In 2011, Margaret Chan, director general of the World Health Organization, launched a major reform of the United Nations organisation. This week, a presentation and discussions around the WHO reform by Gaudenz Silberschmidt, senior adviser in the WHO Office of the Director-General, highlighted the reason for this reform, its organisation and the possible impact the reform could have on the relationship between the pharmaceutical industry and the WHO.
The event was organised by the Geneva Press Club on 16 January. Reform is among the issues on the agenda of the WHO Executive Board meeting next week.
The reform of the WHO consists of three strands: programmes and priority-setting, governance reorganisation, and managerial restructuring.
According to Silberschmidt, this reform is already leading to some positive changes, like prioritisation of themes to be addressed, and changes in the method of financing the organisation.
Silberschmidt described some improvements in the WHO’s funding model. The reform now stresses the assessed contribution of member states and tries to regulate voluntary funding from the private sector. He gave an example where member states created a group to control the voluntary funds allocated to the WHO by private entities – like pharmaceutical companies. There, voluntary funding should be proportionally dependent on the service given by the private entity to the amelioration of global health and not unregulated and unlimited as was the case before the reform. In other words, the quantity of money private entities can give to the WHO should be dependent on the quality of their work and efforts towards public health goals.
For Silberschmidt, this step forward – coupled with the increased transparency efforts underway – could limit the influence pharmaceutical companies are often said to have on the WHO. The WHO is sometimes criticised for an opaque collaboration with the private sector, which can result in conflicts of interest. Through voluntary funding to the WHO, non-state donors can try to influence the way the organisation sets its priorities and can seek to manipulate the way their money is used.
Silberschmidt took the opportunity of this discussion to insist on the low proportion of funding coming from pharmaceutical companies. However, he did not use any figures to illustrate this statement.
The overall aim of the reform is to permit the WHO to keep its central coordination role in the global health domain. This is a clear priority in the WHO constitution, as per Chapter 2, Article 2 (a), which states:
In order to achieve its objective, the functions of the Organization shall be: to act as the directing and co-ordinating authority on international health work.
Yet, as expressed by Silberschmidt, since the creation of the WHO, new agencies and international organisations working on global health have emerged, some of them with bigger resources than the WHO. In this context, it is only through a reform having at its heart a programmatic reorganisation that the WHO will be able to keep its legitimacy as the global health coordinating agency.