Re: Memorandum on Key Elements for the Draft Policy Paper on WHO s Engagement with NGOs

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1 Dr. Margaret Chan, Director-General World Health Organization Dear Madam, Re: Memorandum on Key Elements for the Draft Policy Paper on WHO s Engagement with NGOs The 65 th World Health Assembly has requested the Director General (DG) to present a draft policy paper on WHO s engagement with NGOs, to the Executive Board at its 132 nd session in January As stated in the letter to the DG by the Democratising Global Health Coalition, dated 6 th August 2012, the draft policy that is to be prepared is not a mere technical document but a framework within which WHO will define and relate to external nongovernmental actors which in turn will influence WHO s capacity to play a leading role in international health work. Thus please find attached a Memorandum highlighting some of the key elements that should in our view form the basis of such a policy paper. This Memorandum is being presented by the undersigned NGOs as an early contribution to the drafting process. It is hoped that the proposed elements will help WHO shape the political vision and, consequently, the main elements of the policy on WHO s engagement with NGOs. We understand from our previous communications that a consultation on the draft NGO policy will be held at the end of September. We look forward to discussing the proposed elements as well as your analysis and views during that consultation. We would request that the consultation be held as a formal consultation, and that the Secretariat distribute any information prepared for the meeting in advance and with adequate time for review, as this will facilitate a more interactive and productive meeting. Finally, we also kindly request that NGOs be given the possibility to put in written responses to issues raised by the Secretariat in the formal consultation. These written responses should be made publicly available. We look forward to hearing from your office. With kind regards, 1

2 SIGNATORIES Members of the Democratising Global Health Coalition on the WHO Reform (DGH): Health Innovation in Practice HIP (International) International Baby Food Action Network IBFAN (International) Medico International (International) Medicus Mundi International Network MMI (International) People s Health Movement PHM (International) Third World Network TWN (International) Wemos (Netherlands) CO-SIGNATORIES Alcohol Focus Scotland (Scotland) Arugaan (Philippines) Association for Improvements in the Maternity Services AIMS (UK) Association of Breastfeeding Mothers ABM (UK) Centro Feminista de Informaccion y Accion - CEFEMINA (Latin America) El Poder del Consumidor (Mexico) FoodFirst Information and Action Network FIAN (International) Health Poverty Action (UK) Heart of Mersey (UK) Lactation Consultants of Great Britain (UK) National Childbirth Trust - NCT (UK) NGO Forum for Health (International) The Informative Breastfeeding Service TIBS (Trinidad and Tobago) The International Insulin Foundation (International) Contact persons: Ina Verzivolli, International Baby Food Action Network - IBFAN, ina.verzivolli@gifa.org, Sangeeta Shashikant, Third World Network TWN, ssangeeta@myjaring.net 2

3 Memorandum to Dr. Margaret Chan, Director-General of the World Health Organization Key Elements for the Draft Policy Paper on WHO s Engagement with NGOs Introduction Civil society organizations (CSOs) have played a critical role in supporting WHO to fulfil its primary mandate i.e. the attainment by all peoples of the highest possible level of health. CSOs have been instrumental in advocating for issues of public health promoted by WHO and taking them to a broad audience, as well as bringing to the attention of WHO health issues experienced at the grassroots level, performing a watchdog function in the protection of public health concerns, raising sensitive issues that WHO as an intergovernmental organization may not always be in a position to address for various, often political, reasons including political reasons. CSOs continue also to be important partners of WHO at the national level as they are often involved in building up national capacity of health systems and implementing WHO programmes at the country level. The work of CSOs worldwide has contributed to a profound change in the way that health, human rights and development are approached by governments and international organizations such as WHO. Examples of CSO s contribution to WHO s work include: supporting the development of international instruments such as the Framework Convention on Tobacco Control, and the Pandemic Influenza Preparedness Framework; advocating for implementation of the FCTC and effective national regulation on tobacco control, as well as on the marketing of breastmilk substitutes and of foods and beverages to children; rational use of medicines and medicines regulatory policies generally, etc. However, despite CSOs important contributions to WHO as noted above, there have been significant constraints and challenges in the WHO-CSO relations. WHO-CSO relations are governed by the 1987 Principles Governing Relations between the World Health Organization and nongovernmental organizations. The constraints and challenges in WHO- CSO relations include: (a) lengthy, onerous, rigid and outdated procedures for CSOs to enter into official relations with WHO; (b) lack of distinction between the different types of CSOs/NGOs; (c) insufficient safeguards against conflicts of interest; (d) lack of transparency with regard to the interest groups behind the CSOs/NGOs; (e) unnecessary and unacceptable restrictions imposed on CSOs/NGOs, such as. requiring NGOs to submit statements 24 hours prior to delivery, censoring CSOs/NGOs 3

4 statements, and prohibiting CSOs/NGOs from delivering statements that WHO staff do not agree with; (f) flawed implementation of the 1987 Principles, which has led to business associations entering into official relations with WHO as NGOs. CSO s contribution to WHO as well as most of these constraints and challenges raised above are also highlighted in the WHO Review Report WHO s interactions with Civil Society and Nongovernmental Organizations 1 (hereinafter referred to as the Review report ). This report came about following the launch of the Civil Society Initiative in 2001 by Dr. Gro Harlem Brundtland, then Director-General of WHO. This Review report is the result of a desk review of documents and of a process of consultations held between July 2001 and July Several key elements are highlighted below that address the constraints and challenges raised above. These elements are proposed taking into account the outcome of the Review report. It is hoped that WHO will use these elements for guiding its preparation of the Draft NGO policy paper. 1. Defining NGOs The Review report notes that there is no single definition of the terms NGOs and CSOs and often they are used interchangeably. Even more importantly, the Review report recognizes that in practice the boundaries between market (private for-profit sector) and not-for-profit organizations is blurred by the fact that many non-profit organizations are closely related to commercial enterprises. This could be by virtue of their operation, governance mechanism or funding. For the purposes of the draft NGO policy, we strongly urge WHO to adopt a sufficiently broad and clear conception of civil society to adequately reflect the range of CSOs that support its mission worldwide. In particular, it is important that the scope of the draft policy includes social movements and horizontal networks 2 and the way the policy is implemented should allow them to be fully accredited to WHO for purposes of participation in WHO meetings and to collaborate with WHO. In addition, it is imperative to differentiate between NGOs with commercial interests/links and those without such interests and links, as market interests/links can conflict with health outcomes. This is of great importance in light of WHO s public health mandate, and most particularly its normative and policy role, and given the possibility of real or perceived conflicts of interest between commercially linked motives and public health goals. Accordingly, it is important that the definition of NGOs and the scope of the policy include only nongovernmental organisations that are independent of the for-profit sectors. 1 WHO/CSI/2002/WP6 2 Organisations without an hierarchical structure. 4

5 2. Differentiating organizations and entities interacting with WHO WHO interacts with a wide range of organizations and entities, with diverse structures, mandates and funding sources. To date, however, WHO has made no differentiated between the organizations and entities interacting with it and all organizations (even industry associations) are considered to be NGOs. This is so despite the key criterion for admission of NGOs into official relations is that the NGO shall be free from concerns which are primarily of a commercial or profit-making nature. 3 The importance for WHO to differentiate between organizations with commercial interests and links and those without such interests and links has been highlighted above. As WHO has been mandated to draft a policy paper on NGO relationship and another policy paper regarding the private sector, it is timely to take action to differentiate between the different organizations and entities interacting with the WHO. In this regard we propose the following: (a) Organizations that represent commercial interests or that are business-interest front groups should not be categorized as NGOs. Similarly organizations that are linked to commercial interests (e.g. by way of their governing structures, membership, operations or reliance on industry financing), should also not be categorized as NGOs. To identify these organizations, the WHO should establish appropriate criteria and NGOs should be consulted to this end. WHO s interactions with these organizations should be governed by the draft policy paper on the private sector that is to be prepared by the Secretariat as well as the existing Guidelines on working with the private sector to achieve health outcomes 4. WHO should further ensure that there are adequate safeguards against conflicts of interests as the vested interests of these organizations could compromise WHO s public health mandate and bring about severe consequences for the implementation of Health for All. Other UN intergovernmental bodies, such as the Committee on World Food Security (CFS), offer useful examples in this regard. The CFS Advisory Group clearly distinguishes CSOs/NGOs from private sector associations and philanthropic organizations, which are treated as different categories 5. 3 See Section 3.1 of the 1987 Principles 4 The existing Guidelines on working with the private sector to achieve health outcomes is applicable to a variety of other institutions including State run enterprises, associations representing commercial enterprises, foundations not at arms length from their sponsors, and other not-for-profit organizations. See 5 Committee on World Food Security, Reform of the Committee on World Food Security Final Version, CFS:2009/2 Rev.1, available at ftp://ftp.fao.org/docrep/fao/meeting/017/k3023e3.pdf 5

6 (b) Only organizations that are non-state, not-for-profit, voluntary organizations formed by people within the social sphere of civil society and which do not represent, are not linked to, nor are reliant on commercial interests (financially or otherwise) should be considered as NGOs. Within this category, WHO is encouraged to further distinguish between the different constituencies such as: professional associations, disease specific NGOs, development NGOs, humanitarian NGOs, patient group NGOs, consumer group NGOs, scientific or academic NGOs, health-related NGOs, student group NGOs, women group NGOs, social movements, etc. Examples can be found of these distinctions in other UN bodies that classify CSOs in different ways according to the nature of their mandate and of the particular constituencies that interact with them. For instance, civil society organizations that interact with the CFS have organized according to their different constituencies in the following groups: farmers, fisherfolks, landless, indigenous people, pastoralists, consumers, agricultural workers, urban poor, women, youth, and NGOs 6. The Joint United Nations Programme on HIV/AIDS (UNAIDS) distinguishes CSOs as follows: key populations (gay men and other men who have sex with men, people who inject drugs, sex workers and transgender people); migrants and mobile populations; people affected by emergencies, conflicts and other humanitarian events and environments of concern; prisoners and other incarcerated populations; women and girls; young people; people living with disabilities; nongovernmental advocates for human rights; nongovernmental actors in other health and development fields; community-based organizations, networks and coalitions; nongovernmental organizations; nongovernmental civic organizations; trade unions, labour organizations and other workers groups; faith-based organizations and groups 7. (c) (d) (e) WHO should establish through transparent processes, clear criteria to identify organizations mentioned above in (a) and to distinguish such entities from those that fall within sub-para (b). During governing body meetings as well as other WHO meetings, WHO should distinguish between organizations listed in sub-para (a) and (b) by issuing different coloured badges. To facilitate transparency and public scrutiny, it is important for WHO to make publicly available information on all organizations (commercially linked or otherwise) interacting with WHO (i.e. accredited to WHO or collaborating with WHO). Information that should be made available includes: the mandate, governing structure 6 International Food Security and Nutrition Civil Society Mechanism, Constituencies, available at 7 UNAIDS guidance for partnerships with civil society, including people living with HIV and key populations, available at society_en.pdf 6

7 (organization chart if available) of the organization, such as the charter/statutes/constitution/by-laws or articles of association, composition of its governing board members, type and range of activities undertaken by the organization; and funding sources, in particular in respect of any financial assistance received from the industry, and the extent of such industry contributions. The WHO Secretariat should also initiate a regular information collection procedure to periodically update the information provided. Framework policy on WHO s interaction with philanthropic organisations To govern WHO s interactions with philanthropic organizations, the Chairman s summary of the 130 th session of the Executive Board envisaged discussions during the 2012 World Health Assembly on development of a separate framework policy. However this discussion did not materialize, particularly as a decision point on it was conspicuously absent from the draft resolution prepared by the Secretariat (A65/5 Add.3). We urge the WHO Secretariat to develop a separate policy to guide WHO s interactions with not-for-profit philanthropic organizations. Such a policy must be developed to ensure transparency with regard to WHO s interactions with such organizations, and adequate safeguard mechanisms against conflicts of interests. WHO Secretariat should also establish criteria to identify these organizations, so as to ensure that philanthropic organizations falling within the category are organizations that have aims and purposes consistent with WHO s Constitution and the policies of the Organization and are not driven by commercial or other interests that could conflict with WHO s public health mandate. 2. Accreditation vs. Collaboration Currently the WHO-CSO relationship is governed by the 1987 Principles Governing Relations between the World Health Organization and nongovernmental organizations. These principles contain lengthy, onerous and rigid procedures for NGOs to enter into official relations. To obtain the status of official relation, NGOs need to establish a joint programme of work and a 3-year plan with a technical department of WHO. A review process of these relations is based on 3-year reports and the drawing up of new work plans. On this the Review report concluded that [t]he process is perceived as among the most complicated of UN agencies. Indeed in comparison to existing accreditation procedures in UN agencies, WHO system is simply unreasonable and outdated, and thus needs to be revised. It is thus proposed that in the draft NGO policy paper, WHO distinguish between a NGO Accreditation Policy and a NGO Collaboration Policy. (a) The NGO Accreditation Policy should contain procedures pertaining to NGOs attendance at WHO meetings and privileges available to such NGOs. As noted by the 7

8 Review report, In contrast to the current official relations system, accreditation would not be conditional on working relations with the Secretariat. The accreditation policy should enable NGOs including social movements and horizontal networks that have aims and purposes consistent with the WHO s Constitution and that are in conformity with the policies of the Organization, to participate in governing body and other meetings convened by WHO as observers without voting rights. Under the policy, accredited NGOs should have the right to appoint representatives to participate in WHO meetings and the freedom to make statements without prior scrutiny and censorship by the WHO Secretariat as well as access to privileges listed in Section 6.1 and 6.2 of the 1987 Principles. Accredited NGOs should also have the right to organize side events during WHO meetings, particularly during the World Health Assembly, as well as to a fully equipped and well-positioned room for internal meetings and briefings during WHO meetings. In this regard the WHO Secretariat should have the responsibility to ensure that appropriate and adequate arrangements are made. (b) The NGO Collaboration policy would pertain to and govern WHO Secretariat s interactions and collaboration with NGOs. The purpose of such policy would be to provide clear guidance to WHO staff, its member states and to CSOs on how to encourage and secure meaningful participation and collaboration of CSOs with WHO. As noted in the Review report, collaboration must be on the basis of respecting the autonomy, integrity, limits and differences of the other and on clearly agreed responsibilities by the parties involved when agreeing to common plan of action, identification of resources and strategies for implementation and monitoring. Collaboration between NGO and the WHO should aim at advancing the objectives and policies of WHO. It is also very important that the NGO collaboration policy establishes appropriate safeguards, including increased transparency, to eliminate all risks of real or perceived conflicts of interests. 3. Strengthening NGO engagement In 2001 in recognition of the growing importance of civil society, Dr. Gro Harlem Brundtland then Director-General of WHO established the Civil Society Initiative to, among others, identify and develop propositions for more effective and useful interfaces and relationships between civil society and WHO. However since its launch little has emerged from the initiative and in fact over the years WHO-NGO engagement has been in decline. 8

9 We are of the view that there is mutual benefit in a strengthened NGO engagement and this should be reflected in the draft NGO policy. Toward this end, we propose the following: (a) Revive and re-launch the Civil Society Initiative (CSI). We urge the Director-General to revive and re-launch the CSI, with the specific aim to create and/or improve mechanisms for NGOs to interact promptly and effectively with WHO on the full range of health matters as well as to strengthen capacities within WHO for strengthened engagement with NGOs. The mechanisms should also empower NGOs to play a more active role in providing input to WHO on health matters including on issues pertaining to WHO partnerships as well as to promote and implement public health matters advocated by WHO nationally and regionally. A civil society mechanism for enhanced engagement is suggested below. We also call upon the DG to undertake formal consultations with NGOs to discuss the proposed suggestions as well as other options to achieve the above objective. (b) A Civil Society Mechanism A mechanism that could be used to strengthen the engagement and contribution of CSOs in WHO s work is a civil society mechanism. An interesting example can be found in the International Food Security and Nutrition Civil Society Mechanism (CSM). As part of the reform of the Committee on World Food Security (CFS) in 2009, CSOs/NGOs and their networks were invited to establish autonomously a global mechanism for food security and nutrition, which would function as a facilitating body for CSO/NGOs consultation and participation in the CFS processes. The CSM was launched in 2010 and represents an inclusive and open space in which CSOs worldwide share information and participate in policy debates and processes in relation to the CFS. Its purpose is to facilitate civil society participation in agriculture, food security and nutrition policy development at national, regional and global levels in the context of the Committee on World Food Security (CFS) 8. CSOs within this mechanism have organized themselves around 11 constituency groups (see paragraph 1(b) above) and 17 sub-regional groups. Members of the CSM are able to contribute to political processes relating to the CFS and its mechanisms at the global and regional levels through sharing of experiences, analysis and positions and through participation in policy working groups. A similar mechanism should be promoted and supported by WHO. 8 International Food Security and Nutrition Civil Society Mechanism, 9

10 (c) National Dialogues with NGOs The NGO policy should encourage member states to hold national level policy dialogues with civil society on health matters including those concerning WHO. Involvement of civil society at the national level will surely greatly assist member states in their interaction with WHO at the regional and international levels and this in turn will strengthen the ability of WHO to play a leading role in global health. 4. In Conclusion: The above recommendations are made with the aim of providing guidance to WHO in its preparation of a draft NGO policy. The recommendations call for revised rules for NGO participation in WHO meetings at the international level. However it is also hoped that rules for the participation of observers at regional committee meetings can be streamlined to reflect the abovementioned recommendations. 10

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