The financial sustainability of the WHO and the political economy of global health governance
Unraveling Global Health Financing
The World Health Organization (WHO), established in 1948, stands as a pillar of global health governance, working tirelessly to address pressing health challenges worldwide.
However, the WHO's effectiveness has been hampered by a range of financial challenges that have sparked debate and concern among global health scholars, policymakers, and stakeholders. In this article, we delve into the intricate landscape of WHO financing, outlining the major critiques, challenges, and opportunities for reform.
I - Predictability and Sustainability of Organisational Funding
One of the foremost concerns surrounding the WHO's financial structure is the unpredictability of its funding sources. The organization primarily relies on assessed contributions (ACs) from member states, which are based on each country's wealth and population. However, this system has faced significant hurdles. The shift from "zero real growth" to "zero nominal growth" policies has disassociated ACs from inflation and currency adjustments, rendering the WHO increasingly reliant on extra-budgetary funds (EBFs). This dependency has left the organization vulnerable to fluctuations in donor support, hindering its ability to respond to emerging health crises.
The solution to this challenge lies in enhancing the predictability and sustainability of WHO's funding. Proposals have been put forth to diversify funding sources, including attracting new donors such as foundations, emerging economies, and the private sector. The aim is to increase the organization's flexible and unearmarked funds while safeguarding its autonomy. Ensuring sustainable financing will require member states to consider raising their mandatory ACs, possibly doubling the overall budget with a significant portion coming from ACs. This move would reduce the WHO's reliance on volatile voluntary contributions (VCs) and enable the organization to carry out its vital work effectively.
II - Improved Transparency and Accountability in Financial Governance
A lack of transparency and accountability in WHO's financial governance has been a consistent challenge, undermining confidence in the organization's performance. In a rapidly evolving global health landscape, transparency is crucial for maintaining trust among member states and donors. Several proposals have been made to address this issue. These include disclosing disbursements to regional offices, enhancing communication, and implementing external evaluations to demonstrate the value of WHO's activities. By embracing these measures, the WHO can create a more transparent and accountable financial environment, bolstering its credibility and fostering trust among its stakeholders.
III - Organizational Function and Financial Autonomy
The WHO's scope and function have been subject to ongoing debates. Some argue that it should refocus on areas where it holds a comparative advantage, while others suggest outsourcing certain activities to other global health organizations. Decentralized governance and the redistribution of funds to individual countries have also been considered. The underlying principle is to ensure that the WHO's financial resources are used efficiently to achieve its objectives while maintaining its financial autonomy.
At the core of this issue is the need to preserve the WHO's leadership role in global health governance. To do this, it is suggested that the organization should concentrate on setting standards (normative functions) and leave technical matters to other agencies. Proposals for a multi-stakeholder forum to address global health issues have been put forth but faced challenges due to lack of support.
IV - Existential Conundrum
The debate surrounding the WHO's financing structure also uncovers a philosophical challenge. Some states are hesitant to invest in the WHO, perhaps due to concerns about relinquishing state sovereignty in favor of global institutions. This reluctance is amplified by the changing global political order and increasing insular politics. Bridging this philosophical gap is essential to strengthen the WHO's financial foundation and enable it to lead global health governance effectively.
In conclusion, the journey toward WHO financing reform remains a work in progress, with several critical focal points demanding attention.
First and foremost, the pursuit of improved transparency, flexibility, and predictability within WHO's financial structure stands as a paramount objective. Significant strides are still needed to ensure that contributions from member states align more effectively with the organization's goals, while also accommodating the flexible demands of emerging health issues.
The WHO financing dialogue plays a pivotal role in fostering better understanding and cooperation among stakeholders, ultimately improving the organization's financial operations.
Yet, a formidable challenge remains, casting a shadow over the WHO's autonomy and global leadership. The heavy reliance on external donors for funding major programs has the potential to influence the organization's priorities and agendas. It threatens the autonomy essential for the WHO to lead the way in global health governance. The delicate balance between securing financial support and maintaining independent decision-making looms as an ongoing concern.
The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals
https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0436-8