Global Governance callisthenics – the David Goggins guide to the WHO’s Agile Member States Task Group

Look him up. Below are some thoughts on recent work by WHO’s Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance (something to work on). Yes, yes, I know, not the most scintillating topic for a blog post. What can I say? If the inner workings of WHO excite you, seek therapy.

Paragraph 38(e) of the Working Group on Sustainable Financing (WGSF) recommendations, which were approved by Member States at the 75th WHA, May 2022 (WHA75(8)), “Stressed that any increase in Member States’ assessed contributions needs to be accompanied by appropriate governance reforms, to be agreed by Member States, together with the further strengthening of transparency, efficiency, accountability and compliance within the Organization” (p66 of A75_REC1). The WGSF recommended the establishment of an “agile Member States task group” to provide recommendations that would assist in the implementation of these reforms by WHO’s Secretariat (para 39(e)(i) and para 40). The Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance (henceforth referred to as the Task Group) was duly established at the May 2022 Executive Board (see decision EB151(1)). The Task Group’s 1st report (which proposed 11 recommendations and 27 sub-actions to enhance the performance of the Secretariat and strengthen its budgetary, programmatic, finance and governance processes, and its accountability) was presented, discussed and endorsed at the January 2023 Executive Board (EB152/33; EB152/34; EB152(16)), the PBAC and also the WHA in May 2023 (A76/31).

But, Andrew, why are you writing about this now? Oh come now. Don’t tell me you didn’t know that the 154th meeting of WHO’s Executive Board was just around the corner – January 22-29th? Oh, you didn’t. Well, it is, and there are some very interesting documents provided for the January 2024 EB that pertain to the work of the Task Group. These include a progress report on the Secretariat’s implementation plan (EB154/32), a progress report on the Secretariat’s actions in support of specific Task Group recommendations (EB154/33) and outlined in decision EB152(15), and three additional documents (EB154/33 Add.1, EB154/33 Add.2 and EB154/33 Add.3). The Secretariat has also prepared a further related document, EB154/34 Add.1, containing an update on decision WHA69(8) paragraph (10) (2016) (Improving transparency of the process for the selection of Assistant Directors-General), linked to part of recommendation T5 of the Task Group. This post teases out some of the key points from these various documents.

EB154/32, 13th Dec 2023:  Secretariat implementation plan on reform. Report by the Director-General

The Secretariat is responsible for producing and then providing updates on the progress of its implementation plan of reforms recommended by the WGSF. The plan (see EB152/34) contains 98 actions across the seven thematic categories (accountability function and systems; country-level impact; financing; governance; human resources; programme budget; resource mobilisation). 38 actions had been implemented by the end of 2022 and the remaining 60 actions were progressing in 2023. For the January 2024 EB, document EB154/32 provides an update on developments of the implementation plan, including progress towards completing those remaining actions. It reports that “between January and November 2023, the number of implemented actions progressively increased from 38 in January 2023 to 42 in March 2023. Since March of this year, the Secretariat has implemented an additional 25 actions” (para 10). 

Paragraphs 5-7 give an insight into the demands placed on the Secretariat and an acknowledgement of risks associated with such demands. For example, the Secretariat has to ensure that a total of 269 separate actions from its own implementation plan, the Task Group, the transformation initiative and the ARG action plan ‘fit together’. Risks associated with these demands are driven by “no specific allocation of funds to carry out the implementation plan, and an unprecedented increase in governing body negotiations, intergovernmental body meetings, and Member States consultations and information briefings” (p2).

The document lists 8 highlights (program budget, transparency, PRSEAH, financing, accountability, resource mobilisation, country level impact and governance). Wrt transparency, the Secretariat has established a Member States Portal which includes a dedicated dashboard for monitoring the implementation plan and the transparent communication of progress, and also various digital platforms to monitor the program budget and access relevant budget-related documents. This is a significant effort on the part of the Secretariat and a really useful resource. Wrt country level impact, the report notes the importance for impact of the “selection and placement of heads of country offices and revised delegations of authority to country offices”. In the light of that country-level commitment, I hope WHO is reflecting on the controversy surrounding the recent election of the SEARO RO Director – what’s important at the country level is as (if not more) important at regional level.

EB154/33, 4th December 2023: Strengthening WHO’s budgetary, programmatic and financing governance: follow-up to the implementation of decision EB152(15) (2023). Report by the Director-General. 

In January 2023, the EB reviewed the Task Group’s 1st report and, based on the report, made some specific requests of the Secretariat (EB152(15)). EB154/33 is an update on progress towards meeting those requests. The Secretariat has now provided an organigram of the Organization and contact details of all its senior staff. Frustratingly, for me at least, it’s unclear to whom program budget enquiries should be directed. Possibly of interest is an analysis of the value chain in the production of reports for governing body meetings.

Definitely of interest (no, really) is “an analysis of voluntary contribution earmarking flexibility and limitations”. Apparently, a review and some analysis was conducted last summer (no details provided) which found that “entities with substantially higher amounts of flexible and unearmarked voluntary contributions tend to use a “replenishment’ model” for resource mobilization, for which unearmarked funding is a key parameter (eg. The Global Fund to Fight AIDS, Tuberculosis and Malaria; and Gavi, the Vaccine Alliance)”. I’m not sure this gets us very far: both of these ‘entities’ have quite specific mandates (unlike WHO) and they have ‘business models’ (unlike WHO). They were also both funded – and continue to be funded – by the Gates Foundation, which would have influenced significantly their business models to include many (if not all) of the “incentives” described in para 32. It’s hard to get a clear picture without seeing the Task Group’s original analysis. The document notes: “The Secretariat has observed the best practices of other entities, adapting lessons learnt to WHO’s context in planning for the Investment Round” (p10). Given the importance to WHO of the Investment Round, I think it’s important that more details are provided here – which entities, what practices? Other than the GF and GAVI, which entities (preferably with more similarities to WHO than these GHPs) have lessons that WHO can learn from?

EB145/33Add1, 4th December 2023: Proposals for improving the effectiveness of the WHO governing bodies. Report by the Director General.

The Secretariat’s implementation plan for reform (EB152/34) included a request for the Secretariat to provide proposals for reform of WHO’s governing bodies. EB154/33Add1 gives us those proposals. Before getting to those, para 2(e) is interesting:

The Health Assembly adopts approximately 18 resolutions and 25 decisions each year, many of which mandate reports on progress. These “progress reports” amount to approximately 600 words apiece and are considered only by the Health Assembly,1 often reflecting solely on implementation efforts by the Secretariat, and are discussed towards the end of the meeting in a rushed manner. Approaching progress reports in a different way would allow the Organization to take stock of implementation more fully by including the efforts not only of the Secretariat but also of Member States and other stakeholders.

I’m not sure what to make of that last reference to “other stakeholders”. Who is the Secretariat thinking about here? Civil society, I imagine (not). That aside, the point of concern for the Secretariat is that “the body of governing body documentation has become unmanageable”. Happily, it has some proposals for mitigating said unmanageability.

Recommendation A: Establishment of a new committee of the Executive Board on technical matters.

Seems innocuous enough, right? We already have a committee that looks at program, budget and admin issues (PBAC), so why not have another one for technical issues? Well, I’m not clear how that is going to address the chore of managing the mountain of governing body documentation – a new Committee is going to produce more documentation, isn’t it? But there’s a more serious issue here. As others much more knowledgeable than I have pointed out, this could exclude civil society participation in discussion around key technical issues.  Currently, the EB allows civil society organizations in official relations with WHO to provide statements. Will this opportunity continue through the new committee? PBAC does not permit this level of interaction, so there’s real concern at the moment that Recommendation A will limit CSO participation to a discussion of the new committees report with no opportunity to ‘re-discuss’ each agenda item separately (para 17). The Secretariat is all set to start drafting the TOR for this new Committee. The Secretariat is being urged by civil society groups to clarify the situation. It doesn’t have to, but it should. The irony is that Recommendation G is titled: Effective participation in governing body processes and meetings. ‘Effective participation’, however, is all about IT and – it would seem – not by encouraging and facilitating a diverse range of views.

EB145/33Add2, 4th December 2023: Project plan: implementation of digital solutions for interactions between the Secretariat and Member States on matters related to the governing bodies. Report by the Director-General 

Credit where credit’s due, the Secretariat has been investing in a really useful digital ‘portal’ for Member States. If you haven’t accessed this portal yet, give it a go. More work is underway, as described in Add2, including a searchable online database of WHO resolutions and decisions. Watch this space!

Andrew