McMaster Health Forum and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Bull World Health Organ. 2012 Nov 1;90(11):854-63. doi: 10.2471/BLT.12.109827. Epub 2012 Oct 11.
The Member States of the World Health Organization (WHO) are currently debating the substance and form of an international agreement to improve the financing and coordination of research and development (R&D) for health products that meet the needs of developing countries. In addition to considering the content of any possible legal or political agreement, Member States may find it helpful to reflect on the full range of implementation mechanisms available to bring any agreement into effect. These include mechanisms for states to make commitments, administer activities, manage financial contributions, make subsequent decisions, monitor each other's performance and promote compliance. States can make binding or non-binding commitments through conventions, contracts, declarations or institutional reforms. States can administer activities to implement their agreements through international organizations, sub-agencies, joint ventures or self-organizing processes. Finances can be managed through specialized multilateral funds, financial institutions, membership organizations or coordinated self-management. Decisions can be made through unanimity, consensus, equal voting, modified voting or delegation. Oversight can be provided by peer review, expert review, self-reports or civil society. Together, states should select their preferred options across categories of implementation mechanisms, each of which has advantages and disadvantages. The challenge lies in choosing the most effective combinations of mechanisms for supporting an international agreement (or set of agreements) that achieves collective aspirations in a way and at a cost that are both sustainable and acceptable to those involved. In making these decisions, WHO's Member States can benefit from years of experience with these different mechanisms in health and its related sectors.
世界卫生组织（世卫组织）会员国目前正在讨论一项国际协议的实质内容和形式，以改善满足发展中国家需求的卫生产品研发的供资和协调。除了审议任何可能的法律或政治协定的内容外，会员国不妨考虑将任何协定付诸实施的所有执行机制。这些机制包括各国作出承诺、管理活动、管理财政捐款、作出后续决定、相互监督执行情况和促进遵守的机制。各国可以通过公约、合同、宣言或体制改革作出有约束力或无约束力的承诺。各国可以通过国际组织、次级机构、合资企业或自主组织的进程管理活动以执行其协定。资金可以通过专门的多边基金、金融机构、成员组织或协调的自我管理来管理。可以通过一致同意、协商一致、平等表决、修正表决或授权作出决定。监督可以通过同行审查、专家审查、自我报告或民间社会提供。各国应在各种执行机制类别中选择其偏爱的方案，每一种机制都有其优点和缺点。挑战在于选择最有效的机制组合，以支持以可持续和可接受的方式和成本实现集体愿望的国际协定（或一套协定）。在作出这些决定时，世卫组织会员国可以借鉴在卫生及其相关部门使用这些不同机制方面多年的经验。
