Financing the WHO: emerging dependence on extra budgetary funds
In 1993 Gill Walt (Health Policy 1993;24:125-44) declared WHO to be in crisis; a crisis of funding and legitimacy.
"A crisis is increasingly challenging the authority and prestige of the United Nations’ specialized agencies. Although the World Health Organization is still held in great repute, it has not escaped criticism. Member countries have expressed concern about WHO’s bureaucratic procedures, costs, proliferation of meetings, reports, lack of budget transparency. Doubts have been cast on the effectiveness of some programmes. This paper argues that such criticisms must be understood within the context of the huge changes that have occurred since WHO was established in the late 1940s. There has been a major shift in the financing of WHO, with extrabudgetary funding now providing more than half the total budget, which has implications for policy influence within the Organization. Policy is also being decided within an increasingly political milieu. These changes put significant pressure on the Organization in a number of ways, and it is essential to generate a public debate about WHO’s future role if the Organization is to retain the esteem within which it is generally held. This paper makes an initial contribution to that debate."
In September 1994 the Governments of Australia, Norway and the United Kingdom, with the support of WHO, commissioned an international research and consultancy team to focus on the role of EBFs in the WHO, particularly at the global level. The team also reviewed the policies of the three donor governments towards WHO, together with the support provided to the Organisation by the UN Development Programme (UNDP), UNICEF, UN Population Fund (UNFPA) and the World Bank. The team did not include an evaluation of WHO country activities. The main sources for financial data were the WHO programme budgets and the audited accounts that are presented to the World Health Assembly. The full report was published but does not appear to be available on line.
In 1996 the team published an article in Health Policy (35, 229-245) based on their report to the three governments and entitled: 'Financing the World Health Organisation: global importance of extrabudgetary funds'. The abstract follows.
From 1948, when WHO was established, the Organisation has relied on the assessed contributions of its member states for its regular budget. However, since the early 1980s the WHO World Health Assembly has had a policy of zero real growth for the regular budget and has had to rely increasingly, therefore, on attracting additional voluntary contributions, called extrabudgetary funds (EBFs). Between 1984-85 and 1992-93 the real value of the EBFs apparently increased by more than 60% and in the 1990-91 biennium expenditure of extrabudgetary funds exceeded the regular budget for the first time. All WHO programmes, except the Assembly and the Executive Board, receive some EBFs. However, three cosponsored and six large regular programmes account for about 70% of these EBFs, mainly for vertically managed programmesin the areas of disease control, health promotion and human reproduction. Eighty percent of all EBFs received by WHO for assisted activities have been contributed by donor governments, with the top 10 countries (in Europe, North America and Japan) contributing about 90% of this total, whereas the UN funds and the World Bank have donated only about 6% of the total to date. By contrast, about 70% of the regular budget expenditure has been for organisational expenses and for the support of programmes in the area of health systems. Despite the fact that the more successful programmes are heavily reliant on EBFs, there are strong indications that donors, particularly donor governments. are reluctant to maintain the current level of funding without major reforms in the leadership and management of the Organisation. This has major implications for WHO’s international role as the leading UN specialised agency for health."
The full report or the article in Health Policy provide very useful background to the current discussions.
Now return to WHO Watch topic: WHO Reform