The World Health Organization (WHO) held the 154th session of its Executive Board (EB154) in Geneva on 22-27 January 2024. The Executive Board of the WHO meets at the end of January every year, where it sets the agenda for the World Health Assembly (WHA) which takes place in May.
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Over the last four years, both the Executive Board and Health Assembly meetings have structured their deliberations along the lines of the three pillars of WHO’s 13th General Plan of Work, which runs till 2025. These are, Pillar 1: One billion more people benefiting from universal health coverage; Pillar 2: One billion more people better protected from health emergencies, and; Pillar 3: One billion more people enjoying better health and well-being.
Public Services International is the only global body of organised labour in official relations with the WHO. We bring the voice of health and care workers to the decision-making forums of WHO, including its constitutional meetings, as a Non-State Actor. And we emphasise the pivotal importance of universal access to quality public services for the attainment of health for all, and building a fairer, more democratic and inclusive world. In line with this tradition, which we have maintained over the last six years, PSI intervened on several issues of concern at the EB154.
In his opening remarks, Dr Tedros Ghebreyesus, Director-General of the WHO, pointed out that events in 2023 once again underscored why “the world needs a strong, sustainable, effective and empowered WHO”. PSI shares this conviction. WHO Member States need to strengthen WHO’s capacity to fulfil its constitutional roles by adequately funding it, and upholding resolutions they collectively reach as WHO. They also need to deepen their efforts at achieving health for all, which is the overarching aim of the establishment of the WHO. It was with this perspective that we intervened in agenda items in each of the three pillars of the EB154 meeting.
PSI delivered statements on two agenda items under Pillar 1, covering “universal health coverage” and the “draft global action plan for infection, prevention and control”
According to the Director-General in his report on Universal Health Coverage, over half of the world’s population doesn’t have access to necessary healthcare services. A quarter of people worldwide also face financial catastrophe due to healthcare expenses.
The WHO Secretariat committed to continue supporting Member States in “reorienting health systems towards a primary health care approach as the most equitable, effective, inclusive and efficient path to UHC”.
It also confirmed that collaboration with Member States and partners will continue to address health system issues that are hindering progress towards UHC. This involves focusing on strategic investments in the healthcare workforce, especially in countries with shortages and specific challenges such as small island developing States. Once again, the report identified inadequate health financing as a major obstacle to building health systems that can deliver universal access to health and care. However, one of the mechanisms designed to address this problem is the Health Impact Investment Platform, which WHO launched mid-last year in collaboration with OECD and the World Bank.
In our intervention, we pointed out that the extent to which the world is far off the track in achieving UHC is alarming. Governments and international organisations have made numerous declarations and commitments, yet there remains a clear inconsistency between their words and actions, evident in the severely insufficient public funding of healthcare. Also, private-sector engagement in the health sector, promoted in different guises such as Public-Private Partnerships (PPPs), has been inimical to achieving universal access because of the inherent for-profit interests of private providers.
In addition, we pointed out that constricted fiscal space for low- and middle-income countries (LMICs) limits their budgetary prioritisation of health. Loan conditionalities from international financial institutions set limits on public sector spending, including their capacity to employ more health and care workers. Increasingly, in high-income countries as well, governments are putting ceilings on salaries of health and care workers. But our affiliates across the world are leading their members to fight for fair wages.
PSI took a critical stance against the Health Impact Investment Platform. Its concessional loans will only increase the debt burden of LMICs. Instead of mechanisms such as this platform, we urged Member States to rather call for the cancellation of LMICs debts, and link this to their expanding investment in primary health care.
As the global union for health and care workers, we also expressed our deep concern about the shortage of, and deficit of decent work for health and care workers. Repeating the need to prioritise strategic investments in the health and care workforce is not enough. We called on Member States to walk their talk with the implementation of the recommendations of the 2016 United Nations High-Level Commission on Health Employment and Economic Growth (UN-COMHEEG).
PSI represented organised labour on the High-Level Commission and contributed to the formulation of its ten-point recommendations. These informed the joint WHO-ILO-OECD Working for Health programme. We will continue to push for governments of Member States of WHO to go beyond verbal commitment and implement these recommendations and outcomes that have flowed from it, such as the Global health and care worker compact.
Our stance on the draft global action plan for infection prevention and control (IPC) at EB154 was informed by our responsibility as the global organised labour body in the health and care sector, as well as the need for active public involvement of people in all aspects of promoting and ensuring health.
We thus welcomed the draft action plan that will help put into practice the global strategy on infection prevention and control agreed upon at the 75th World Health Assembly in 2022. But we drew the attention of Member States to some gaps that we called on them to address.
Top on this list for is failing to integrate application of the precautionary principle into IPC guidelines and practices, particularly in the face of health emergencies where there is insufficient evidence on the nature and modes of transmission of infection. During the COVID-19 pandemic, PSI and its affiliates persistently requested this application for health and care workers, but our demands were ignored.
Perhaps fewer health and care workers would have died whilst helping to save lives during the pandemic if this had been done. We have also demanded an explicit inclusion of the application of the principle in the pandemic accord under negotiations. However, so far, the Intergovernmental Negotiation Bureau of WHO Member States has not included this in any iteration of the draft text.
We also asked Member States to ensure that procurement and stockpiling of consumables, including medical supplies and personal protective equipment (PPE), effectively ensure IPC for health and care workers, by not limiting these to the profit-seeking logic of market forces.
Support for LMICs to strengthen their institutional capacity for disease surveillance, national public health standards and quality assurance cannot be overemphasised, as we pointed out. Finally, on this agenda item, PSI called for the inclusion of IPC in the community within the action plan. This would involve emphasising the need for Member States to finance clean water and sanitation provided by local and regional governments.
WHO’s work in health emergencies was at the heart of discussions under Pillar 2. This covered reports presented by the Director-General on “Public health emergencies: preparedness and response” and “strengthening the global architecture for health emergency preparedness, prevention and response and resilience”
PSI commended WHO’s assiduous work in health emergencies and the efforts of the WHO Secretariat and staff across the world at strengthening health emergency prevention, preparedness and response (PPR). Nevertheless, there were several important issues that Member States needed to address.
First, the gross under-funding of the WHO Health Emergencies Programme, by up to 40%, is indefensible. Member States should honor their responsibility to fund this important programme for the benefit of humankind, considering the traumatic global experience of the COVID-19 pandemic and the ongoing planetary crisis and conflicts we are confronting.
PSI pointed out that equity and even enlightened self-interest demands that high-income countries (HICs) live up to the responsibility of ensuring that the programme is adequately funded, without prejudice to contributions by LMICs. Pathogens and diseases, as we have seen, do not respect boundaries. Global solidarity requires better resourced countries to do what is needed in terms of funding.
We also called on Member States to empower the Health Emergencies Programme with adequate authority and resources in line with conclusions reached last year by the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme (IOAC).
We also emphasised the importance of financial justice and equal access to medical counter-measures and technologies for effectively addressing health emergencies. This would include suspension, at the very least, of intellectual property rights (IPR) to these measures.
The increasing attacks on health facilities and the killing of health workers in conflict zones have bothered PSI. We urged governments to commit to not attacking healthcare facilities or preventing access to healthcare. We further highlighted the need to protect health workers, and urged for zero tolerance towards the killing of health workers in conflict zones.
The Director-General’s report on Climate change and health underscored the worrisome fact which we all know; “the world is warming at a faster rated than at any time in human history, mainly as a result of the burning of fossil fuels”. Resting on the Sixth Assessment Report of the Intergovernmental Panel on Climate Change, the report noted that “climate change is already having observable adverse impacts on human health and well-being”. But regrettably, governments are not taking requisite measures to abate this slide further, towards climate chaos.
During our intervention, we highlighted the insufficient response from governments and world leaders to this crisis that poses an existential threat to humankind. Drastic actions need to be taken. The health response to climate change must denounce fossil fuels unequivocally for their impact on people’s health and planetary well-being. We thus urged WHO Member States to declare fossil fuels as dangerous commercial determinants of health, with a grave impact on planetary health inequity. This would require that governments take a stand against the fossil fuel industry and its influence, as was done with the tobacco industry.
We equally pointed out the need for steps to be taken in the health and care sector itself as part of steps to curb the worsening climate crisis. 5% of all Green House Gas (GHG) emissions stem from the health sector. Notably, three quarters of these occur in the wealthier countries of the Global North.
Building more environment friendly health facilities and processes should not be a case of greenwashing. Governments of countries in the Global North have to take the lead with health workers’ unions and local communities. They must also support similar processes in the Global South.
We also urged Member States to enhance primary health care for the integration of climate resilience in health systems.
The last agenda item which PSI intervened on at EB154 was on the report of the Council on the Economics of Health for All (2021-2023). We supported the recommendations of the Council led by the influential economist Mariana Mazzucato. But we disagreed with the view expressed in the Director-General’s report that it brings a “new narrative on health and the economy.”
The argument for economics that puts people before profit and health over wealth has always been there, even in the annals of the WHO itself. It is simply that governments have chosen not to pay attention, and rather implement neoliberal orthodoxy despite its perennial failure on several fronts as PSI and several other entities in the civil society movement have argued over the last four decades.
In our statement, we drew attention to the need for far-reaching steps to be taken now, on the foundations that the Council has once again set. This is in the spirit of the 1978 Alma Ata Declaration’s affirmation of the need for a New International Economic Order (NIEO) for “health for all” to be achievable.
The COVID-19 pandemic revealed the strong connections between health and the economy, prompting governments and international organisations to act quickly when they deemed it necessary. The world is facing a plethora of health emergencies that demand a major shift in international political economy. To achieve this, we need to reorganise the global financial system, cancel debts, and prioritise healthcare for everyone. PSI thus urged WHO Member States to remove the structural and political impediments to achieving health for all.
In the wake of the EB154, PSI will be following up on these and other issues that will be going forward for further discussion and resolution at the 77th World Health Assembly, which will take place in Geneva on 27 May to 1 June 2024.