STOP TB response to activist letter

RE: Follow up on improving transparency, accountability and governance at the Stop TB Partnership

Dear Mr Harrington and others,

Thank you for your letter of the 11th of October, which was well received by dr Rifat Atun. He forwarded the letter to me for answering, as I am the chair of the Sub-Committee on Governance, Performance and Finance.

Let me first apologize for the late reply. Many of the concerns you raised in your letter are also issues we have tried to address. In this message I will try to respond to most of the points raised.

I would like to first make sure that we are all on the same page. In your letter, you refer to a “resolution on Partnerships.” The only formal resolution on Partnerships, which dates back to May 2010, requests the Director General (among others) “to create an operational framework for WHO’s hosting of formal partnerships” and “to submit to the Executive Board any proposals for WHO to host formal partnerships for its review and decision”. The document you refer to is a draft Memorandum of Understanding (MoU), which is currently under negotiation with room still for modification and will probably be part of proposals that need to be sent to the Executive Board for endorsement. Related to this MoU:

 - We share many concerns you have highlighted, in particular the concern that the MoU does not reflect the spirit of true partnerships. The Sub-Committee on Governance, Performance and Finance identified several inappropriately worded paragraphs  which might cause difficulties in practice, particularly among others, those relating to the reporting lines of the Executive Secretary to WHO management, working with the private sector, ownership of products and the performance of WHO as a host. The Secretariat has also shared its view on the draft MoU in a memo to the Director General Dr Margaret Chan.

- I would like to stress that some legal provisions provided by WHO as the host institute may not seem agreeable but in the interest of all, it would be most productive to focus the discussion with WHO on those things that can be modified to contribute to a stronger and more flexible partnership.

- Stop TB Partnership is one of the partnerships affected by the MoU, which was discussed between several partnerships (including Roll Back Malaria, UNITAID, Stop TB Partnership and Maternal and Child Health Partnership) and with ADG Dr. Jama, who is responsible for the general management of WHO. A follow-up meeting is planned soon.

During the Executive Board, Dr Chan expressed her intention to strengthen WHO leadership in global health, including the promotion of greater coherence in the actions of multiple health partners to maximize their impact. This year, WHO will focus on the Board’s role in oversight over partnerships and next year a framework will be developed to guide stakeholder interactions. This means that there will be additional opportunities to discuss the role of WHO in relation to partnerships. These changes also mean that the Stop TB Partnership should critically assess its own performance.

Finally, I would like to make a few notes in reply to your statement that the Stop TB Partnership funding was used to strengthen the WHO STOP TB Department.

1. WHO is a full partner of the Stop TB Partnership. It is therefore eligible for funding, like any other partner. The question is: do they get too much or too little for what they do?

2. WHO – as a partner – should also contribute to the Partnership either in cash or in kind (hosting arrangement and/or technical contribution). Although many argue that the overhead which is paid by the Partnership to WHO should be enough, it is clear that this does not adequately cover the costs (housing, financial control, staff support etc). During the last WHO Executive Board it became clear that the core contribution to WHO is used to cross-subsidize other activities hosted by WHO. The Executive Board expressed strong support for WHO to employ a full cost recovery system. In that case, we should advocate for WHO to contribute by other means to the Partnership. This can - again– be it in kind or cash.

3. One can ask if WHO is doing enough as a partner, or is doing the right things. You are right that the overhead just pays for administrative tasks. But we have to acknowledge that WHO has a formal and natural mandate that the Member States, but preferably all partners, should support. We partner with certain partners because we value their specific knowledge. Your proposal for tendering overlooks this important note.

4. One can ask if different partners within the partnership report back to the Board in a timely and adequate manner. This is not just an issue related to WHO. As you may remember, the Board also expressed concern on how the different Working Groups monitored their progress. I agree with you it also has to do with the composition of the Board, as many of the Board members may have direct interests in what is being discussed.

5. Finally, one can ask if WHO, being the host institution, has a conflict of interest in the decision making around allocation of resources. Yes, naturally WHO has an interest, as it is responsible for some parts of the partnership. But I agree that it is undesirable for the Executive Secretary to formally report to her technical counterpart within WHO. Moreover, I think it is undesirable that the technical partner also represents the host institution on the Board meeting. Mario Raviglione and Lucica Ditiu should be able to work as full partners, and any hierarchy between the two should be avoided, even if it is just a delegated one.

The Sub-Committee on Governance, Performance and Finance has – until now - focused its activities on the hosting agreement with WHO. However, during the next Board meeting the Sub-Committee will propose action to ensure progress in relation to other areas in a constructive, forward looking way.

I hope I have addressed your concerns and suggestions in a way that clarifies the Sub-Committee position in relation to current future discussions. We are more than happy to continue our discussion.

Kind regards,
Marja Esveld, chair Sub-Committee on Governance, Performance and Finance
Stop TB Partnership