WHO’s Finance Structure is ‘Fundamentally Rotten’ – Reforms On Table Next Week Would Restore Responsibility to Member States
Björn Kümmel, Germany’s deputy head of global health in the Ministry of Health

The way in which WHO is financed is “fundamentally rotten” with excessive financial dependence on just a handful of rich countries and a few private donors. 

But Germany’s deputy head of global health in the Ministry of Health, Björn Kümmel, is hopeful that WHO member states may turn course in coming months – and reclaim responsibility for the financial support of the global health agency.  

A member state Working Group on Sustainable Finance is due to meet Monday, for the fifth time this year, to consider a set of recommendations that would see regular assessed contributions paid by member states to fund WHO rise to 50% of its budget by the 2028-2029 fiscal year.  Currently, the regular annual fees assessed to WHO’s 194 member states represent only about 16% of the agency’s US $3 billion a year annual budget for 2020-2021.

The draft recommendations, which still need approval by the Working Group, also call for exploring a “replenishment mechanism” to broaden further WHO’s financing base – a model that has been successfully used by public-private partnerships like the Global Fund and Gavi to drive higher budget pledges from countries and foundations in high-profile events – but without strings attached to the money. 

If the Working Group of member states gives the greenlight, then the reform proposals would go to the Executive Board in January 2022 and then to the full World Health Assembly for its 75th meeting in May. 

Kümmel, speaking at an event on Sustainable WHO Finance Tuesday, moderated by Suerie Moon, co-director of Geneva Graduate Institute’s Global Health Center.

He said that the Working Group had heard testimony from several different independent committees that had recently reviewed WHO’s operations and performance in the wake of the COVID pandemic, and: 

“All of them shared the view that, in my words, WHO’s financing is fundamentally rotten.”

Piecemeal reforms no longer possible 

“Practically, it’s not possible to come up with piecemeal reforms, but we need to change the way, substantively, how WHO is financed,” said Kümmel, who chairs the WHO Working Group as well as serving as vice-chairman of the WHO Executive Board. 

The Independent Panel [IPPR], in its report, had even recommended that 66% of WHO’s funds should come from regular, assessed contributions by its 194 member states, Kümmel noted. “And the  remaining part should be financed through a replenishment model that we already know, is useful and is well working, working at the Global Fund, Gavi [the Vaccine Alliance] and the World Bank.”

The other key recommendation is that all of WHO’s core budget operations should be funded in a “fully flexible manner”, so that individual donor countries included, can no longer “earmark” those contributions to their pet projects and initiatives. 

Such earmarking, now a trademark of WHO financing, creates distortions whereby WHO’s top leadership cannot prioritize according to wide strategic goals.  

“The donor could, for example, say the funding should be used only in Switzerland and by an officer who is called to do something very specific – and not what WHO, the entirety of the 194 member states have budgeted,” he said. 

In addition, such “voluntary” funding by countries is also unpredictable – and if it arrives too late in the Organization’s two-year budget cycle the funds can’t be effectively applied to activities, and implemented efficiently.   

High dependency on limited number of country donors – and Bill Gates

Top contributors to WHO’s Budget (2018)

The current funding structure has made WHO highly dependent on a “very limited” number of donors, Kümmel noted.  

“I think roughly the top 18-20 donors provide, on a voluntary basis, roughly 90% of what is being implemented.  We member states are always very proud to say that WHO is member-state owned and driven organization.  Well, that is true of 16% of what WHO does.  The rest is owned and driven by individual donors. 

“And I think that is what we need to realize… we need to open our eyes to something that we’ve pushed away, because it’s not comfortable … It means that all of us need to invest more, in order to make it our organization again, and to align, practically, the political will with finances. 

The distortions are so great that had the United States really pulled out of WHO, as former US President Donald Trump had pledged to do last year, one single foundation would have remained as WHO’s the single largest funder of WHO, Kümmel said, in a clear reference to the Bill and Melinda Gates Foundation.  

Added Moon, “And in many ways, this was a bit of a wakeup call to a number of member states, regarding this years-long debate about if it is truly a member state-financed, owned and governed?” 

Political will to move on the reforms? 

Big questions still remain as to whether the World Health Assembly of member states have the political will and financial means to move on the reforms, said Moon at the session, which was staged as a conversation between the GHC co-director and her German interlocutor. 

However, Kümmel pointed out that other reform initiatives currently being considered – such as the $10 billion-a-year pandemic emergency fund – will cost far more than the proposed new assessments on member states to fund WHO more sustainably. 

In comparison, the cumulative cost to all 194 member states of changing the financing structure would be only about $1.2 billion a year. 

“So I think money doesn’t seem to be the challenge here,” Kümmel stated. 

In addition, the Working Group has already moderated the reform proposals made by others, such as the independent panel, to fund two-thirds of WHO’s annual budget with regular, assessed contributions by its member states . 

“Consciously we moved away from the even bolder and more ambitious proposal by the IPPR to start straight away to increase [country’s assessed contributions] to 66%. Our proposal foresees an increase to 50%.” 

Growing momentum at ‘greatest crisis since World War 2’

Kümmel added that he senses “growing momentum” among member states in support of the proposed changes.  During the deliberations of the Working Group, which has been meeting since last spring, some 75 member states submitted written proposals that “explicitly supported both steps forward – especially with regards to substantively increasing the assessment budget.

“I’ve been focusing on WHO’s budget now for most likely a decade,” he said, “and I haven’t seen this coming up [in this way] before – so that it becomes clearer and clearer that member states need to take over.

“We are in the wake of the greatest crisis, from a German point of view, since the Second World War,” he added. “With WHO being in the middle of it, with clear indications that WHO’s ability and expectations far outweigh the given abilities, and that we would be much better positioned with a stronger WHO.”  

At such a watershed moment, a bigger investment in WHO is “a very good investment, given the fact that much of the crisis we are finding ourselves in now, potentially could have been averted  by a stronger WHO – and all experts share the view that this is not the last global health crisis.  So we better set up a system that really helps us to prevent crises that we are finding ourselves in… .

“For everyone who watched the WHA Assembly Special Session, just last week, there were statements by presidents and health ministers and whoever – all of them said ‘we need a stronger WHO, and a stronger WHO is impossible without tackling this historic challenge of sustainable financing. 

“There’s one way of proving by a member state that they want a strong WHO – and we will see that next week. And that is practically to strengthen the organization.” 

Image Credits: WHO .

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