On 4 December 2023, the World Health Organization (WHO) published a document entitled Matters emanating from the Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance: Proposals for improving the effectiveness of the WHO governing bodies. This document can be found here: https://apps.who.int/gb/ebwha/pdf_files/EB154/B154_33Add1-en.pdf. The paper makes a few observations about WHO governing bodies meetings (including the Executive Board and the World Health Assembly).
Governing body agendas are too long and based almost exclusively on previous mandates and standing items, leaving an insufficient amount of time for forward-looking strategic discussion and debate.
Redundancies between governing bodies should be reduced, including clarification of the division of labour among the Standing Committee on Health Emergency Prevention, Preparedness and Response, the Programme, Budget and Administration Committee, the Executive Board and the Health Assembly, which would lead to greater efficiencies.
An explicit process is needed whereby the governing bodies carefully consider the programmatic and financial implications for the Secretariat of draft resolutions and decisions proposed for adoption by the Executive Board or Health Assembly.
The volume of governing body documentation has become unmanageable both for delegations to review in advance of governing body meetings and for the Secretariat to produce on time in all official languages.
The schedule of informal consultations on draft resolutions and decisions has become unmanageable, with consultations often running back-to-back from early in the morning until late in the evening for weeks in the lead-up to governing body meetings, and with no guarantee that consensus will have been reached prior to the opening of the meeting. Smaller delegations in particular do not always have the capacity to participate actively in the numerous consultation processes.
The proposal to reform the architecture of the Executive Board in relation to the consideration of draft resolutions and decisions on technical matters emanates from “discussions and guidance provided by Member States during the three meetings of the Agile Member States Task Group on strengthening WHO’s budgetary, programmatic and financing governance” (Source: EB154/33 Add.1). The Agile Member States Task Group met three times in 2022. The Task Group proposed that WHO establish a new committee of the Executive Board on technical matters to ” discuss all substantive reports by the Director-General that fall outside the mandate of the Programme, Budget and Administration Committee” and “consider proposals for draft resolutions and decisions on technical matters and examine, in particular, their relationship to the general programme of work” (Ibid). The Task Group proposed that the new technical committee meet in mid-January of every year to be followed by the Executive Board in February.
Under the the Task Group’s proposal, the “Executive Board or Health Assembly would focus its discussions on the recommendations provided in the reports of the new committee and the Programme, Budget and Administration Committee.” (Ibid). The Board paper notes that any “recommendations requiring action and follow-up by the Secretariat could be reflected in draft resolutions or decisions proposed by the new committee for consideration by the Executive Board or Health Assembly, as appropriate” (Ibid).
In relation to the functioning of the Executive Board and World Health Assembly, the Agile Member States Task Group proposes some drastic new methods of work (EB154/33 Add.1, Page 5):
C. The Executive Board
17. Under this proposal, the Board would focus discussion on the reports of its committees, rather than taking up and rediscussing each agenda item individually. The Chairs of the committees would be invited to present their reports and the outcomes of the discussions on each of the agenda items that fell within the respective mandates of the committees. The Board would have the opportunity to decide whether it concurred. It would then take action on any proposed draft resolutions or decisions, as appropriate.
18. The Board would devote more time to strategic discussion, such as on emerging global policy trends and cross-cutting issues.
D. Health Assembly
19. It is proposed that the Health Assembly focus its discussion on the outcomes of the Executive Board and any committee meetings held following the January session of the Board, rather than taking up technical and administrative matters individually. As the supreme decision-making body of WHO, the Health Assembly would thus be action oriented and provide more opportunities for strategic discussion and engagement.
In relation to the new technical committee, the Board document (EB154/33 Add.1) proposes the following action item for the Executive Board:
“The Executive Board, having considered the report by the Director-General on proposals for improving the effectiveness of the WHO governing bodies,1 decided:
(1) to request the Director-General, in consultation with Member States and taking into account paragraphs 4, 5, 6 and 7 of document EB154/33 Add.1, to develop the draft terms of reference for a new committee of the Executive Board, for consideration by the Board at its 156th session in 2025, to enable the Board, should it so wish, to establish the new committee at the same session;”.
Jaume Vidal, Senior Policy Advisor at Health Action International (HAI) provided the following response.
The right diagnosis but the wrong remedy; there is an overwhelming consensus that an increasingly bloated agenda and an accumulation of mandates is rendering WHO governing bodies inefficient. The result is an organisation unable to fulfil its mission to protect and promote global health effectively. However, proposals for reform with so much political and legal weight, should not exclusively come from small groups of Member states but from the WHO secretariat, submitted to the entire WHO membership, and only after extensive consultations with WHO staff and non-state actors. This is especially true when it comes to public-interest civil society, which for some time, a squeeze on space for participation in governing body deliberations.