delivered 18 May 2001 by Annie Heaton

Save the Children commends the World Health Organisation on its recent work to improve access to drugs. In pursuit of this goal, however, it is vital that the standards and integrity of the WHO are not compromised. Noting the rapid trend towards joint public private initiatives by the WHO and other UN bodies, most recently in the emerging concept of a Global Health Fund, Save the Children is concerned that the potential these present for both conflicts of interest and the dilution of accountability in the WHO must be avoided.

The WHO's collaboration with the private sector is only justified as a means of better pursuing the protection and promotion of the human right to health-a goal whose pursuit requires long term commitment. Mindful that the mission of the for-profit sector is ultimately different from the WHO, we believe it is important that there are mechanisms to prevent any conflict of interests in such collaborations.

Let us remember also that it is the state that has the primary obligation to protect the right to health of its children and citizens. Any joint public private initiatives, therefore, must be accountable to governments and civil society for their contribution to this objective.

Their impact on the people's right to healthcare must be clear for all to see.

Many of the joint public private initiatives emerging are based on donations or preferential pricing arrangements. Concerns have been raised about how sustainable these can be if commitments are limited. There are also important questions about the contribution of such programmes to public health systems, particularly if they set up parallel delivery systems. Save the Children voices such concerns in a report released this week.

WHO is working on a number of different guidelines of potential relevance here, and Save the Children is pleased to see this process. Its global framework for expanding access to drugs, referred to in the Revised Drug Strategy, has provided a sound basis for the International Pharmaceutical Coordination Group's draft Guidelines on Accepting or Endorsing Preferential Pricing and Donations of Single Source Pharmaceuticals.

With renewed efforts on polio, schistosomiasis, leprosy and many other communicable diseases, and most recently with offers of preferential prices for antiretroviral drugs, these guidelines will be crucially important for assessing the potential impact of such initiatives on people's lives and their access to sustainable, quality healthcare.

Whilst Save the Children has comments on the details of the IPC guidelines, their value rests in their implementation. Yet no tools are provided with which to monitor adherence to the guidelines. The most obvious way of holding joint public private initiatives to account for their adherence to such guidelines is to contractually require it.

Unfortunately such requirements are not yet part of the WHO's Guidelines on Working with the Private Sector. These merely state that commercial enterprises working with the WHO "will be expected to conform to WHO public health policies" in a few loosely defined areas. Again, no mechanism to assess compliance with these policies is defined.

Nor is a channel for third parties to report on non-adherence to these policies identified. One solitary line at the end states that "the application and impact of these guidelines shall be periodically reviewed." And there is no process for rectifying a situation where standards are being abused.

Save the Children recommends that the WHO's Guidelines on Working with the Private Sector should require every joint initiative between the WHO and the private sector to be subjected to a transparent contract. This contract should specify, where relevant, compliance with the IPC guidelines on preferential pricing or single-source drug donations, and any other relevant WHO standards. For example, if the initiative is undertaken with a pharmaceutical company, then international standards on marketing and promotion of pharmaceuticals would be relevant. Performance of the initiative should be measured against the terms of the contract.

The WHO should furthermore establish a mechanism to enable independent observers to assess the impact of any such initiative according to its stated contractual objectives and standards. The Board of the initiative to respond to all such assessments, and a report of this process should be sent to the Assembly annually.

Finally, with the imminent launch of a global health fund, and conscious of the evidence Save the Children releases in a report this week that the health systems in 44 countries are in a state of collapse, we believe that any drug delivery programmes undertaken by the WHO, especially the emerging joint public private initiatives, must contractually aim to strengthen not erode the state's capacity to fulfill its duty, under international human rights law, to ensure access to healthcare for all.

With the growing interest among civil society observers of the impact of public private initiatives both on the livelihoods of the poor and on the integrity of the UN bodies, the tools of transparency and public accountability are essential to ensure that the standards which the WHO represents are maintained and indeed furthered. In adopting such measures, the WHO will be setting a much needed example among UN bodies.