Although it was a disappointment to many NGOs, WHO Member States were mostly relieved: after five years of negotiations, the Framework of Engagement with non-State Actors (FENSA) has finally been adopted. I am concerned about FENSA, as it now will be easier for commercial parties to influence decision-making processes in international health in their favour. However, FENSA also provides opportunities for Wemos and partners to closely monitor the promised transparency and management of conflict of interests.
FENSA replaces existing WHO policy on entering into ‘official relations’ with NGOs and guidelines for cooperation with commercial businesses. During the past years, Wemos advocated with partners for an improved framework. This has been partially realized. For example, secondment from the private sector is not included anymore. However, we could not prevent a warped definition of conflict of interests. This is most likely because of one of the main reasons why WHO really needs this framework: more money. The definition completely disregards the institutional conflict of interests within WHO itself: the organization depends on parties that pursue different goals from its own.
What’s the goal?
Businesses often pursue goals that run counter to those of WHO and therefore public health. Philanthropic organizations pursue – for a large part – similar goals to those of WHO, but they are not created in a democratic manner. In many cases, there is little or no accountability.
In the new framework, both philanthropic institutions and representatives of businesses can acquire the ‘official relations’-status. In other words, they are allowed to collaborate with WHO and get access to meetings of WHO governing bodies: the Executive Board meetings and World Health Assembly. By accepting FENSA, WHO Member States perpetuate an ongoing trend of growing influence from private parties as opposed to governments and intergovernmental organizations.
Wemos has covered the dire financial situation of WHO before. The so-called ‘assessed contributions’ of Member States have been frozen for years and are disproportionate to voluntary donations. The difference between the two is that the former are not earmarked and can be spent freely by WHO, while the latter are earmarked and must be spent on specific programs, depending on the provider’s preference.
Member States have been earmarking an increasingly larger proportion of their donations to WHO. The Bill and Melinda Gates Foundation is the second largest financier of WHO and – just like most philanthropists – allocates its funds to specific programs, and therefore has a large influence on what the organization can or cannot do. There is no doubt that this is reason for concern.
Despite all this, I have to admit that there are positive aspects to FENSA as well, such as the strict requirements for transparency. Still, WHO has several duties to fulfil if the aim is to correctly implement FENSA and prevent undue influence from private actors. Sufficient manpower and financing are necessary. Employees should be trained to know how to deal with conflict of interests, and the costs of transparency requirements are high. Moreover, civil society organizations want to be better heard. In this light, FENSA can provide a framework for broader consultations in which resource-constrained NGOs can participate as well.
Wemos will continue to monitor this process. The next World Health Assembly in May 2017 will be the first test: this is when Member States will follow up on FENSA’s developments. In January, an interim report will be published during the Executive Board meeting, and an evaluation has been planned for 2019.
WHO and its Member States hope that FENSA will make more money available. Yet, they should not forget that a sound implementation will also cost money. The framework is certainly not a sustainable solution for the financial stranglehold on WHO. The solution lies in the hands of Member States, as only they can decide to lift the freeze on assessed contributions and increase non-earmarked payments to WHO. Then all Member States will have a voice in WHO – not only the affluent ones – so that the organization can determine its own course. After all, we do not want rich Member States and philanthropists to dominate WHO, do we?