Since 2010 the World Health Organization is going through a reform process grounded on the need for creating a more efficient institution. This process started with the organization and its member states’ concern about the impact of the economic crisis in the area of public health. However, this concern evolved into a discussion about the effectiveness and capacity of the WHO to address the challenges of the 21s century.
The WHO reform is a broad issue which considers multiple aspects, from financial issues to planning, from governance to representativeness, as well as to build a more inclusive organization by improving the channels for participation of key players in the decision-making process. I consider this latter element is particularly important for the future of global health governance.
The WHO reform process also arises in the middle of a debate about the need for a more inclusive and effective global governance. In the case of health, in the last decade, a number of circumstances increased the involvement of non-state actors in health related activities. A significant aspect of this phenomenon is that most of these actors are having an important presence in places where the state is unable or unwilling to deliver health services. Moreover, some of them are not only delivering services but also providing large amounts of financial resources to invest in health systems. Under this context, it is relevant to examine to what extent this reform would be able to transform the WHO into the foundation of truly global health governance. I consider this is still far from being a reality. Although one of the goals of the reform is to make the WHO an organization that enables the participation of all the actors contributing to the improvement of health around the world, the WHO has emphasized since the beginning that this process is Member-State driven.
This does not imply that the opinions and roles of non-state actors are not being taking into account at all. In fact, the organization released an on-line consultation allowing all interested stakeholders to express their opinion about the WHO’s future priorities. Besides the importance of these non-state actors can be seen in the alliances for health, which for a long time have been crucial for the WHO’s operation and financing. What I want to point out is that states are at the center of the process and they are the ones making the key decisions about the future of the organization.
The participation of non-state actors for the creation of an improved system of global health governance is an important goal. However, It is also imperative to build a more democratic and equalitarian organization with its own members. The last decade some countries have blamed the WHO of being donor-driven and protecting special interests. This controversy started during the negotiation of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property. A critical point was reached when Indonesia decided not longer to share samples of H5N1 influenza virus strains claiming that WHO was benefiting big pharmaceutical companies from Northern countries.
Whether these claims have been reasonable or not, at the end it is true that the current governance structure of the WHO allows certain countries to have more influence than others. Therefore, the system of global health governance first requires equal relationships among states and then the creation of mechanisms for allowing non-state actors to participate. Both are complex changes that require a great deal of political commitment and willingness from the states. If the WHO reform is able to change at least the internal arrangements, allowing more inclusiveness and creating an apparatus for an equalitarian participation of all its state members, that would be a major step for global health governance.