A ghost in the machine? Politics in global health policy.

Members of the 67th World Health Assembly in 2014 were presented with a framework document to guide World Health Organization (WHO) engagement with non-state actors, a key part of WHO reform kick-started in 2011. According to this document, non-state actors include four distinct constituencies: i) non-governmental organizations (NGOs), ii) private sector entities; iii) philanthropic foundations; iv) academic institutions (1). While the WHO has collaborated in a variety of ways with non-state actors since its foundation, a comprehensive policy for engagement has remained elusive and politically fraught. Some commentators are concerned that a more formal engagement will strengthen the already undue influence of well-resourced non-state actors, particularly companies, who seek to influence policy and priorities through extra-budgetary project funding (2). The World Health Assembly has requested the WHO Secretariat to go back and develop the policy further, leaving the organisation without clear guidelines on how it is to engage with non-state actors.