WHO Director-General addresses NGO community

Dr Margaret Chan
Director-General of the World Health Organization

Opening remarks at a consultation on WHO engagement with nongovernmental organizations
Geneva, Switzerland

18 October 2012

Representatives of nongovernmental organizations, ladies and gentlemen,

I warmly welcome you to this informal consultation.

The May 2012 Health Assembly gave WHO a number of assignments to support the ongoing process of reform. As part of efforts to strengthen governance, we were asked to prepare a draft paper on WHO’s engagement with NGOs, for discussion during the January Executive Board.

We are holding this consultation to gather your guidance and advice. We will be focusing, in particular, on a framework for ongoing consultation, collaboration, and accreditation.

The deliberations of this consultation will be summarized and made available to Member States. They will inform the preparation of the draft paper for January. In line with comments made during the EB, the paper will be further refined for submission to the May 2013 Health Assembly.

What you say today is very important. I want to hear your views, your wishes, your concerns, and your complaints.

Some of this thinking has already been communicated to me in writing by several of you. I appreciate this, as it gives me insight into some specific concerns, as well as suggested ways of improving WHO engagement with civil society organizations.

This is not an easy or an entirely straightforward assignment. As you will be aware, several other efforts, including the Civil Society Initiative, have addressed the need to improve WHO engagement with the NGO community.

Some issues are still a little fuzzy. Some issues still make Member States a little nervous.

I think we can all agree with the view of WHO’s governing bodies, who have expressed a need to review and update the principles governing WHO’s relations with NGOs.

Let me emphasize one point. No one questions the contribution your organizations make to the work of WHO. Worldwide, your numbers have increased dramatically in recent years, as have your influence on health policies, and your impact on health conditions.

Your influence is most visible during the negotiation of instruments for global health governance, such as those for tobacco control or access to medicines. Your impact is most visible at the country level, where many of you work as implementing agencies.

As I have said on several occasions, improvements in health outcomes within countries are the most important measure of the effectiveness of all WHO activities.

NGOs occupy a unique political space. You gather and express the social power of ordinary people, as opposed to the coercive and regulatory powers of governments and the economic power of the market.

NGOs operationalize WHO technical recommendations, taking them in particular to poor and marginalized populations. In conflict situations, or in very poor or poorly governed countries, NGOs can be the main providers of health services. The same is true during humanitarian emergencies.

You bring coalitions of researchers, professional societies, medical schools, and medical students to bear on specific health problems. You crusade for human rights.

Because of your unique political space, you can speak out bluntly when international agencies, like WHO, must be diplomatically discrete. We are not permitted to rant and rave. Some of you do this extremely well.

Your importance has grown as the world has changed. At a time of radically increased interdependence, international systems, such as those governing trade, financial markets, and business relations, often have more power than a sovereign government to influence the lives and opportunities of citizens, including the chances they have to enjoy a healthy life expectancy.

This is the space created by transnational trends and threats. You occupy this space nicely, as a counterbalance to commercial interests and political views.

You conduct campaigns for fair trade, access to essential medicines, including lower prices, R&D for neglected diseases, people before profits, exclusive breastfeeding, tobacco control, and an end to drink-driving.

Ladies and gentlemen,

I fully understand your concern about insufficient safeguards against conflicts of interest, a concern strongly voiced by our Member States.

At the same time, the NGO community is not a uniform group of altruistic organizations.

I understand there are many subcategories, like BINGOS (business-interest NGOs), PINGOS (public-interest NGOs), GONGOS (government-operated NGOs), even CONGOS (community-organized NGOs) and TANGOS (technical-assistance NGOs).

Organizational and operational frameworks differ. The size of operations vary, as do degrees of effectiveness and sustainability of results. In the best cases, your programmes closely align with WHO technical guidelines, but this is not always true.

Questions of legitimacy have been raised by WHO Member States. You operate, often in large numbers, within individual countries, but you are not usually subject to government regulation.

I hear complaints. Where is government oversight? To whom are NGOs accountable? To the people and government in the country where they serve or to the people who provide the funds?

Nothing is clearly black and white.

Can sources of funding alone define the legitimacy of an NGO? I think not. Many highly respected and highly effective NGOs receive the lion’s share of their funding from government sources. But few would accuse these NGOs of being nothing but arms of foreign policy.

As another example, NGOs representing air transport or the airline industry are clearly linked to commercial interests. But WHO collaboration with the airline industry during the investigation and control of outbreaks is absolutely essential and, I believe, readily justified.

Ladies and gentlemen,

There are two final points I ask you to keep in mind. They are especially important, as they reflect the strong views of the Member States of this Organization.

The first is straightforward. While collaboration with multiple stakeholders, including NGOs, is essential, decision making remains the prerogative of governments. The intergovernmental nature of WHO’s decision-making remains paramount.

Second, WHO has been overextended and overstretched, which is one justification for reform. An overarching purpose of reform is to streamline WHO, to make it leaner, more flexible, and more responsive to rapidly changing health needs.

Time and time again, our Member States have rejected proposals for reform that involve establishing new mechanisms or adding additional layers of complexity.

In other words, my ability to respond to some of your requests may be limited by the explicit wishes of Member States. After all, they are the shareholders and owners of this Organization.

Thank you.