Rabin Martin

Photo credit: World Health Organization/Pierre Albouy 

In her opening remarks during the 67th World Health Assembly (WHA) on Monday, May 19th, WHO Director-General Margaret Chan noted that “within the framework of our leadership priorities, WHO is shaping the health agenda as needs evolve, and using multiple mechanisms and partnerships to meet these needs.”

Dr. Chan’s emphasis on partnership clearly illustrates the increasing need for multisectoral and cross-industry engagement to overcome new global health challenges—such as the rise of noncommunicable diseases (NCDs)—emerging viruses such as H5N1 and H7N9 avian influenza and the Middle East Respiratory Syndrome (MERS) coronavirus—and new public health emergencies, such as the worrying spread of polio to Syria and Central Africa.  Yet the mechanism for non-state actors (NSAs) to engage with WHO and other multilaterals remains suboptimal and keeps important NSA resources far from people who need them.

The roles of NSAs—including non-governmental organizations, private sector entities, philanthropic foundations and academic institutions—in addressing these challenges complement those of the WHO and other public agencies. Resources from NSAs include knowledge, people, medicines and money. They represent assets that the WHO needs to achieve its goals. The question is how to manage collaboration and coordination with NSAs effectively in the context of WHO governance. Appropriately, organizing relationships between NSAs and the WHO was an issue high on the agenda of the WHA this year. It was discussed both in the context of WHO reform – Member States had asked the WHO Secretariat to develop both a framework for interaction with NSAs, as well as discrete policies on engagement with different groups of NSAs – and in the context of NCDs, as WHO develops a Global Coordination Mechanism (GCM) for the prevention and control of NCDs.

The topic of how to best engage NSAs emerged at a seminar organized by the World Health Editors Network (WHEN) on the margins of the WHA on May 18^th, where panelists including Dr. Jeffrey Sturchio—Rabin Martin, Mario Ottiglio—IFPMA and Peter Ungphakorn—World Trade Organization concur that the WHO reform process was likely to be a protracted exercise, given Member States’ various and conflicting interests. The current consensus reached at an April 2014 Member States consultation on the GCM for NCDs led to the decision that it should be organized using existing WHO governance structures, thus relegating NSAs to a marginal and as yet undefined role. This approach would also place the GCM in competition with all other WHO priorities and bureaucratic mechanisms, a missed opportunity for using the energy and commitment of a global group of NSAs in helping the WHO and Member States make rapid progress in addressing NCDs, which everyone agrees present a huge challenge for public health. The Assembly did agree on the terms of reference for the GCM, which include a potential role for NSAs in the Working Groups, but the practicalities of it still need to be defined.

I agree with Dr. Chan’s comment in her WHA address that policies matter, especially those that make equity an explicit objective. I feel equally strongly that private sector resources and expertise matter in supporting the health work of the public sector. And I am not alone in this conviction. The role of the private sector in health was mentioned in many side events held during the WHA in Geneva. And, when I say the role of the private sector, I mean not only the pharmaceutical industry, but also other industries, such as education, nutrition, energy, communications, banking, logistics and information technology. As the global challenges we face in health and development increase, the observation of the German philosopher, Arthur Schopenhauer, that “health is not everything, but without health, everything is nothing,” seems more salient than ever. The private sector can contribute to tackling issues related to the costs of health care through its capacity to innovate and look for out of the ordinary solutions. Working with partners in both the public and private sectors can bring flexibility and scale to public health challenges, along with a proactive, evidence-based and results-oriented approach that has proven helpful repeatedly in solving global health challenges. At the same time, private sector involvement alone is not enough: for any health intervention to be successful, there needs to be shared purpose and shared accountability between governments and their partners, including the private sector, to ensure sustainability and public health impact.

The World Health Assembly did ask the WHO Secretariat to report back to the next Executive Board meeting in January on the NSA question after consultation with the Regional meetings, so please stay tuned for new developments. My hope is that the current debate on the nature and structure of WHO’s engagement with NSAs finds common ground and moves quickly in the direction of increased collaboration, for the benefit of patients around the world.