WHO’s big idea: what if countries peer-reviewed each other’s health systems?

Perhaps one of the most positive and palpable results of the proximity between international organisations offered by Geneva’s multilateral ecosystem is the Universal Periodic Review (UPR), a state-led, peer-reviewed and cooperation-based process, set up by the UN Human Rights Council in 2006, and meant to ensure the respect of human rights worldwide.

As the World Health Organization (WHO) celebrates its 75th anniversary and holds its World Health Assembly from 21 to 30 May, several countries are considering introducing a similar mechanism: the Universal Health and Preparedness Review (UHPR).

‘All in the same boat’

“It would be a trust-based instrument in which countries commit on a voluntary basis to take stock of their health system through the eyes of their peers, meaning other countries,” a diplomat said. 

As an intergovernmental mechanism, the UHPR’s aim is to help countries improve their health systems and is underpinned by the increasingly-generalised idea that health issues now transcend borders like never before. As WHO director general Tedros Adhanom Ghebreyesus often stressed throughout the Covid-19 pandemic: “We are all in the same boat.” 

The UHPR rests on the idea that it’s in every country’s best interest that the health system of their neighbour is working well. In order to raise all country standards, the health review would follow the same approach as the Human Rights Council’s UPR: no naming and shaming, no pillorying a country for its health record, but rather helping it improve.

The periodic health review would take place every five years and governments would be free to choose whether to submit to it or not. The evaluation would consist of two phases: At the national level, the government and civil society organisations would assess what is working and what isn’t in the country’s health system. By engaging all actors, this first phase would help “strengthen national capacities in terms of preparation for a health emergency” and “update a health security action plan”. 

This type of exercise has already proven its worth: At the Human Rights Council, the UPR has had an unexpected effect on countries – spurring state services, civil society and the private sector into action, and has exposed the hidden fault lines in efforts to protect fundamental rights.

The second phase of the UHPR would consist of a peer review by WHO member states, where every country would be assisted by a group of three countries called the troika. States would hold a dialogue to share their conclusions on the country’s report, make recommendations on gaps detected and exchange best practices. The process would take place during a special session at the WHO and the final report would be submitted to the health organisation’s executive board, followed by the World Health Assembly.

Resistance

Summing up the ins and outs of the mechanism, Tedros told the 73rd World Health Assembly in 2020: “Its purpose is to build mutual trust and accountability for health, bringing nations together as neighbours to support a whole-of-government approach to building national capacity for pandemic preparedness, universal health coverage and healthier populations.”

The UHPR is already in the works. Four states have launched phase one, consisting of a national review, or check-up, of their own health systems. This is the case of the Central African Republic (the UHPR’s first proponent), Iraq, Portugal and Thailand. Several other countries have also shown interest, including Switzerland, the United States, Germany, France, the United Kingdom, Benin, Cameroon, Indonesia, Luxembourg and the Maldives.

The first peer review may be held as soon as July. “The mechanism could be included in the future pandemic treaty that will be struck by May 2024,” the diplomat said. The UHPR and the treaty share the same aim: to strengthen national health systems for the world to be better prepared to face future pandemics. It could also help the pandemic fund, created in 2022 by the World Bank under WHO’s technical leadership, to identify weaknesses and gaps in national health systems.

But obstacles remain. Some countries are not ready to be held accountable for the performance of their health systems. Low- and middle-income countries may also be reluctant to show how little they invest in health, and military forces may have their own reservations about other countries having a peek at their virus surveillance systems. 

In principle, Russia and China are not opposed to the idea, but they would like more clarity on the mechanism. Some countries have said they are satisfied with the Joint External Evaluation (JEE), a similar mechanism proposed by former US president Barack Obama’s administration, and overseen by the WHO. But others consider it too American and have called for a more universal process like the UHPR.