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The World Health Organization programme of work 2019-2023 is one step closer to being adopted by member states and serving as a guideline for the future vision and mission of the organisation. The Executive Board approved the programme last week and recommended its adoption at the upcoming World Health Assembly. The programme issued by the secretariat in autumn was revised twice, as countries requested amendments.

The draft thirteenth general programme of work [pdf] (GPW13), 2019–2023 (Rev2) was adopted on 26 January by the Executive Board, which met from 22-27 January.

The draft resolution [pdf] approving the GPW13 notes that the approval of the programme does not imply approval of the financial estimate, which was provided by the secretariat before the Board meeting (US$10 billion) (IPW, WHO, 18 January 2018).

The resolution requests that the WHO secretariat finalise the “outstanding work on the Impact Framework, financial estimates and investment case for consideration of Member States prior to the Seventy-first World Health Assembly [2019).”

The resolution further “urges Member States to support work towards achievement of the vision of the Thirteenth General Programme of Work, 2019−2023,” and requests the WHO to:

“(1) to use the Thirteenth General Programme of Work as the basis for the strategic direction of planning, monitoring and evaluation of WHO’s work during the period 2019–2023 and to develop Programme Budgets in consultation with Member States, based on a realistic assessment of income and WHO’s capacity;

(2) to take into consideration the changing state of global health in implementing the Thirteenth General Programme of Work, and keep Member States informed on progress with implementation through regular updates to governing bodies;

(3) to provide guidance and support to regional and Country offices on the implementation of the Thirteenth General Programme of Work, taking into account different contexts;

(4) to provide a report to the Seventy-fifth World Health Assembly to inform potential extension to 2025 of the Thirteenth General Programme of Work to align with the wider United Nations planning cycle.”

Delegates worked from a draft resolution [pdf] presented on 24 January, which was followed by a revised draft [pdf] on 25 January.

Among changes is the deletion of a paragraph asking members “to identify their roles, and the specific actions they need to take in order to achieve the Sustainable Development Goals and the related ‘triple billion’ goals” of the GPW13. The triple billion goals refers to 1 billion more people benefitting from universal health coverage, 1 billion more people better protected from health emergencies, and 1 billion more people enjoying better health and well-being.

The 24 January draft also suggested that the WHO report to the 77^th WHA (2024) on progress made during the period 2019-2023. The adopted resolution brings that date forward to the 75^th WHA (2022).

The 24 January draft suggested that WHO take into consideration the changing state of global health in implementing GPW13 ”in consultation with member states,” while the adopted resolution says the WHO should take into consideration the changing state of global health in implementing GPW13, and “keep member states informed“ on progress with implementation.

Numerous Amendments

The second revision of GPW13, adopted last week, shows a number of amendments made to the first revision of the document issued for the Executive Board. Amendments introduced by member states are shown with bolded text and a footnote.

For example, New Zealand suggested that GPW guide for each biennium makes “stepwise progress in strategic priorities.” The country also asked that the wording “to reduce health inequalities,” in the context of the WHO support government to improve the health and well-being of populations, be changed to “achieve health equity.”

In reaching the ‘no one left behind’ objective, New Zealand also changed “hard to reach” people to “geographically isolated” people.

Sweden and the United Kingdom rephrased language on the collaboration of the WHO with other United Nations agencies and relevant partners from different sectors on the issue of antimicrobial resistance.

Under the headline of multisectoral action, France asked that the mention “as needed” be removed, in the context of the application of FENSA.

Germany, on measuring impact to be accountable, added language on risk management, ethics, compliance and evaluation. “The corporate responsibility of WHO is to be able to identify those risks that may impact the agreed results with Member States. WHO has the responsibility to Member States, partners and the international community in general, to guarantee the judicious use of the resources and maintain the good reputation of WHO….”

Malta, on behalf of the European Union, on 22 January underlined the importance of transparency and accountability, and called for the creation of an oversight and accountability mechanism. The Netherlands also underlined the challenge of measuring the impacts of GPW13.

New Zealand, which chairs the WHO Programme, Budget and Administration Committee of the Executive Board (PBAC), said the GPW13 should be inspirational but the programme budget should be realistic. Japan asked for continuation of the budgetary discipline introduced by former Director General Margaret Chan.

In their first comments on revision 1 of the GPW13, on 22 January, the African region said WHO should support research and development (R&D), local production of medicines, facilitated access to pre-qualification, and help countries to better take advantage of the flexibilities included in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

Zambia said WHO should mobilise political will on the issue of access to medicines, but also to press industry to take action to facilitate access.

Different countries, like Sweden, raised separate issues, such as sexual and reproductive rights. Italy drew attention to kidney failure and the need for kidney transplantation, and Japan highlighted ageing.