The future of financing for WHO 2010 DENMARK

The future of financing for WHO 2010 DENMARK

THE FUTURE OF FINANCING FOR WHO Danish Contribution to the web-based consultations May 2010 General remarks Denmark welcomes and fully supports the Director General s initiative to debate the future of financing for the WHO as well as the WHO s future role and core business. We will remain committed to engage constructively in this debate and to support the Director General in implementing the challenging decisions which will hopefully follow. From a Danish perspective one of the fundamental challenges for the WHO now and in the years to come is related to credibility. It is paramount for the organization to remain credible to the public when issuing guidelines and advice in relation to public health issues, not least in connection with public health emergencies of international concern. In this connection focus is needed on transparency and ensuring a continuous independence from vested interests. At the same time it is crucial for the organization to remain credible to donors and member states by ensuring transparency and consistency in the follow-up and implementation of decisions taken in the governing bodies, including those relating to the allocation of funds in the budget. In this connection clear objectives, prioritization and thorough, credible and timely performance reviews and reporting are central. Furthermore Denmark would like to point to an issue which is not touched upon in the report on the future of financing for the WHO. That is the role of the regions and the relationship between Headquarters and Regional Offices. Denmark believes that it is important to include this perspective in the debate with a focus on how to ensure greater coherence between the work and priorities of Headquarters and Regional Offices as well as between the World Health Assembly and the Regional Committees. A) Initial reflections setting priorities Denmark agrees that there is an indispensable need to focus and prioritize the work of the WHO. As the Director General has pointed out if the WHO is everywhere, it is nowhere. To our mind, a number of principles should be guiding in the prioritizing process: The WHO s normative and standard-setting functions are among the most fundamental tasks of the organization along with development of evidence based guidelines and policies. Here the WHO has an indispensible role to play by developing country specific policies and guidelines, while implementation remains the responsibility of the countries themselves. Closely associated with this is the role of the WHO in monitoring global health and assessing global health trends. With regard to broader determinants of health there is no doubt that health development is closely associated with achievements in a number of other areas - inter alia education, employment, working conditions, social welfare, environment and housing. In the social area for example it is evident that the health sector and the health professionals have an obligation to support initiatives with the aim to reduce the impact on health stemming from poverty, loneliness, broken families, deprivation, lack of network, insecurity and other social problems. On the other hand the WHO and the professionals in the field of health should neither take the lead in nor the responsibility for solving social policy problems in our societies. Social policy has its own legitimacy and needs no crutches. The same goes for the other areas listed above. The focus of the WHO must be on areas where the WHO has a natural part to play, where it has its strength, knowledge, skills, comparative advantages and where it can exercise its leading role

undisputed. When deciding on such areas it is necessary to take into account responsibilities and capabilities of other partners. As numerous issues are raised in the WHO governing bodies by individual member states eager to promote certain agendas it is a shared responsibility of member states to keep the WHO focused on core issues. The work of the WHO should reflect the overall disease burden in the world. On this background focus on non communicable diseases should be strengthened, also in financial terms, while maintaining the principle of prioritizing cost-effective and affordable health interventions. It is the role of the WHO to shape the research agenda, but research as such should be left to other actors. The role of the WHO in the provision of technical support should be to catalyse change and build sustainable institutional capacity. The results of the prioritizing process should be reflected in the WHO General Programme of Work (GPW). While the current GPW provides good contextual information, it provides very little in the way of articulating WHO s specific role, including its strengths and comparative advantages. Priorities must also be narrowed down. In its current iteration, the document lists a broad range of priorities that cover virtually all areas of global health. In view of its limited resources, WHO must make some hard choices as to what it will focus on in the coming years. In other words, WHO cannot be all things to all peoples. This should be reflected in the next revision of the GPW. B) Elements of core business WHO has an important role to play in servicing Member States negotiations in areas of public and international health. The ability of the WHO to lead such negotiations should be strengthened for instance by cooperating with other actors involved in the area concerned. Denmark supports the leading role of WHO in coordinating and facilitating the humanitarian global health cluster. C) Health and development Given its neutral status and nearly universal membership, WHO has a unique role to play in the promotion of global health and development, including health related MDGs. WHO should position itself as one actor among others, taking the lead role in areas where it has a comparative advantage. Thus WHO should maintain focus on core areas where its role is unique and vital, and not seek to cover all aspects of health despite a very broad mandate There is a need to improve coordination, coherence and alignment with overall agreed priorities at all levels of WHO. It is important that division of labour between country, regional and global level of WHO is always clear and rational. WHO should play a stronger role in supporting countries sexual and reproductive health and rights agenda. Performance at country level remains weak in most places, and WHO country offices need to improve their capacity to provide timely and relevant technical advice on strengthening national health systems and building sustainable institutional capacity. D) Partnerships Partnerships create new opportunities to meet the health-challenges currently confronting us. However, Denmark is concerned that the organization ends up with a system so complex that member states loose oversight and influence.

We see the new guidelines which were adopted by the WHA in May 2010 as a significant tool in this regard. Especially the principle ensuring that the Executive Board will be consulted on proposals for the WHO to host formal partnerships. In principle we would find it natural if these proposals were presented to the EB for approval. We also welcome that the goals of the partnerships should to the largest possible extent be consistent with the WHO s strategic objectives, which are approved by member states. Denmark has on several occasions mentioned the need for added value and the importance of avoiding the risk of overlap and duplication when entering into partnerships. We would also like to point to the risk of ambiguity in relation to responsibilities. In this connection we welcome the fact that clear roles of partners are a part of the guidelines adopted by the WHA. Denmark is a strong supporter of the new aid effectiveness agenda as laid down in the Paris Declaration and Accra Plan of Action. At country level WHO should support developing country governments together with other health development partners in formulating and implementing coordinated equitable national health plans and strategies as an integral part of national development plans. There is a need for WHO to more actively implement the One UN reforms with special focus on the development of a common organization culture across the UN system, integrated work plans and budgets at country level, decentralization of decision making authority and implementation of results based management. WHO participation in IHP+ and the Head of Agencies group (Health8) are positive examples of efforts to coordinate and harmonize collaboration at global and country level. WHO also has an important role to play in providing technical support to the Health Systems Funding Platform. E) Country Support/ Technical Collaboration WHO should assist countries in adapting global norms and standards based on the specific national context (capacity, funding levels, disease burden etc.) in close collaboration with other health development partners. A main function of WHO at country level is to provide technical assistance to national governments in preparing national plans and strategies, incl. health systems strengthening efforts Technical assistance should be country driven and include more use of South - South networks. F) Implications for the Governance of WHO As stated above Denmark attaches great importance to the issue of credibility. On this background we would be very reluctant to open the WHO governing bodies to other than member states. Doing this could call into question the independence of the WHO. Being able to distinguish between expert advice and decision taking is in many cases important. Already today non governmental organizations have an opportunity to speak at meetings in the governing bodies and many make their opinions heard by contacting the WHO and member states prior to and after meetings of the governing bodies. Increased alignment between decisions taken in the governing bodies and resource mobilization and allocation should be ensured by increasing the WHO s possibility to channel funds more freely towards priority areas identified by the governing bodies (see also remarks to point G). G) Implications for Financing: Not More But Better Denmark agrees that there is little prospect of increasing assessed contributions. Efforts should focus on increasing the WHO s possibility to channel funds more freely towards priority areas identified by the governing bodies. As of 2010 Denmark has chosen to unearmark our voluntary contribution to the WHO to

facilitate this process. We believe that again credibility is a key word. By focusing on fewer and clearer objectives and ensuring a fully transparent budget and monitoring/reporting system more donors could be encouraged to shift to unearmarked funding. In this connection it important that central documents pertaining to budget and financial matters, including performance assessment reports, are published in good time before meetings in the governing bodies. The growth in the WHO budget over the past decade is indeed remarkable and reflects the important role of the organization. However, rapidly growing budgets, decreasing implementation capacity and large transfers of funds from one biennium to the next is to our mind not a good cocktail, and we believe that the WHO should take this very seriously. Denmark finds that it is time for the WHO to consolidate growth and strengthen its implementation capacity. We encourage the Secretariat to continue its work to ensure not necessarily more funds, but more flexible and secure funds for the coming years.