Fensa, Not a “Fence” to protect public health

WHO has been undergoing a reform process for the past few years in three main areas: programmatic, managerial, and governance. FENSA, the Framework of Engagement with Non-State Actors, part of WHO’s governance reform, was adopted through WHA Resolution 69.10 http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R10-en.pdf on 28 May, 2016.  The outcome is worrisome for those including IBFAN-ICDC, who were still holding out hope for WHO to maintain its independence.

FENSA, which now officially replaces WHO’s previous rules on its formal Official Relations status to NGOs has long been a controversial debate of grave concern to IBFAN and 60 other civil society organisations committed to protect the public interest. Throughout the negotiation process, NGOs have voiced their perplexed concerns on the “faulty” and “flawed” conceptualisation of ‘conflicts of interest’ – and their concerns are well-supported by the summary outcomes of the WHO Technical Report “Addressing and Managing Conflicts of Interest – In the Planning and Delivery of Nutrition Programmes at Country Level”. The former Official Relations status excluded NGOs “of a commercial or profit-making nature”, but now FENSA puts private sector entities on an equal footing with other non-state actors (i.e. NGOs and other civil society organisations) in the name of “principle of inclusiveness”. It legitimizes lobbying by the private sector at WHO governing bodies, and leaves WHO open to undue influence by the corporate and venture philanthropic sector; as FENSA allows business interest groups to obtain “Official Relations” under the label of Non-State Actors.

The failure of the resolution to call for development of comprehensive ‘conflicts of interest’ safeguards enables the inclusion of transnational corporations, business associations and philanthropic foundations into public health decision-making. This compromises WHO’s “integrity, independence, credibility and reputation” in setting and applying policies, norms and standards”; as well as its mandate to promote peoples’ human right to health.

And not just at the international level – fences are torn down at national level as well.

WHO has an institutional mandate to set norms, standards and regulations for its Member States, but – FENSA, as adopted, makes ongoing work on preventing and addressing conflicts of interest at country level even more challenging. Take Botswana for example, a country that has comprehensively implemented the International Code and relevant WHA resolutions. Its MoH recently announced that appropriate action will be taken against Professor Gabriel Anabwani for serving as the Executive Director of Baylor Children’s Clinic, while at the same time being the Chairman of the Board of Nestle Nutrition Institute (NNI). A clear conflict of interest. The Professor also was a member of several MoH committees on public health and infant and young child feeding. Even though he denied that the NNI was a part of the baby food manufacturer Nestle, Professor Anabwani’s conflicting engagements in public health and NNI – a subsidiary funded by Nestle – is considered a serious violation of the Botswana Marketing of Foods for Infants and Young Children Regulations, adopted in 2005. The Regulations, clearly influenced by resolutions WHA 49.15 (1996) and WHA 58.32 (2005), which stipulate that financial support and other incentives for healthcare professionals and programmes in infant and young child health should not create conflicts of interest. These resolutions are important legal instruments for the government of Botswana to take action in cases such as above. [Link to news: http://www.thegazette.news/?p=13695]

Now with the adoption of FENSA, ironically a tool that is supposed to protect WHO from undue influences, comes the undoing of much work at national and international levels to safeguard public health from conflicts of interest.

Despite exhaustive lobbying efforts by civil society organizations, including IBFAN, in the past years, WHO Director-General gave praise to Member States in her opening address of the 69th World Health Assembly, stating that the adoption of FENSA, would “mainstream a major area of reform”. In the new era of FENSA, does “mainstream” still bear any resemblance of the interests of the public? Or does it mark a new chapter in the legitimisation framing of public health problems and solutions that favour the interests and agendas of industry and the forces linked to them?

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