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