71st World Health Assembly: Hits, misses and a few things in between

While Universal Health Coverage and Early Childhood were in focus, it was a missed opportunity, too, in more ways than one.

ByBiraj Swain
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71st World Health Assembly: Hits, misses and a few things in between
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Full disclosure: The author’s trip to Geneva to attend the 71st World Health Assembly (WHA) was sponsored by International Centre for Journalists, Washington DC.

The World Health Assembly is the single most important event in the global health calendar where the health leadership of all 194 sovereign countries of the world are in attendance. It was held from May 21 to 26, 2018 at Geneva, Switzerland. It is hosted by the World Health Organisation, WHO. This was the 71st WHA, but WHO turned 70 this year. WHO was founded on April 7, 1948. Here’s a wrap from the 71st WHA, on hits, misses, and India’s pitch and participation.

The good news

This was the first WHA of WHO Director-General Dr Tedros Adhanom Ghebreyesus, an Ethiopian-African global health expert. He is the first African to be elected to the position of Director General. The symbolism of this is massive. Consider it akin to the 2010 FIFA World Cup in South Africa, the first FIFA Cup in that continent. Dr. Tedros came through a hard-fought election, defeating Dr. Sania Nishtar of Pakistan and Dr. David Nabarro of the United Kingdom, two other career UN diplomats. Dr Tedros is passionate about universal health coverage, better representation of women in health leadership positions and putting an end to an unpaid internship at WHO.

Dr. Michelle Bachelet, the former Chilean president took over as the Board Chair of the Partnership for Maternal New-born and Child Health, PMNCH, one of the largest partnerships co-hosted by WHO. Again, another iconic leader, a trained doctor and feminist, who had been imprisoned and exiled by the military dictator Augosto Pinochet. She came back to win two democratic elections and was two-term president of Chile. She was also the first Executive Director of UN Women. PMNCH could not have asked for a better chair. She is committed to the cause of children and started one of the first universal creche programmes in the world, the Chile Crece Contigo. The author has done a full interview with her, here.

Release of the Essential Diagnostics List: Forty-one years after release of the Essential Drugs List, 2018 saw the release of the Essential Diagnostics List at the 71st WHA.

It was ambitious since many tests crucial of non-communicable diseases were also included, like the Blood Glucose Measurement. What does it mean? That technologies and ecosystem will be created to reach these tests across the world to the last (wo)man and these tests will be made more affordable with price caps or state funding. This is landmark and the enormity of this is captured well in this article in The Conversation.

Launch of the Early Childhood Care and Nurturing Framework: The WHO, UNICEF, and the World Bank Group, in collaboration with the PMNCH and the Early Childhood Development Action Network, launched the Nurturing Care Framework for Early Childhood Development on 23 May 2018.

The Framework builds on latest evidence about how early childhood development unfolds and how it can be supported and improved. It focuses on the critical period from pregnancy to age three when children are most sensitive to environmental influences. And because of this it draws special attention to the role that the health sector can play, in collaboration with other sectors.

It makes the economic argument, too, for investing in early child development. Through economic modeling and evidence reviews, it demonstrates that investing in ECD can boost economic growth, promote peaceful and sustainable societies, and eliminate extreme poverty and inequality.

In the first years of life, parents and caregivers are the best providers of Nurturing Care to children, which comprises five key components: good health, adequate nutrition, security and safety, responsive care-giving and opportunities for learning. The Framework outlines how policies and services can support parents, families, other caregivers and communities in providing nurturing care for young children. It gives country-by-country fact-sheets and priority actions too.

In the case of India, there is a crisis of creche care that we have discussed in the opening episode of #ChildhoodMatters series. Watch it here. Considering the abysmally low learning outcomes, focusing on stimulation and learning in early childhood is equally important.

There was also unanimous resolution to invest and scale up nutrition policies and programmes to improve infant and young child feeding.Member States discussed efforts to achieve the World Health Assembly Global Nutrition Targets, because progress had been slow and uneven.

A small step forward in the reduction of stunting, with the number of stunted children under five years falling from 169 million in 2010 to 151 million in 2017. WHO is leading global action to improve nutrition, including a global initiative to make all hospitals baby friendly, scaling up prevention of anaemia in adolescent girls, and preventing overweight in children through counselling on complementary feeding.

A new report was launched on the implementation of the Code of Marketing Breastmilk Substitutes, highlighting that six more countries had adopted or strengthened legislation in 2017 to regulate marketing of breastmilk substitutes.

Non-Communicable Disease (NCD) Alliance: About time! There were many meetings and the WHO Commission on NCD was gearing up for launch of its first report on June 1. Considering 70 per cent of the global mortality is because of NCDs (yes, 70 per cent!), this alliance was not a day early. India is considered the global capital of Type II Diabetes and the Disease Burden Report launch in India stated, by 2016, 61 per cent of deaths were from NCDs. We did a full discussion on the Disease Burden report. Watch the episode here.

Palestine was on the table too: After the relentless Israeli attacks on the occupied Palestine (that is, Gaza Strip) and the Golan Heights of Syria, unsurprisingly, there is a massive health emergency. The Director General had sent a fact-finding mission which presented its findings, and called for an immediate stop to Israeli attacks and also for building the health infrastructure of Palestine and Golan Heights.

This is important, considering a prominent section of the Indian media has completely blacked-out the latest Israeli aggression. While the current Indian government looks up to the Israeli-Zionist militarism, India has still voted against Israel, for Palestine, at the UN, consistent with its historical Palestinian position.

What got left out

The task force on social determinants was dismantled. Why should this matter? Because it was the WHO, which 10 years ago, came out with the seminal work that, health is not just an outcome of medicines and hospitals, but social determinants and set up one of the most inspiring commissions, the WHO Commission on Social Determinants of Health, looking at sanitation, habitation, working conditions, public policies etc. The task force was meant to advise and track progress on social determinants, and now it’s no more. Self-contradictory, considering, so much of early childhood and NCD is about social determinants too, explained Dr Amit Sengputa of the People’s Health Movement.

Same fate for the secretariat level coordination between World Trade Organisation and the WHO on trade and health. Considering how important trade rules are for drug pricing, access to medicines, technology transfer for diagnostics and procedures, disbanding this coordination committee will be a body blow to universal health coverage, says Dr Amit Sengupta.

Big pharma and private sector galore The presence of big pharmaceuticals, across multiple forums, even in exclusive decision making meetings, was massive. While civil society and medical ethicists barely got decent meeting space to do their events at the venue, the UN Headquarter at the Palace of the Nations (or Palais de Nations), lobbyists from big pharma seemed to find all the plum locations. They were also in exclusive meetings as observers and panelists, where members of media were not allowed.

And while civil society is still fighting for a seat at the table in key meetings, big pharma lobbyists seem of have got a whole sofa for themselves.

Access to media and conflicts of interest

The big question we need to raise is, why are so many meetings at these global level, still done in closed doors, with no-entry for the media. In this day and age, how can global health, our shared destiny, be written and inked in closed doors?

To add to that, the WHO Framework for Engagement with Non-State Actors, or FENSA, has become a free for all. The problem is that while FENSA has kicked in, its conflict of interest safeguards are yet to be finalised and tested. Until then, there is a big danger of big pharma and profiteering corporate hospitals hijacking the entire mechanism.

In India, the National Pharmaceutical Pricing Authority found out that private corporate hospitals are marking up drugs, diagnostics and consumables and making profits to the tune of 1,737 per cent. And this is why addressing conflict of interest at FENSA is so crucial.

India at 71st WHA

Health Minister JP Nadda led the Indian delegation and the Yoga session on May 20, 2018 to kick-off the WHA. India’s National Health Protection Scheme, Ayushman Bharat, came in for high praise, from the WHO Director General in his inaugural speech and later through the WHA too.

India led the deliberations for a global architecture for Digital Health and patients’ data sovereignty. Considering its progressive stance in Geneva, perhaps the Indian government’s Adhaar defence team in Supreme Court, should take tips from the Health Ministry.

India also pushed back against US and big pharmas’ insistence on fair pricing of medicines. Alongwith many countries like Morocco and Chile, India did the heavy-lifting, calling for the need to define fair pricing and the need for ensuring it is pro-patient, instead of pro-Big Pharmas.

Taiwan was denied an observer status Taiwan was an observer from 2009-2016, but China raised the issue in 2017 that Taiwan was part of the sovereign country of China and hence should be denied an independent entry at UN. Pakistan supported China’s move and they were denied observer status. The Marshall Islands representative said China’s act was reducing WHA into a political forum rather than and global health forum.

The Director General’s Independent Accountability Panel is looking at private sector and regulation this year, but the meetings continue to be behind closed doors and their report is yet to be tabled. Not a good sign, considering the medical malpractice we are subjected to, in India and elsewhere. If not challenged, media non-entries coupled with private sector lobbyists’ over-presence pose a risk to the public good approach to global health policy.

Acknowledgments: The author would like to acknowledge the support of Azhar Hasan Abbas in this article. The author can be reached at biraj_swain@hotmail.com 

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