Should the WHO be rebuilt from scratch?

This is an onsite edited excerpt of the G|O Briefing newsletter

It is now abundantly clear that the reform of the WHO will need to be profound in nature and comprehensive in scope. That’s in essence what The Independent Panel on Pandemic Preparedness and its blunt conclusion that the COVID-19 pandemic could have been “preventable,” and two related reports presented during the 74thsession of the World Health Assembly (WHA) suggest. Add the External Audit conducted by the Office of the Comptroller and Auditor General of India to the catalogue of interrogations reinforcing the case for profound change.

Somewhat overlooked as all the attention has lately been concentrated on the institutional aspects of the organization’s reform, the document, which covers 2020 opens a wide window on the daily managerial inner workings of the organization. Its key findings are cutting and its conclusions blunt. “WHO did not depict its cash and short-term investments distinctly (…) resulting in incomplete and non-transparent disclosure,” (…), a high priority program adopted from 2019 “was not yet rolled out in any of the four country offices we audited,” “There was an increasing trend of misconduct, especially relating to fraud, harassment and non-compliance to professional standards and sexual misconduct. There were delays in investigation and taking disciplinary actions. (…) Efforts at prevention were found to be inadequate.”

" The firm’s role in procurement constituted a conflict of interest as the firm provided assistance to both WHO as well as the supplier.”

On that very subject, the auditors make a point of writing that “the number of complaints or reports of misconduct are a reflection of the ethical climate of an organization and its ‘tone at the top;’ and therefore, an increasing trend of such complaints should be a cause of concern for the management.”

The audit found repeated and major weaknesses in the organization’s procurement system and mechanisms, which are the focus of this piece.  The report also flags problems and questionable practices when dealing with consultancy companies. “We noted several transgressions in the selection and engagement of a consultancy firm. The firm was assisting WHO in the procurement of personal protective equipment (PPE), without due approval. (…) The firm’s role in procurement constituted a conflict of interest as the firm provided assistance to both WHO as well as the supplier,” the report notes about one contract.

In addition to the clear conflict of interest described above, there appears to be favoritism in another contract’s attribution. The report explains that in December 2020, “WHO initiated an open competitive bidding process for further engagement of consultants to ‘support the long-term vision for WHO supply chain and to build capabilities’ to execute the long-term supply chain vision.” Two firms, D and A, both qualified, ended up competing.  In the final technical evaluation, D obtained the highest score. As the auditors write, “The consultancy should have been awarded to Consultant D.  However, WHO changed the evaluation criteria and re-evaluated the bids as per which Consultant A scored higher and was awarded the consultancy.”

In their conclusions, the inspectors also dismiss the validity of the explanation provided by the WHO for its choice. “This justification and bid evaluation was not in compliance with the WHO Procurement Manual provisions and violated the norms of public procurement. Changing the technical requirement or scope of work, from what was stated and changing the evaluation criteria at the time of evaluation violates public procurement principles and vitiates the tendering process” they write.

“The role of consultants in the health sector has been a problem for quite some time, especially since the last 10 or 20 years when the Gates Foundation got all these big consultants,” a WHO insider told The G|O under the condition of anonymity. In effect, the Gates Foundation created a new market for consultants.  “Even people within the health organizations are not happy with this situation. They find that these consulting firms are not adding value, they are just piggybacking on the Gates Foundation to enter the health sector. It’s a small group of firms, always the same,” the source added.

A lucrative business

“The WHO’s consultancy pool completely lacks diversity. It relies heavily on a few firms, essentially American and British that have a de facto exclusive relationship with the organization,” bemoans a senior member of the Geneva diplomatic corp. “The consultants’ selection process must be made much more rigorous, and the current situation must be corrected, it is a matter of concern and will be part of the reform,” he told The G|O.

It is a lucrative business.  According to the audit, “During 2020, total expenditure on contractual services was US$ 986.13 million which was the second highest expense item after staff costs. The main components within contractual services are direct implementation; general contractual services; and consulting and research contracts. Consultancy contracts worth US$ 332.79 million were signed in 2020. Eight contracts with a total value of US$ 11.72 million were placed with one consulting firm.”

Another audited case analyzed the procurement of COVID-19 related emergency equipment.  Ninety percent of the US$ 866.72 million spent in 2020 by the WHO went to the purchase of medical supplies and materials, including personal protective equipment and Covid-19 testing kits.

While acknowledging “the fact that 2020 was an abnormal year for the medical sector, which saw disruptions in the market and supply chain due to a surge in demand and shortage of supplies,” Subramaniam and his team also note that they identified “deficiencies in quality assurance and technical evaluation” and a “lack of objectivity in bid evaluation and selection of suppliers the testing kits,” stressing that “the procurement system suffered from inadequate documentation and lack of supplier performance evaluation.”

When the COVID-19 crisis hit in early 2020, the WHO did not have clear technical specifications for PPEs even as the auditors write, “the critical importance of PPE was known to WHO from the previous outbreaks over the last two decades, including the recent Ebola virus disease outbreak. As part of its preparedness for emergencies, WHO should have adopted specifications for PPE much earlier.”

That led to the WHO having to cancel orders for protective gowns worth US$ 4.42 million after a WHO supplier spotted quality issues. The auditors’ report not only reveals that it took WHO more than four months to cancel the orders and place new ones with another firm, but that the credential of the new firm could not be verified: “Before issuing the purchase order and while examining the credentials of Firm U, the Firm was asked to give references of its past customers. The Firm initially declined to give the references on grounds of confidentiality. Later the Firm gave the names of three customers. While two customers did not confirm, the third customer did not exist. Further, it was seen that the Firm did not have an export license. Despite these anomalies, orders were placed with the Firm.”

All red flags that according to the inspectors, the WHO ignored.

“The pandemic has upended many things and it’s not a surprise that last year’s audit is therefore more critical than the years before,” the same diplomat tells The G|O. But, besides the severity of its conclusions, what is also striking in the report is the number of occurrences and the care the investigators take in calling WHO’s explanations unconvincing.

Such is the case in the signing of a consulting firm’s contract.  Again, let’s let the audit speak:

“At the start of the pandemic in March 2020, Consultant A offered ‘pro bono’ services to help WHO in procurement and supply of PPE and essential equipment. WHO accepted the offer and engaged Consultant A. According to the offer of Consultant A, the firm was to provide the service for seven months, in different phases.  The total cost of the engagement, as worked out by Consultant A, was US$ 7.30 million, of which 55% (US$ 4.03 million) was to be borne by Consultant A, 35% (US$ 2.53 million) by WHO and about 10% (US$ 0.73 million) by The Bill & Melinda Gates Foundation.”

“We are of the view that calling this engagement pro bono is not correct because Consultant A had proposed a project of US$ 7.30 million in which WHO was made to commit US$ 2.53 million. Details of how the pro bono services were valued was not available on record.”

Diplomatic sources told The G|O that the report of the External Auditor is being meticulously studied by the WHO Member States.

“We hope our inputs and the lessons learned are used to strengthen the system of emergency procurement so that WHO is better prepared for the next emergency,” Khrisna Subramaniam told the World Health Assembly last week in introducing his report.

He will be closely monitoring the implementation of his recommendations.