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Comments submitted by Norway to the web-based hearing on Reform

Last updated: 07.12.2011 //

A successful reform, within the framework of its current Constitution, is a fundamental necessity for WHO to remain relevant and maintain its leadership role in today’s complex global health environment.

The objective of the reform should be a reinvigorated WHO – better positioned to meet the health challenges of our time. As the only truly representative and democratically governed organisation in global health, WHO is uniquely placed to build trust and confidence among its Member States.

A successful reform calls for full commitment and active engagement by all Member States and all parts of the organization. It is important that adequate time is given Member States to develop ownership to the process.

Financing of WHO

A critical issue in the reform process relates to how WHO is being financed. Greater coherence must be ensured between the strategic priorities as agreed by the governing bodies and allocation of resources.

WHO must continue to explore ways of increasing the level of flexible, non-earmarked funding in order to respond to this challenge. In this regard, Norway encourages other donors to support the Core Voluntary Contributions Account (CVCA) in order to fulfil its intended role.

At the same time earmarked funding is likely to remain high also in the future. WHO needs to look into new and innovative methods of resource mobilisation in order to make sure these resources match and underpin the agreed strategic priorities in the best possible way, as well as improve predictability of funding.

We find the idea of a replenishment model interesting and would like to receive more information on how it can strengthen predictability and democratic governance. At the same time we want to underline that all new models of financing must be based on democratic principles and secure involvement by all Member States in the process.

We note the idea that was raised at the discussion in Baku to split the budget in two; to develop one budget for core allocations and another one for earmarked project money. We would like to receive information from the Secretariat on how such a model could be developed, and whether a combination between the replenishment model and a split budget could be considered an option.  We emphasize the importance that the complete budget model must lay the foundation for democratic decisions.     

Reform should further ensure that resource mobilisation is done in a coordinated manner by the organisation as a whole, not by multiple individual units at different levels of WHO HQ or across the organisation, which is the current practice.

This may include new ways of managing the relationship with donors, including the private sector. The current method of WHO negotiating funding by one donor at a time, leads to a lack of transparency. More transparency, openness on guidelines and criteria and increased exchange of information would potentially motivate donors to provide more flexible funding.  When seeking new donors, it must be done in a manner that ensures avoidance of conflict of interest.

An improved results based management framework is a condition for Member States’ willingness to increase their flexible funding.

Prioritization – core functions

Member states have agreed to the 5 core functions of WHO at the World Health Assembly in May 2011. To date the focus has been on which areas WHO can improve their performance, with less focus on those areas that should not be a priority for WHO.

Prioritizing within the core functions must be given priority in the reform process. This relates i.a.to the way we adopt resolutions in WHA. There is currently no system for prioritization between them. A system of prioritization and of improved management of resolutions, should be explored.

A rationalised and streamlined planning and budget process will be helpful in this regard.

WHOs role in the global health architecture

Norway wants to safeguard WHOs position as the leading normative organisation in global health. As the UN’s specialised agency for health, WHO has a unique role as a global convenor, where its Member States meet to discuss and negotiate intergovernmental standards and agreements.This is a function first and foremost carried out at headquarter level. It must be ensured that the HQ has sufficient resources to carry out this function also in the future.

While recognizing the need for better coordination within the global health architecture, we are at this stage not convinced that the proposed World Health Forum will achieve this purpose.

Issues relating to the working methods of WHOs governing bodies raise important questions of representation, legitimacy and effectiveness. We believe that these questions ultimately have to be answered by the Member States themselves. We believe an Open Ended Working Group of the Executive Board would be the right forum to reflect on these issues. Hence; Norway supports the establishment of such a group as part of the reform process.

Strengthening the role of the Executive Board

Norway encourages a debate on how to strengthen the role of the Executive Board in order to contribute to a more effective governance of the WHO. A board which meets mainly to prepare the agenda for WHA may not achieve its full potential when it comes to contribute to the governance of the organisation. With article 28 in the constitution as the point of departure, options should be explored on how to give the Executive Board a more active role.

One WHO

The reform process should involve a thorough analysis of what are the major obstacles to better alignment and coordination between the three levels of the organisation and provide recommendations for action. In times of scarce resources, avoiding duplication of work and ensuring synergies and complementarity, is particularly important.

The proposed actions in the paper “WHO Managerial Reform” are timely and important, including determining division of labour and complementarity and streamlining how global and regional strategies are coordinated. This also includes the proposed actions aimed at reducing the layers of planning, streamlining the budget process and making the results chain more easily understandable.

The important role of the country offices, where strategies and plans are being translated into action, has to be at the center of the reform discussion. There is also a need to look into establishing mechanisms to strengthen the links between the DG and the RDs. We would like to suggest stronger mechanisms to make sure the agenda at the regional level is a consequence of or a preparation for the global agenda.

Evaluation

Norway supports an independent formative evaluation of health systems strengthening of WHO. Health system strengthening is one of WHOs core functions, and thus a relevant focus for the evaluation. If the planned evaluation is intended to contribute into the reform work, Norway would encourage the evaluation to take place as soon as possible so the evaluation report can be made available as soon as possible.

We believe the draft terms of reference provide a satisfactory basis for the review and subsequent endorsement by the Executive Board in November.

Gender

The gender perspective must be mainstreamed and reflected in all the technical and strategic work of the WHO, including the paper on managerial reforms.


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