Influence of interest of external actors, particularly interest of donors, in developing policies and programs of the recipient country is an issue which is widely talked about for a long time. Apparently, external actors consist of non-state sectors including multi-national companies, business houses, civil society organization, professional unions and others. As in other sectors, it is also true in health sector.
The Executive Committee of WHO defines conflict of interest as a relationship that may arise:
“in circumstances where there is potential for a secondary interest (a vested interest in the outcome of Member States’ work in the area of public health nutrition) to unduly influence, or where it may be reasonably perceived to unduly influence, either the independence or objectivity of professional judgment or actions regarding a primary interest (related to Member States’ work in the area of public health nutrition)” (A71/23, para.10).
These interests are largely influencing the process and contents of health policy and strategic planning, designing programs and setting their priorities. Such conflict of interest may arise even within the systems and sectors hindering development of rational health policies and programs. Recognizing this reality, World Health Organization (WHO) raised the issue of conflict of interest with serious sensitivity in 65th World Health Assembly (WHA) in 2012 when it endorsed the agenda Maternal, Infant and Young Child Nutrition.
Finally, WHO tabled the agenda of safeguarding against possible conflict of interest recently in 71st WHA, which was held on May 21-26, 2018 for discussion and endorsement of the tool to assess and manage possible conflict of interest in nutrition policy and program.
A tool developed by WHO has been described as “a step-by-step decision-making process” to support member states to decide whether an engagement with an external actor should be started, continued, discontinued or be rejected.
The tool consists of six steps as below:
The agenda was taken with profound seriousness in 71st WHA. Different member states and non-state actors expressed their views and concerns on different dimensions of the agenda.
Being a member of People's Health Movement (PHM) watch team through Medicus Mundi International (MMI) Network, I was honored to present the statement on this agenda item in 71st WHA. PHM is a global network raising voices for equity and justice in health. PHM had prepared the statement and policy brief on the agenda after a long discussion over several weeks. Each point of the agenda documents was reviewed, discussed and critically analyzed to conclude into the statement.
PHM highly appreciated and applauded WHO for its initiative to safeguard the member states, particularly the weaker states, against the conflict of interest in maternal and child nutrition policy. The statement has explicitly alerted that operations of external actor representing business interests are often camouflaged when they operate through front ‘institutes’ or ‘foundations’. States having less capacity to analyze, understand and assess the risk profile of external actors are mostly at higher risk of being victim of conflict of interest. Often these countries are weak in resisting pressures from external actors. Therefore, PHM has strongly urged WHO to assist the Member States in building their national capacity to implement the tool for managing conflict of interest.
PHM expressed its concern that attention should be given to manage conflict of interest at the global level. Global public-private partnerships (GPPPs) in particular Scaling up Nutrition (SUN), the Global Alliance for Improved Nutrition (GAIN) and the World Food Program, play a very influential role in international policy and action around food and nutrition. We also urged WHO to employ similar mechanism to prevent conflicts of interest in global initiatives.
Nepal is not an exception in this issue. Like many other countries, Nepal is equally vulnerable to the risk of conflict of interest in the process of nutrition and in general health policy development and implementation. It is a fortunate opportunity for us that tool and process guidelines developed by WHO are now available. But it is definite that we should adopt these instruments based on our context and ground reality. It is also important to create an environment to implement them with profound understanding of these instruments. We should make our own efforts and seek support from WHO to build our national capacity to implement the tool in order to prevent conflict of interest in health policy and programs and so to achieve the national goal of health for all.
(Simrin Kafle, Project Manager of Nepal Public Health Foundation)
