MMI Network News, June 2015

Dear reader,

For the past two weeks, as much of the world went about its business unaware, a critical meeting has been held in Geneva regarding the state of the world’s health – the 68th World Health Assembly. This year’s theme was resilient health systems, which when considering the number of complex disasters, humanitarian crises, conflicts, and health emergencies that are simultaneously occurring around the world, was aptly chosen. As a result, the 68th WHA arguably took on additional meaning this year and several critical topics were debated and, for the most part, agreed, that will have long-lasting implications for the world’s most vulnerable populations for years to come.

On the agenda this year were several pressing issues such as preventing the spread of antimicrobial resistance, global plans to increase the access and affordability of life-saving vaccines, polio eradication, progress in tackling non-communicable diseases, the need to address adolescent health, efforts to the health-related Millennium Development Goals and the inclusion of health targets in the post-2015 sustainable development agenda, implementation of the International Health Regulations, and reform of the World Health Organization itself. While debates at times became heated around specific aspects or proposals, the majority of discussion on the above topics proved comparatively straight-forward with governments declaring their support for the principles under consideration, if not the associated guidelines and recommended measures. As occurs throughout each WHA new pledges of support were announced, resolutions were amended, and eventually passed after being tweaked in drafting groups.

As anticipated, the 2014 Ebola outbreak in West Africa and global health security featured prominently throughout the assembly, serving as a catalysing point for many of the agenda items under consideration. Ebola was, for example, one of the key topics addressed by German Chancellor Angela Merkel in her opening address where she stressed the need to further reform the WHO so that it was capable of reacting more quickly to health emergencies. Consistent with the meeting’s theme of resilient health systems, the Chancellor also announced new commitments to support low-income countries strengthen their capacities and pledged that this would remain a priority throughout Germany’s presidency of the G7. The Ebola outbreak also emerged as a central theme of Dr Margaret Chan’s opening remarks to delegates. In an attempt to circumvent further criticism following the release of the interim report by an independent panel established to review the organization’s handling of the outbreak, the WHO Director-General outlined a series of reforms. These included:

• establishing a global emergency health workforce to respond rapidly to adverse health events;
• the creation of an USD$100 million emergency contingency fund to facilitate the WHO’s rapid response;
• creating a single programme for health emergencies with clear performance indicators and metrics for response; and
• strengthening the WHO’s surge capacity and adding new skills in logistics, anthropology, and risk communication.

The creation of the global emergency health workforce and emergency fund were discussed at length while government representatives sought to find common ground on a draft resolution on Ebola. Agreement was eventually reached on the proposed scope and operation of these measures, but it is also apparent that the devil remains very much in the detail and many months of work will be required to make these proposals a reality.

Importantly, however, not every topic under discussion gained agreement. One of the more controversial items under discussion had been to raise the level of annual government payments to the WHO, otherwise known as assessed contributions. Since the 1980s governments have declined to increase their assessed contributions, preferring instead to make additional funds available on a voluntary basis only. These voluntary funds frequently come with strings attached that serve, amongst other things, to prevent the WHO from reallocating financial resources when unanticipated events like the Ebola outbreak arise. Given that financial audits revealed that only 20 contributors provide 80% of the World Health Organization’s funds – and that not all these 20 donors were governments – it had been suggested that perhaps 2015 was the year in which the level of assessed contributions would be raised. For many governments, however, this proved too difficult to agree upon and even before the World Health Assembly had commenced the Director-General had brokered a compromise suggestion, advocating instead for an 8% increase of the overall budget. Yet again, even this alternative suggestion proved too much for some, and member states have agreed to temporarily increase the voluntary contributions they make while the level of regular payments remains unchanged.

Arguably one of the most critical elements under consideration at this year’s World Health Assembly that did not secure agreement was the proposed Framework for Engagement with Non-State Actors, or FENSA. Negotiations on the draft framework continued throughout the entire eight days of intergovernmental deliberations, and often late into the evenings after the formal work agenda had ceased. A number of non-governmental organizations, including Medicus Mundi International and the Peoples’ Health Movement, spoke against the risk of commercial and industry interests interfering with the work of the WHO, while industry representatives stressed the need that any agreed principles and practices should be applied equitably across the board without discrimination or distinctions being drawn. At the end of the day, however, member states were not able to arrive at a consensus amongst themselves on several key elements of the framework, and as a result this item has been deferred until the next World Health Assembly in 2016. Amongst those areas that proved especially problematic to resolve were issues around financial resources that the WHO could accept from non-state actors including industry groups; the level and extent of oversight to prevent conflicts of interest arising; the creation of an online register for non-government organisations that would require, for example, the disclosure of assets; and several other aspects. These areas of dispute will be discussed and ideally resolved at an intergovernmental meeting on the FENSA agreement later this year, but if the WHA offers any indication, it may very well be that the only actors happy with the agreement will be the WHO’s member states. Time will, most definitively, tell.

Adam Kamradt-Scott, University of Sydney
Member of the MMI delegation to the WHA
Editorial also published in: IHP news

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Network conference report: MMI
General Assembly and workshop in Geneva

23 May 2015. The General Assembly of the MMI Network took place at the Red Cross Museum in Geneva. It focused on the adoption of a new Network Strategy for the years 2016-20. The statutory part of the Assembly was be followed by a well-attended internal workshop. The documentary “A Luta Continua”, produced by Medicus Mundi Catalunya and referring to the case of Mozambique, was emotionally touching and provided a lot of food for thought and debate on the role of international health cooperation in strengthening – or weakening – national health systems.

> MMI Assembly: Documentation
> MMI Network Strategy 2016-20: Download PDF
> “A Luta Continua”: Documentary and background

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Network event: medico international
Fit for Catastrophe?

Frankfurt am Main, 5-6 June 2015. “On its 10th anniversary the foundation medico international wants to have a critical look at the concept of resilience that in the past years emerged as a panacea against all kinds of crisis and problems that societies and individuals are facing nowadays.”

Website in German: https://www.medico.de/fit-fuer-die-katastrophe-15981/

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Network conference report: MMI/HW4All
WHO Global Code of Practice – initial achievements and future challenges.
Civil society side event to the World Health Assembly

Geneva, 20 May 2015. The WHO Global Code of Practice (Code) on the International Recruitment of Health Personnel was adopted by the 63rd World Health Assembly on 21 May 2010. The 2010 WHA resolution requested the first review of the relevance and effectiveness of the Code be made during the World Health Assembly in May 2015. An expert advisory group (EAG) was convened to carry out the review and will submit its report to the WHA for consideration. The side event organized by MMI in cooperation with several civil society partners provided a good an opportunity to get insights and assessments from members of the EAG before the formal WHA debate. With over 120 participants and some inspiring statements, the side event was a strong and encouraging call for making the Code what we want it to be: a real instrument for change.

> http://bit.ly/wha68code

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Network conference report: Medicus Mundi Switzerland
HIV/AIDS and vulnerable groups – no one left behind

Berne, 7 May 2015. “We experienced an exciting conference on the issue of ‘HIV/AIDS and vulnerable groups – no one left behind. In a very impressive way, experts from Switzerland and other countries provided an overview on the gravity of the subject of vulnerable groups and the containment of HIV/AIDS. The main problem of this group is that it often does not have access to information, prevention programmes and health care services. Mainly, access to these services is denies due to stigmatisation, discrimination and specific laws (e.g. sex work is illegal) for this group.” (aidsfocus.ch is a project of Medicus Mundi Switzerland)

> http://bit.ly/aidsfocus-2015

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Network conference report: HW4All
Mobility of Health Professionals in the EU – Ethical Recruitment and Policy Coherence

Brussels, 05 May 2015 – What role can ethical recruitment play for fair distribution of health workers? What role has Europe in ensuring that freedom of movement of health workers in the Single Market does not translate into unequitable access to health services in less affluent regions? These are two of the questions that the event “Mobility of Health Professionals in the EU: Ethical Recruitment and Policy Coherence” that took place on 5 May at the European Parliament responded to. (HW4All is a project with several MMI members participating)

> https://interact.healthworkers4all.eu/pages/releaseview.action?pageId=4623531

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Network conference report: Medicus Mundi Switzerland
Community Participation in Public Health: What’s the Added Value in Research and Implementation

The Swiss TPH Spring Symposium 2015 provided a platform to reflect on the added value of community participatory approaches in public health. Starting with an overview of the current major debates in the field, presentations and discussions then focuses on the added value and challenges in putting into practice these approaches. Speakers presented various ways and reasons for involving community members in clinical and social science research, as well as in project implementation. Critical perspectives were addressed such as the feasibility, sustainability and equity of these approaches and whether these approaches can actually contribute to increasing quality of research and services, stronger accountability within the health system, and ultimately better health outcomes, with a particular focus on the most marginalised and vulnerable populations.” (The Swiss TPH is a member of Medicus Mundi Switzerland)

> http://www.swisstph.ch/news-events/symposia/spring-2015.html

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