International Health: The Institutional
Labyrinth
201. Reforming WHO's internal structure is an
essential, though challenging, prerequisite of improving global
health governance. While it is true that some progress has been
made and that the Regional and Country Offices are now more willing
to cooperate following the SARS experience, a more fundamental
overhaul of the relationship between headquarters and regions
and a review of the current procedures by which Regional Directors
are appointed seems overdue. Given the threats to global health
which we face from newly emerging infectious diseases, a dysfunctional
organisational structure within the world's principal policy-making,
standard-setting and surveillance body simply cannot be afforded.
We therefore recommend that the Government should bring its influence
to bear, along with that of other like-minded Member States, to
ensure that a fundamental review is initiated of the inter-relationship
between WHO Headquarters and its Regional and Country Offices
and of the system of appointment of Regional Directors so that
WHO as a whole is better structured to meet the contemporary challenges
of global health management. (Paragraph 111)
202. We recommend that, when budgetary negotiations
for the next biennium get under way, the Government should support
a re-balancing of WHO's budget in order to make more funds available
for the core budget. (Paragraph 113)
203. Infectious diseases pose a major threat
both to this country and to the wider world, and we believe that
WHO will need additional funding if it is to be able to respond
effectively to these threats on behalf of the international community.
The UK is already a major funder of WHO and we are mindful of
current budgetary constraints. We recommend however that the Government,
in concert with other Member States, should work towards an increase
in financial contributions to WHO. (Paragraph 114)
204. As regards ECDC, we believe that it will
be important that duplication and overlap does not occur and that
ECDC does not become a further complicating factor in an already
complex system of global disease management. (Paragraph 119)
205. We recommend that the Government should
pursue, as a matter of urgency, through its membership of the
relevant IGOs the creation of an event-reporting system for animal
diseases along the same lines as the new IHRs relating to human
health and should encourage the building up of much stronger systems
of cooperation between the bodies dealing with human and animal
health in sharing information and handling reports of disease
outbreaks. (Paragraph 128)
206. We recommend that the Government should
continue to encourage the development of integrated strategies
for combating TB and HIV and should satisfy itself, before committing
funds to fight one or both of these two diseases in developing
countries, that there is adequate local recognition of the problem
of TB-HIV co-infection and that there are sound programmes in
place to address it. (Paragraph 137)
207. We recommend that the Government should,
via its representatives in the relevant UN agencies, seek to ensure
that instances of non-collaborative working are highlighted and
remedied. We recommend also that the Government should urge the
UN Secretary-General to give WHO a clearer lead role. (Paragraph
147)
208. Our assessment of the International Health
Partnership concept is that it represents an interesting and innovative
project which has the potential for bringing about considerable
improvement in the coordination of global health efforts, particularly
at the all-important country level. We shall, however, have to
wait and see how the concept develops—whether other countries
and implementing organisations join and whether the mutual obligations
which participants undertake prove sustainable and really do result
in the increased efficiency of health-related aid which is envisaged.
We are pleased to hear the Minister's affirmation of the importance
of the IHP. We therefore recommend that the Government should
throw its weight behind development of the concept in order to
turn it into a reality as soon as possible. We recommend also
that the IHP should be developed in a way which simplifies and
avoids complicating further the already complex global health
governance picture. (Paragraph 158)
209. We recommend that the Government should
take the initiative, within the global health community, to promote
a strengthening of WHO's role in two principal respects. First,
Member States should be asked to agree, at the 2009 World Health
Assembly, on a new Mission Statement which would give WHO a role
of preparing a strategy for global health governance and promoting,
through negotiation, an increase of collaborative working among
the various actors, State and non-State, in the field of infectious
disease control. Second, Member States should be asked to agree,
on the basis of evidence of need presented to them by WHO, a re-balancing
of the WHO budget between Assessed and Voluntary Contributions.
(Paragraph 173)
210. We recommend that the Government, working
with other donors and with recipients, should aim to lighten the
administrative burden of health aid on developing countries and
to strengthen the capacity of those countries to manage health
programmes. The aim should be to secure the alignment of donor
inputs to disease control programmes within the national health
programmes of recipient countries and to simplify the procedures
for their management and reporting. (Paragraph 176)
Accountability and Management
211. We are pleased to hear that the Government
is alert to the need to operate effective control mechanisms.
In view of this and of the generally favourable comments which
have been made to us in the course of our inquiry by IGOs and
other organisations concerned with infectious disease control
as to the competence and effectiveness of DFID support to developing
countries in the health field, we do not believe it appropriate
or necessary to make any further observations on the management
of UK bilateral aid programmes in this field. (Paragraph 181)
212. We recommend that the initiatives described
to us—MOPAN and what might be termed a Service Level Agreement
approach—should form the basis for new accountability arrangements
between the UK—and, we suggest, other Member States—and
IGOs operating in the field of infectious disease control. (Paragraph
184)
213. We do not suggest that the UK should simply
replicate the Swiss arrangements for global health policy formulation.
Nor do we have a ready-made solution to the problem to offer.
We do, however, recommend that the Government should take another
look at the machinery for coordinating UK policies with a view
to ensuring that the interests of those Whitehall departments
who are closely involved with the international dimension of global
health are given their due weight and that this is reflected in
the arrangements for leadership of the Global Health Strategy.
(Paragraph 189)
