The WHO through the eyes of a rookie: the role of civil society in shaping world decision-making

Aletha joined the 'World Health Watch': an initiative of the People's Health Movement that makes it possible for health activists to closely monitor the meetings of the World Health Organization. In this blog, she describes this experience.

Health is geopolitical, to make a change you must understand the technical processes that shape decision making.

The World Health Organization (WHO) brings together the so-called developed and developing countries to address key aspects of health like universal health coverage, access to medicine, response to epidemics, ... It is a place of diplomacy, lobbying and critical decision-making. It is a place where "power' is displayed: having the ability to shape the agenda, having the political and financial capability to influence global health interventions and most importantly having the power to affect the choice of others. Many countries, most especially rich nations come prepared to control the discussion in a way that the decisions taken don't go against the interests of their institutions, or their corporations.

High level discussions and civil society meetings

For a rookie, it can be chaos: the technical terms, watching, reporting, ... The technical documents discussed at the EB meeting are quite complex. While in Geneva, I attended a meeting of the Geneva Global Health Hub (G2H2), a gathering of civil society organizations to share knowledge and build on ideas to advocate for a more democratic global health governance. TWHA is part of this network.

Civil society organizations play a crucial role in ensuring the World Health Organization's position in global health governance, regulation, policy and decision-making. But civil society organizations are not a just blind patron of the WHO. Through advocacy and mobilization, they monitor the WHO to uphold its principle mandates concerning universal social protection and health care, the need for public health systems, and accessible medicines.

A WHO insider said: 'Health is geopolitical, to make a change you must understand the technical processes that shape decision making.' Well, the civil society organizations have diverse expertise and understand these processes and how decisions are made in regard to public health and well being. In that sense, TWHA and the People's Health Movement along with other civil society organizations follow closely the work of the WHO: they 'watch' and provide critical support.

What kind of WHO do we want?

Civil society organizations are concerned with the WHO's current organizational reform. This reform was intended to get donor's trust and more money, but somehow pushes the organization in a financial crisis which makes it more reliable on funds from private entities and other non-state actors. This financial crisis makes the organization unable to respond adequately to global health problems. The WHO financial stability and independence as global decision-maker lies in the hands of members states; their will or not to increase their contributions will safeguard the WHO from conflicts of interest with the private sector.

In order to achieve this, the question during the G2H2 meeting was: 'What kind of WHO do we want and what should the profile of the new Director General be'? Currently, the WHO is in search of a new Director-General, and by being in Geneva during the Executive Board of the WHO, I got a glimpse on how the process is going.

What I learned from the G2H2 meeting, is the following. The ideal WHO is independent, upholds its constitutional mandate, is publicly funded and is not influenced by non-state actors or influential and rich member states. It should be able to independently set its agenda maintaining the values and principles for health for all.

The work of the Director-General should serve as a guideline and, moreover, lead public health globally. The Director-General must not be influenced by richer and more powerful member states. She or he musts necessitate prudence, acumen, fearlessness and above all a respectable network of people with formidable ethical background and a courageous drive to succeed its objective. As a result, its mission must be good for the foreseeable future, thus free from any self-esteem.

As the election process continues and the candidates narrow down to the final Director-General, it is the hope of civil society organizations that this will lead to some changes in global health governance and decision-making. Whatever happens, we will keep watching!

I wrote a paper on the influence of philantrophic organisations and private actors on the WHO. You can read it here.