“ Amid this uncertainty, the legitimacy and leadership capacity of the WHO – and its future role as a central actor in the global health ecosystem – are at stake” EDITORS’ INTRODUCTIONS 2.1
THREE AREAS FOR STRATEGIC REFORM OF THE WHO Amid this uncertainty, the legitimacy and leadership capacity of the WHO – and its future role as a central actor in the global health ecosystem – are at stake. There are deep concerns about its capacity to lead effectively when multilateralism is out of favour and new challenges loom. With two colleagues, I have recently suggested three areas of reforms. They will require significant political will by member states, a commodity in short supply. 1. Refocus the WHO on its core mandate. The WHO cannot be everything to everyone. Its future lies in concentrating on its constitutional mission. Its core functions are norm and standard setting based on sound science amidst escalating misinformation and disinformation, health intelligence and surveillance, pandemic preparedness and emergency coordination, and convening power. It must remain the forum for global health diplomacy and international dialogue on global health priorities. It must set bold new future-oriented health agendas, many – such as planetary health – based on a new systemic approach. The new way of working in health must be made manifest by a key organisational paradigm shift, as happened in 1978 when the Alma-Ata Declaration on primary health care was adopted. 2. Ensure the WHO’s financial independence. A shift to a funding model anchored in fully unearmarked assessed contributions is overdue. By 2030, 80% of the WHO’s budget should come from assessed contributions, reflecting each country’s economic capacity. That proposed target will become realistic and acceptable through focusing on the four core functions proposed above. Such a reform must be co-led by countries of the Global South, not only by traditional donor states. It is a political opportunity to reshape the WHO’s governance and agenda more equitably and representatively. It is especially the middle powers that should make use of this opportunity. China will emerge as the largest contributor if the US leaves, but next to the classic donor countries on the list of the first 20 contributors of assessed contributions, Brazil, India, Mexico, Korea, Saudi Arabia and Russia will be critical to move such reforms forward. 3. Strengthen WHO governance and accountability. WHO governance must align with the expectations of member states and the international community. The World Health Assembly must regain its authority as the primary global forum on health, as the world needs a platform for health policies across geopolitical divisions. But the Executive Board must also be revitalised and reformed. The WHA must initiate discussions on post-2030 global health priorities in the next two years, especially in the face of the death of the SDGs. BUILDING A NEW SYSTEM BASED ON THE 3X3X3 DYNAMICS We need to study the interface of the three crises with the three systemic challenges to be able to propose systemic and sustainable solutions that can be taken forward by a reformed and strengthened WHO. One thing is clear – it will need long-term as well as substantial commitments – it will need the interface with geopolitical powershifts and the emergence of new leaders in global health and development. ▪
ILONA KICKBUSCH llona Kickbusch is the founding director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva. She is a member of the Global Preparedness Monitoring Board and the WHO Council on the Economics of Health for All. She is co-chair of the World Health Summit Council. She previously had a distinguished career with the World Health Organization and Yale University, and has published widely on global health governance and global health diplomacy. She directs the Digital Transformations for Health Lab. She and John Kirton are co-editors of, most recently, Health: A Political Choice – Building Resilience and Trust .
X-TWITTER @IlonaKickbusch ilonakickbusch.com
Health: A Political Choice – The Future of Health in a Fractured World 21
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