Reform of priority setting at WHO
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, distinguished delegates, friends and colleagues in public health, ladies and gentlemen,
As I have said, and many of you have agreed, improving the way this Organization sets its priorities is the hardest part of the reform process, and likely the most critical.
What we all want to see is efforts and money translated into better health, whether the goal is health protection for the entire world, better health for as many people as possible, or better health for those in greatest need.
Such goals will vary according to the problem or need being addressed.
As health challenges grow in complexity, WHO is asked to address more and more problems and needs. Choices must be made.
We must make these choices carefully, keeping in mind that WHO must become more flexible as well as leaner and more responsive. WHO needs to change, but this must be dynamic change.
And we must have no illusions. Setting priorities for WHO in the 21st century is an enormously complicated and demanding task. I thank all of you for assisting WHO in this process.
An agreed procedure for priority setting will help simplify this task, as will a set of clear criteria and a lean list of categories as a practical framework for setting more detailed priorities.
As I said: no illusions. The challenges facing priority setting come not just from rising expectations, shrinking funds, and competing objectives.
There is another complicating factor. No matter how smart we are in developing a rational and objective approach, the real level of funding available to WHO, and the degree to which it is specified, have a major impact on priority setting and what actually gets done.
This is simply the frank reality at present. This reality underscores the importance of striking the right balance between normative and standard-setting functions that benefit all countries, and WHO’s direct technical assistance to countries.
We have a hard job ahead of us. But if we get this right, we are on the route to greater efficiency, effectiveness, and coherence in the way WHO works. If we get this right, we will be more focused, selective, and strategic in capitalizing on WHO’s unique technical assets and comparative advantage.
No one can question that WHO does indeed have unique technical assets. We do things that are absolutely needed, with a clear impact, that no other agency can do.
We are here today to sharpen this leading edge.
Ladies and gentlemen,
As guidance, this meeting has the scope of work, terms of reference, and objectives set out in the Executive Board’s decision. We have also provided you with the documents requested in that decision together with additional reference documents.
You have the main document assessing current practices for priority setting at WHO and explaining how these practices relate to country cooperation strategies and our main planning instruments.
This document is supported by three other documents. They map the functions of WHO, analyse country cooperation strategies, and explain how a reformed process of priority setting will be reflected in the twelfth general programme of work and the programme budget for 2014–2015.
We have worked hard to meet your expectations, and this work has been a useful exercise for the Secretariat. For example, to better understand what countries need from WHO, the strategic agendas of all 144 country cooperation strategies were thoroughly reviewed, for the first time as a group, by a team of country support staff.
This is already a step forward in getting the focus of our work right, and tight.
But I need to add a word of caution here. Strategies for country cooperation reflect perceived needs. Some countries would never even know they have a problem save for the constant vigilance of WHO.
Moreover, countries understandably concentrate on their most urgent needs. Part of WHO assistance is to encourage long-range planning that helps countries anticipate problems and move towards self-reliance. The inclusion of noncommunicable diseases in so many country cooperation strategies is a direct result of WHO’s work to demonstrate epidemiological trends.
The main document proposes discussion points for this meeting, including suggested categories of work and three options for further organizing and interpreting these categories.
You may want to refine these categories. Many of you have mentioned the desirability of making a distinction between core functions and technical activities linked to measurable outcomes.
The mapping of WHO functions should help you see how constitutional functions and current programme areas fit with the proposed categories.
Our expectation is that this meeting will take us some steps forward in defining criteria and categories that will make priority setting more rigorous and systematic in the near future.
If at the end of this meeting, we can agree on three things, we will have made progress. That is: a set of categories, a list of key criteria, and a timeline for developing the next global programme of work and the programme budget.
Based on your advice and guidance, we can start drafting these planning instruments so that you can judge whether we have correctly applied your agreed way forward for setting priorities.
Ladies and gentlemen,
I will not pre-empt your work by making specific proposals. But I will conclude with a few practical, real-world examples that may help shape your thinking about the role of WHO, why countries look to WHO for guidance and support, and how we deliver.
These examples illustrate the interplay between our normative and standard-setting functions, which benefit all countries, and our direct technical assistance to countries, where international solidarity plays such an important role.
Most norms and standards set by WHO contribute to the safeguarding of public health on a routine daily basis. These contributions to population-wide health protection are usually not conspicuous or high-profile components of WHO’s work. And frankly, they are often underfunded.
Norms and standards contribute to equity. Everyone in the world deserves the same assurance that the air they breathe, the water they drink, the food they eat, the medicines they take, and the chemicals they encounter will not damage their health.
In addition, some of our standard-setting functions directly benefit developing countries because they give the international community a way to provide assistance that is uniform and united by WHO’s precise, and trusted, technical guidance.
Take the example of HIV/AIDS. WHO transformed a basically clinical approach to treatment into a public health approach that made the delivery of antiretroviral therapy feasible, even in the poorest settings.
WHO, and the international experts it relies on, constantly simplified, streamlined, and refined protocols in line with the latest evidence, translating scientific advances into opportunities for public health to advance.
In so doing, WHO paved the way for others to take up the torch, launch campaigns, and provide the funding that now sees nearly seven million people receiving these life-prolonging medicines.
As the international AIDS community will readily tell you, the pioneering technical work of WHO provided the practical foundation, and the inspiration, for this progress.
Direct WHO negotiations with the pharmaceutical industry helped stretch development dollars, as did the WHO prequalification programme, which got prices down through healthy competition. This is the value-added contribution of WHO.
Our direct technical assistance to countries is far more visible. Like the new vaccine for epidemic meningitis developed, in an initiative coordinated by WHO and PATH, for use in Africa’s meningitis belt. The demand was led by African ministers of health, who defined the ideal vaccine, right down to the price. The international community delivered.
Countries also look to WHO when they face an outbreak, need help in investigating an incident of food poisoning or a substandard medicine or device, or want to transform their health system to reach universal coverage.
The list is long, as I have learned from discussions with Ministers of Health over the past five years.
Ladies and gentlemen,
I will conclude with a personal request.
I am asking you to develop a process for priority setting that makes it easier to monitor the performance of WHO. I want WHO to be held accountable for having a measurable impact on people’s health.
I want WHO to be held accountable for the way it uses the financial resources entrusted to us. I want WHO to be held accountable for concentrating on the work it is uniquely well-suited to perform.