Guidelines on working with the private sector
to achieve health outcomes

Mr Chairman, members of the Executive Board,

I am speaking on behalf of Consumers International, Health Action International (HAI) and the International Baby Food Action Network (IBFAN).

Protection of the public`s health is part of the social contract between citizens and their governments. WHO has been mandated by member governments to ensure equity in health care, as set out in the primary health care concept. It also sets standards in many health-related areas. These include internationally agreed standards on promotional practices as elaborated in the International Code of Marketing of Breast Milk Substitutes, related resolutions on infant feeding and the Ethical Criteria for Medicinal Drug Promotion.

In response to the serious shortfall in regular budget funding from member states, WHO now actively seeks funds from commercial enterprises in order to fully implement its work programme. By doing this, WHO sends a message of encouragement and inevitability about involving commercial enterprises in its work. This course of action needs to be more carefully considered as it risks diverting WHO from its mandate and role as the highest, global health policy setting body. It discourages the exploration of other sources of support possibly more in line with WHO`s primary health care goals. WHO`s action could also negatively influence the funding policies of many other traditional partners.

However clear WHO may be about its public health mission, it must recognise that corporate donors will always have a fiduciary duty to their shareholders to maximise profit. It is essential that funding from the private sector be evaluated according to public health criteria. This applies to all corporations, not just the tobacco and arms industries.

Under agenda item 8.3, the Executive Board members have been requested to note WHO`s guidelines on working with the private sector to achieve health outcomes (EB107/20). The HAI and IBFAN networks would like to raise concerns about this type of interaction with the commercial sector: Do such public-private interactions contribute to equity in health care? Do they encourage vertical programmes focused on diseases calling for hi-tech, expensive solutions rather than those identified as national public health priorities? Are they a quick fix or do they contribute to sustainable health benefits ? And, are these well-publicised collaborations actually about donor image-building, product development and marketing?

The guidelines propose a framework for assessing these interactions, but fall short in key areas. First and foremost, they fail to give a clear definition of conflict of interest. One consequence of this is that secondment of staff from the private sector, including pharmaceutical companies, is not perceived as a conflict of interest. Another is the guidelines` failure to emphasise the risks related to involving the commercial sector in research. The guidelines answer to conflict of interest seems to be to involve more companies. This is simply inadequate.

The cardinal principle of the guidelines should be complete accountability and transparency. The guidelines make no provision for independent evaluation of potential donors and their compliance with WHO agreed standards and international agreements on human rights, the environment, marketing and labour practices. WHO`s contractual agreements with all private sector donors should be made public. The process of assessing and approving agreements, as provided in the guidelines, is totally internal. In principle, in-house assessments are inherently flawed because of potential conflicts of interest.. Therefore, independent review should be mandatory. External monitoring and evaluation of work involving commercial enterprises must be carried out to see if equitable and sustainable health outcomes are achieved.

The recent Rome Seminar co-organised by WHO, clearly stated that "it is timely for WHO to step back from the current situation and reflect on the appropriate role of GPPPs [Global Public Private Partnerships] in order to meet public health and equity needs". Seminar participants further called for an open discussion on these WHO guidelines. They said that such discussion should involve member governments, civil society and other interested parties taking into account evidence and analysis at the global and national level. Particularly, stakeholders from developing countries should be involved.

We therefore urge the Executive Board to ensure that the guidelines include: a clear definition of conflict of interest complete transparency on contractual agreements with all commercial enterprises assessment of potential donor companies according to recognised WHO and other international standards regular monitoring and evaluation of all private sector interactions by an external body including representatives of governments and civil society a "whistle-blowing" mechanism so that people can report problems without damage to their professional position or reputation annual reports to the Executive Board on contractual agreements made, their implementation and the public health outcomes, and and finally, we believe that the guidelines should be reviewed by next years Executive Board to determine whether these recommendations have been included and how the guidelines are working in practice. We would be glad to contribute to that review.

Thank you for the opportunity to speak on this important issue.