The 13th General Programme of Work (GPW) 2019-2023 took centre stage at the 142nd session of the Executive Board (EB) of the World Health Organization (WHO) from 22-27 January 2018. The draft emphasises three interlinked strategic priorities, founded on the Sustainable Development Goals (SDGs): advancing universal health coverage (UHC), addressing health emergencies, and promoting healthier populations. “We are already lagging behind in SDG implementation” warned Dr Tedros, highlighting the importance of putting countries at the centre of WHO’s work to build national capacities tailored to context-specific needs and priorities.
The draft was for the first time shaped through a series of consultations, including a special session of the EB in November 2017. This inclusive process has allowed addressing some of the concerns raised by member states in an effort to build a shared vision and ensure ownership. However, some key issues remain, in particular the question of financing of WHO.
A high-level financial estimate for the draft GPW 13 amounts to 10.8 billion dollars over five years. Dr Tedros underlined the crucial need for more flexible funding, calling donors to un-earmark their contributions to provide WHO with a greater scope for prioritisation. The GPW 13 will be used as an investment case to mobilise resources, but WHO also aims to build synergies with other UN organisations and to support other actors such as GAVI and the Global Fund with their replenishments in a more holistic view of global health financing. However, the adoption of the GPW 13 at the upcoming World Health Assembly (WHA) in May will not imply the approval of its financial estimate, creating a tension between aspirational priorities and a realistic, deliverable plan. It also remains to be seen to what extent donors will respond to the appeal for un-earmarked contributions. Financing will, therefore, ultimately determine prioritisation and implementation.
In order to deliver on the GPW 13, the Organization also needs to make fundamental changes in its working model and culture. Particular emphasis is placed on measurable outcomes to assess WHO’s impact and hold the organisation to account. A Technical Expert Reference Group is tasked with reviewing the targets in the draft GPW 13 and advising on monitoring WHO’s expected contribution to achieving these goals. This shift towards more accountability must be understood within the context of Agenda 2030 and is linked to the criticisms raised after the Ebola crisis. It should also further contribute to defining WHO’s role within the global health landscape. In this regard, the GPW strengthens WHO’s normative work by placing countries at the centre and focusing on global public goods. Although Dr Tedros underlined that this will remain the main function of the Organization, WHO's operational responsibilities were highlighted in the case of emergencies and in weak institutional contexts.
The EB adopted Resolution EB142/R2 requesting the WHO Secretariat to finalise outstanding work on the impact framework and financial estimate, and recommended the 71st WHA in May 2018 to approve the GPW 13. In the coming months, further deliberations will allow member states to provide inputs to refine priorities and the expected organisational shifts to deliver on them.