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November 24, 2015

Management of conflict of interest is the bedrock of governance in areas entailing partnerships: Dr Sania


November 24, 2015

Every year, the Union for International Cancer Control (UICC), a Geneva-based apex body with a membership of 900 organisations across 155 countries, convenes an annual high-level global meeting of cancer leaders to deliberate on emerging issues related to cancer. The meeting provides an important forum to secure a coordinated, multileveled global response to address the spiralling cancer epidemic, which is evidenced by the sheer numbers -- more than 8 million people dying from cancer annually and more than 14 million new cases every year. Each year, the World Cancer Leaders’ Summit adopts a different theme.
This year’s summit was held in Istanbul last week, and the theme centred on international collaboration.
According to the official UICC press release, the president of Heartfile Dr. Sania Nishtar from Pakistan was amongst the three high-profile speakers, alongside the Minister of Health of Turkey. The title of Dr. Sania’s keynote speech, ‘Conflict of Interest,’ was intriguing and hence ‘The News International’ sought an exclusive interview with her to better understand the relationship between conflict of interest and the theme of the conference, and the importance of conflict of interest more broadly.
Q: Why did a cancer summit focus attention on conflict of interest?
A: This September, a seminal agreement was achieved at the United Nations with pronouncement of the Sustainable Development Goals (SDGs). There are many differences between the Millennium Development Goals and the SDGs, but one of the most notable is the recognition that a multi-stakeholder partnership based response is needed to deliver on their premise. Public-private interaction has been strongly promoted in the new framework. I strongly believe that management of conflict of interest is the bedrock on which these partnerships need to be framed. Since this year’s cancer summit took place soon after the UN meeting, it was natural to focus on

international collaboration.
Q: What exactly is conflict of interest?
A: Conflict of interest arises in situations when a person or an organisation is involved in multiple, usually two interests, and a risk arises that the individual’s decision-making, judgment or actions in a primary area of interest will be influenced by a secondary interest.
Primary interest refers to the key goal of a professional activity, for example, the health of a patient, the integrity of research, or the duties of public office whereas secondary interest refers to financial gains, the desire for professional advancement, and the wish to do favours for family and friends.
Conflict of interest focuses more on financial relationships because they are relatively more fungible and quantifiable. Secondary interests become objectionable, particularly when they become more important to the individual or the organization, than primary interest.
Q: Does the existence of conflict of interest mean that partnerships cannot be forged?
A: The presence of conflict of interest does not mean the occurrence of impropriety and hence it does not forbid public-private interactions. The existence of conflict of interest means that there is a risk that judgment may be compromised; it does not mean that a lapse has actually occurred and therefore it underscores the need for appropriate management. There are generally two approaches to the management of conflict of interest. One, the “prohibition” model is based on a presumption against relationships that might present a conflict. Prohibition is relevant to organisations, which have a normative or a standard-setting role as it is inappropriate to risk situations where judgment can be compromised. In all other settings, by and large, the “disclosure and peer review” model applies, which rests on the presumption that such relationships are unavoidable but manageable.
Q: Can you give a few examples of conflict of interest?
A: Conflict of interest can be manifest in many different situations. The most common example is in the case of accepting personal gratuities, for example, if an employee receives a ‘free’ mobile phone from a vendor seeking a contract with the organization. “Just try it and see if you like it. No obligations.” Conflicting allegiances are also classed as conflict of interest. A procurement officer’s efforts to steer procurement decisions to favour a company where a family member works, is a case in point. Furthermore, using or disclosing confidential information also constitutes conflict of interest, which can be manifested in a situation where an NGO’s employee uses confidential donor list to solicit gifts for another NGO. Moreover, the most classical example would be maintaining roles that conflict and a hallmark example of this is a cabinet member’s fast-tracking of non-priority projects, which benefit a company in which s/he directly or indirectly has a stake.
Q: What are the mechanisms to hedge against conflict of interest?
A: Well, approaches fall on a spectrum, at one end of which are voluntary mechanisms such as disclosure, financial distancing, and self-regulation. At the other end of the spectrum are institutional approaches, which involve framing of conflict of interest policies and procedures, defining categories of acceptable activities, and a clear definition of what a significant financial interest to be reported is; the establishment of conflict management plans and processes to ensure that the plans are enforced.
Q: What kind of personal advice would you like to give to people and organizations to promote appropriate management of conflict of interest?
A: Management of conflict of interest is a central attribute of governance, especially in areas that entail public-private interaction. At the end of the day, we have to be conscious of and ground our actions in ethics and values, and must embrace integrity in personal and institutional behaviours. In every relationship, you should ask yourself if your actions feel right and if they reflect a basic understanding of generally accepted standards of right and wrong. In public-private interactions, what is important is to serve the public interest, support transparency and scrutiny, promote individual responsibility and lead by personal example.
Dr. Sania Nishtar was the ideal keynote speaker for this event for two reasons. First, because of her subject knowledge of governance and her personal commitment to transparency, which amongst other things was evidenced in the transparency approach to governance while she was in office as federal minister. And secondly, because of her subject understanding of Non-Communicable Diseases (NCDs), a group of four diseases of which cancer is a part. She has been at the forefront of the global discourse which led to NCDs being mainstreamed in the SDGs. In addition, she was also the author of the National Action Plan on NCDs in Pakistan, a strategic planning document, which to this date, continues to be referred to internationally as one of the best approaches to tracking NDDs.

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