all stakeholder groups.
Reflecting these experiences, I believe WHO can and must play an enabling and catalytic role to help all governments achieve universal health coverage and, in turn, advance the human right to health, and I believe it must engage a diverse set of partners, including civil society, in these efforts to ensure success.