The following is the intervention delivered by Brazil on 1 November 2011 at the Special Session of the Executive Board on WHO Reform.
INTERVENCÃO DA EMBAIXADORA MARIA NAZARETH FARANI AZEVÊDO NA ABERTURA DA SESSÃO
ESPECIAL DO CONSELHO EXECUTIVO DA OMS SOBRE A REFORMA DA ORGANIZACÃOGenebra, 1º de novembro de 2011
Mr. Chairman,
Brazil approaches the WHO reform from the perspective of the strengthening of multilateralism. We welcome the holding of this EB special session, but we expect the reform to be debated in an open-ended setting so that every single member of this organization can opine on the reform of an institution that belongs to all of us.
The changes in the global health landscape over the last decade have provoked a debate on the need for WHO to adapt itself in order to lead and operate more effectively in an environment of multiple and fragmented actors and initiatives. We agree with the DG when she says that WHO should “retain leadership at world health”. Having said that, let me share with you some ideas on the issue of reform:
1. Health is global, WHO is global. Health is universal, WHO is the sole universal institution dedicated to global health in the international system. We should take advantage of this exercise to strengthen the multilateral nature of this Organization. We can only do so through an all-inclusive and member-driven reform exercise. As we know, WHO’s comparative advantages stem from its legitimacy as a global intergovernmental body. We cannot lose sight of the increasingly political importance and global character of issues discussed in this building, for instance: strengthening of health systems; universal coverage of health care; access to affordable medication; social determinants of health; non-communicable diseases. We need to profit from this reform to keep on enhancing interaction between the political and technical dimensions of WHO so as to make sure that WHO will continue to play a leading role in global health.
2. WHO should focus on what it does best: its coordinating, normative and advocacy roles and its responsibility to strengthen health systems. It is taken for granted that this Organization has a continuous job to do in the normative domain. Advocacy is also imperative, in particular to highlight the centrality of health in public policies, both at the national and international levels. WHO has recently played a protagonistic role in two major events that highlights the growing importance of health in the international agenda: Non-Communicable Diseases and Social Determinants of Health, in Rio. WHO has to reinforce the areas within the Secretariat responsible to carry out these important issues. Strengthening health systems is an area which WHO cannot shy away from. To this end, WHO should reinforce its presence at the regional and national levels, moving closer to its customers . Let us also bear in mind the cross-regional opportunities facing WHO, which could facilitate the replication of successful experiences from one region to another. If regional policies and practices have to be coherent with the global ones, good practices adopted in the regional sphere could also be applied in headquarters.
3. We agree with the DG: what started as a financial discussion evolved to a larger debate. WHO relies on voluntary contributions for most of its activities. And most of such funds are earmarked. This practice of setting aside specific amounts for particular purposes has little to do with the multilateral spirit of this body. We should make a collective effort to change the perception that this is a donor-driven organization. WHO cannot and should never act as a rubber-stamping agency for national projects. Brazil is not against voluntary contributions but they have to fit in with decisions taken on a multilateral mode. Anyhow, we should strive to align strategies, priorities and objectives with resources. Furthermore, replicating in WHO a United Nations General Assembly 5th Committee-like body – to allow all member states to follow, opine and collectively decide upon administrative and budgetary matters facing the Organization – could be a good idea.
4. The latest report of the Secretariat is a good starting point, but there should be no hurry. We took note of the DG´s comments on the three concept papers, among others. Indeed, we have covered some ground, but there is a lot do be done still. The implications of this exercise need to be well understood by all member states, like Mexico said, from the richest to the poorest. It is actually a matter of concern for us that some decisions have already been taken to downsize some units within the Secretariat. This should not be done without proper consultations with member states. We are in the midst of a reform process. Such decisions have a bearing in this reform and should wait for the results of this exercise.
5. Lastly, the reform is government-driven, but governments have to listen to all interested parties. This is what we do in Brazil to devise our national health policies. Proposals to ensure the increased participation of civil society (NGOs and private sector) are welcome but will require deeper analysis and discussion.
In concluding, Mr Chairman, we need to engage ourselves in a confidence-building exercise and confidence can only come out of a transparent and inclusive process. We learned an important lesson in the PIP negotiations. We cannot rush into precipitated decisions. We need time to discuss, understand and make collective and proper deliberations.
Thank you.