AFRO-NETS> The WHO Civil Society Initiative: Important NGOs respond

[Claudio Schuftan <aviva@netnam.vn>]

The WHO Civil Society Initiative: Important NGOs respond
--------------------------------------------------------

The newly established WHO Civil Society Initiative herewith extends 
an invitation to your Organization to participate in an informal 
electronic consultation on the attached document "WHO Civil Society 
Initiative - work in progress."

The document is the first outline of a possible WHO policy framework 
on relations with civil society. It describes current plans for and 
thoughts about WHO interaction and collaboration with civil society 
organizations (CSOs), and proposes areas of work and activities that 
can lead to improved mutually beneficial relations. We want to stress 
the draft character of the document since many key partners are still 
to be consulted before finalizing the framework. Our plans are to de-
velop a final version of the policy framework by September 2002.

As part of this process we have now chosen to consult with you and 
other selected international CSO partners electronically. It is im-
portant that the policy framework reflects the views not only of WHO, 
but also of a broad range of different types of CSOs with whom WHO 
works and interacts. Thus, we are very interested in your comments on 
the document and on the process.

In order to facilitate your comments a form is attached for your 
electronic usage. We look forward to hearing from you and would be 
pleased to receive your responses by 8 February 2002.

Please return the form to 
Margareta Skold, CSI
mailto:skoldm@who.int

Yours sincerely,

Eva Wallstam 
Director
Civil Society Initiative External Relations and Governing Bodies 
World Health Organisation

--
CIVIL SOCIETY INITIATIVE 
Informal Consultation Document (work in progress) 19 December 2001

1. Why this paper? 
This paper is one of several tools in the development of a renewed 
WHO policy on interaction with civil society. Its purpose is to in-
form stakeholders about the current stage of the WHO Civil Society 
Initiative (CSI), as a basis for consultations with and inputs from 
CSOs and other interested partners. The paper is a "work in pro-
gress", and will be further developed on the basis of further consul-
tations during the next 6 months.

2. What has CSI done so far? 
The CSI was launched by Dr Brundtland at WHA 2001, to review official 
and informal working relations between WHO and CSOs and to guide the 
policy discussion on how to further strengthen mutually beneficial 
relationships. This mandate was later broadened to include the in-
volvement of civil society in health and government/CSO relations. 
The objective is to develop a WHO policy framework for more effective 
collaboration, information exchange and dialogue with CSOs, and to 
strengthen WHO's support to Member States in their work with CSOs in 
global and national health.

Initial investigations have included consultations with a range of 
stakeholders at all levels within WHO, and with partners outside WHO, 
including CSOs. It has included:
* mapping WHO experiences and relations with CSOs both at HQ and at 
  the Regions offices;
* identifying current forms of interaction between CSOs and WHO, and 
  the opportunities and concerns to which they give rise;
* exploring current thinking about civil society and CSO involvement 
  in health;
* gaining insights from other UN entities, donors and financial in-
  stitutions on their policies and processes for interaction with civil 
  society;
* listening to the expectations of CSOs and initiating dialogue with 
  them; and
* identifying specific areas of concern and issues that WHO needs to 
  address.

To date, about 50 WHO HQ staff have been interviewed, and this proc-
ess will continue with staff at WHO Regional and country offices.

3. Working definitions 
WHO has traditionally worked with health-specific non-governmental 
organizations and utilized the term "NGO", but the terminology of 
"civil society" and "civil society organizations" is increasingly 
preferred. This reflects the growing recognition by WHO of the impor-
tance of collaborating with and reaching out to a broad range of ac-
tors. The term 'Civil society organisations' (CSOs) generally refers 
to non-state, voluntary organisations, not formed for purposes of 
making profit. These networks and associations draw from community, 
neighbourhood, workplace, social and other connections, and include 
formal and informal voluntary organisations, non government organisa-
tions, professional associations, social movements, community groups 
and so on. WHO works CSOs that are health related, whose interests 
are consistent with WHO values. Foundations, academia and media are 
not dealt with by CSI, as they are covered by other WHO units.

WHO's primary interest is in working with CSOs which share its values 
and offer the greatest opportunities and synergies for improving 
health outcomes. As in relations with the private-for-profit sector, 
there are potential conflict of interest for the WHO. Relations with 
the for-profit and non-profit actors are therefore developed in par-
allel to ensure consistency. 

4. WHO's past and current relations with CSOs 
Collaboration with NGOs is not new for WHO, and interaction, consul-
tation and co-operation with them are clearly encouraged by its Con-
stitution. The first World Health Assembly, in 1948, adopted a set of 
working principles governing admission of NGOs into Official Rela-
tions, which were amended and expanded by later WHAs. The current 
principles have been in place since 1987. Collaboration with NGOs is 
a standing agenda item at both the EB and WHA. It was the theme of 
Technical Discussions 1985, and was highlighted in the Executive 
Board's 1997 and 1998 discussions and the consultations on the re-
vised Health for All process 1997. As such, the governing bodies of 
WHO have shown long-standing support and encouragement for strength-
ened WHO relations with NGOs, including those whose main area of 
competence lies outside the health field.

WHO interactions with CSOs can be formal (official relations) or 
informal.

There are now: - more than 190 NGOs in formal, official, relations 
with WHO. They have responsibilities and privileges that are outlined 
in the Principles governing relations between the World Health Or-
ganization and Non governmental organizations; and

- an even larger number of CSOs/NGOs that have working relations or 
other interactions with WHO at different levels (at HQ, regions and 
countries), but are not in official relations.

Both type of relations can include different types of activities such 
as:

* joint action and research in service provision, programme and com-
  munity outreach, technical and resource inputs in specific areas, and 
  co-ordinated fundraising and financial contributions;
* advocacy and information sharing, building wider alliances for 
  health goals and sharing information through existing networks; and
* policy dialogue and development through round table discussions, 
  issue management groups for policy development, policy strategy advi-
  sory committees, public hearings, commissions and consultations. 

5. Issues and Challenges 
The CSI investigations have resulted in many findings of importance 
for a future WHO policy framework. The following issues and chal-
lenges are some examples of these findings, but do not represent an 
exhaustive list. 

5.1 At global level 
During the last 20 years, there has been a dramatic growth of civil 
society organizations (CSOs) and an increase in the political influ-
ence of civil society. Global political, economic and social changes 
have had a profound influence on the role of the nation state, nota-
bly in health, pressuring governments to align national policies with 
global and regional agreements within a more demanding and constrain-
ing environment. This has raised the profile and increased the par-
ticipation of non-state actors in health service provision, both non-
profit and for-profit.

In addition, increasing CSO concern about the effects of globaliza-
tion and global policies on health has led to a greater involvement 
in public policy debates, eg on globalization, trade, development co-
operation and health. In this role, civil society can enhance the ac-
countability and performance of national governments and global gov-
ernance systems, adding a political dimension to civil society in-
volvement in health.

5.2 At national level CSOs have become critical elements in the 
health domain at the national level. They contribute resources and 
skills to service outreach; development aid is increasingly chan-
nelled through them; and global initiatives such as Roll Back Ma-
laria, the Global Fund to Fight HIV, Tuberculosis and Malaria and the 
Tobacco Free Initiative, are involving CSOs as major actors at coun-
try level. New development processes such as PRSPs and SWAPs also re-
quire CSO participation. This situation has in some cases increased 
tensions between governments and NGOs regarding the handling of ex-
ternal funds to the health sector; and many Ministries of Health are 
reluctant or uncertain about how to handle the processes. Another 
area of interest is the governments contracting out health services 
to CSOs. Member States will increasingly look to WHO for guidance and 
support in handling these relations.

5.3 At UN level ECOSOC revised its policy on CSO relations in 1996 
(Resolution 1996/31). In July 1998, a report to the Council by the 
Secretary General (Renewing The United Nations: A Programme For Re-
form) stressed the need to reach out to civil society in activities 
such as research and information outreach, policy dialogue and advo-
cacy as well as fund-raising and programme delivery, and to facili-
tate the emergence of CSOs in developing countries. Lack of financial 
means and inadequate access to relevant information have prevented 
Southern NGOs from contributing as much as Northern NGOs in the pol-
icy dialogue conducted in UN forums.

The Millennium Summit Declaration in September 2000 similarly re-
flected the need for the United Nations to work in different types of 
partnerships with civil society, including finding ways for UN lead-
ers to hear the voices and advice of CSOs.

Collaboration with CSOs takes many forms. Most UN entities have a 
system of official status establishing admission criteria, obliga-
tions and privileges. With the notable exception of ECOSOC, the num-
ber of CSOs in official status is typically limited to a few hundred 
at the most. However, there is informal collaboration on a wide range 
of activities with other CSOs, often based on registers or rosters.

The increased importance attached to the role of development CSOs by 
the UN has led to reviews of existing policies and strategies and the 
introduction of new forms of communication and collaboration. A num-
ber of UN entities have "up-graded" headquarters units dealing with 
CSO issues and designated liaison officers at departmental level. 
Mechanisms are being established at senior management level for in-
volvement of CSOs, with and without official status, in policy mak-
ing, such as "CSO Liaison Committees" and "Civil Society Advisory 
Committees".

5.4 At development partner level Among bilateral and multilateral do-
nors the emphasis on enhancing relations with CSOs is perhaps even 
stronger, work with CSOs being seen as closely linked to the overall 
aim of poverty reduction which features prominently in donors' devel-
opment programmes.

Strategies aim to support Northern as well as Southern CSOs, support 
to the latter often being channelled through the former. All the do-
nors studied have specific funding instruments for which Northern 
CSOs can apply, some also funding Southern CSOs directly. Service de-
livery and capacity development are important components of CSO pro-
grammes, and there are various mechanisms to enable CSOs to partici-
pate in and influence policy formulation, programme development, etc, 
and to support CSO networking and strengthen their capacity.

5.5 At WHO level WHO's corporate strategy clearly outlines strategic 
directions that build on contributions from a broad range of other 
partners including CSOs. It is recognised that the global changes de-
scribed above and WHO's outreach to new actors call for a review and 
renewal of the way the Organization itself interacts with civil soci-
ety. There are many issues that need to be addressed.

Technical departments' desire to work with CSOs is strong, and there 
is added value. However, there are also some perceived risks in-
volved, arising from the North-South imbalance in current CSO rela-
tions; limited representativeness, unclear legitimacy of some CSOs; 
and possible conflicts of interest associated with governance and fi-
nancing arrangements. While many CSOs voice increasing concerns about 
the growing partnerships between WHO and the for-profit sector, oth-
ers participate directly in such partnerships.

Differences in current approaches to interaction with CSOs, between 
clusters and between regional offices, cause some confusion to CSOs. 
Both within and outside WHO, the present system of official relations 
is seen as being in need of revision and updating.

One issue raised, at regional level, was the possibility of decen-
tralising authority to Regional directors for the establishment of 
official relations with national NGOs.

There is a recognised need for improved knowledge, attitudes and 
practices relating to interactions with civil society among WHO staff 
at all levels, and particularly at the country level. An internal in-
stitutional forum or network between HQ and ROs, for discussion on 
CSO relations, has been requested. Policies and guidelines are in ur-
gent demand.

6. Tentative workplan for CSI in the next biennium
The above developments form the basis for CSI's work-plan for the 
next biennium, which will evolve as a result of continuing consulta-
tion. CSI has set four main objectives for its first phase:

6.1 Coherence in WHO policy on CSO relations, to maximise synergies 
and opportunities for joint work towards WHO goals, while managing 
the risk of conflicts of interest.

The planned activities aim at: 
- a renewed system of relations with CSOs that appropriately recog-
nizes the contribution of CSOs to the work of WHO and clearly out-
lines their privileges and responsibilities, based on a review and 
evaluation of the current official (formal) relations system and an 
assessment of other informal working relations; and

- development of appropriate tools for screening, selecting and as-
sessing prospective CSO partners (including identification and man-
agement of possible conflicts of interest), based on the experience 
of the official relations system and lessons learned.

6.2 A knowledge bank on civil society actors and issues, to inform 
WHO effectively on civil society involvement in public health.

The planned activities aim at: 
- a knowledge base that covers policy analyses on civil society and 
health, a research agenda and reports, practical and technical infor-
mation on areas of civil society contributions to health, tools, 
guidelines, briefings to support WHO work with civil society and 
regularly updated inventory of WHO/ CSO relations.

- collaborative projects between CSI and technical departments to de-
velop knowledge relevant to civil society activities in health at the 
country level.

6.3 Improved communications and policy dialogue based on better in-
formed links within WHO and between WHO and CSOs.

The planned activities aim at: 
- a communication strategy, using tools and mechanisms such as a CSI 
website and information materials on WHO policies, and the knowledge 
base on CSOs and health.

6.4 Strengthened WHO capacity to support and facilitate mutually 
beneficial Government/CSO relations at the country level.

The planned activities aim at: 
- WHO staff training and support in the form of tools, guidelines and 
seminars.

--
Consultation form for CIVIL SOCIETY ORGANISATIONS on the document en-
titled "WHO Civil Society Initiative-work in progress" dated 19 De-
cember 2001

1. Name of CSO: Primary function: HQ address: Website:

Name of Respondent: Position: Address: Email:

2. Does the document cover your concerns about WHO relations with 
Civil Society? YES/NO If no, are there gaps in the paper or other is-
sues that could be included? Do you have specific comments on the 
workplan of CSI?

3. Do you think the current system for WHO relations with NGOs/CSOs 
is adequate? YES/NO If no, in what ways, if any, could the relations 
between CSOs and WHO be improved? How should the formal (official re-
lations) system for CSO relations be changed?

4. Do you currently collaborate with WHO in any area of your work? 
YES/NO If yes, what has been the most constructive way of collaborat-
ing with WHO? What have been some of the constraints or drawbacks?

5. Do you think the communication between WHO and CSOs is satisfac-
tory? YES/NO If no, what information would you like to receive from 
WHO? What could CSI provide or do to strengthen communication between 
WHO and CSOs?

6. Do you produce and make publicly available any of the following in 
the area of civil society and health? If YES, please include a list 
of these documents.

- research reports YES/NO 
- technical guidelines YES/NO 
- training materials YES/NO 
- policy papers YES/NO

7. Any other comments?

Please return this form to: 
Margareta Sköld, CSI
mailto:skoldm@who.int 

--
Claudio Schuftan
mailto:aviva@netnam.vn

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