An influential sub-committee of the World Health Organisation (WHO)’s Executive Board (EB) has greenlighted a proposal by the cash-strapped global body’s Secretariat to seek additional funds via a replenishment fund, that would be filled by voluntary donations from both member states and philanthropies recruited at high-profile events.

In its report published on Monday just as the WHO’s Executive Board’s began a week-long meeting, the Programme, Budget and Administration Committee (PBAC), accepted that a replenishment fund could provide an avenue for flexible funding that the WHO so desperately needs.

“The committee acknowledged WHO’s need for more flexible, predictable and sustainable financing and considered that a replenishment mechanism provided a possible solution, especially for chronically underfunded areas of the organization’s programme budget,” according to the report, which concluded the deliberations of the three-day meeting of the PBAC last week.

The Global Fund to fight AIDS, Tuberculosis and Malaria raised $15.7 billion in its ‘replenishment drive’ last year, while Gavi, The Vaccine Alliance as well as the World Bank and other UN-backed global organisations also run replenishment fundraising drives to attract additional funds from donors. 

Last year’s World Health Assembly mandated the WHO Secretariat to explore a replenishment fund based on six principles, including that it is driven by member states, allows flexibility in allocation, covers the base budget, and aligns with the WHO’s resolutions.  

Funding crisis

The Executive Board is now expected to consider the proposal further this week in a series of discussions on improving WHO’s financial sustainability.  A nod by the EB would pave the way for a full-fledged vote by the World Health Assembly in May.  

At the EB’s opening session on Monday, Director General Dr Tedros Adhanom Ghebreyesus confirmed that he expected that the proposal for a replenishment process would be submitted to member states for consideration.

“We recognize that with increased flexibility and sustainability come increased expectations for transparency, efficiency, compliance and accountability. All of this leading to results,” said Tedros.

Only around one-fifth of the WHO’s budget comes from members’ countries’ “assessed contributors” (calculated on their GDP), with the rest being made up from donations. But the donations are usually tied to particular programmes, inflexible and can be withdrawn at any time.

At last year’s World Health Assembly, member states agreed to increase their contributions to cover half of the WHO’s budget. This year, members’ annual contributions are slated to be increased by around 20%.

However, even when member states increase their contributions, there will still be a gaping shortfall, obviously undesirable given disease outbreaks and other demands.

Developing the replenishment option

Recommending that the executive board accepts the replenishment mechanism, the PBAC has advised the secretariat to develop the proposal further by examining “replenishment mechanisms established by other global health organizations and [analysing] the advantages and disadvantages of the various systems”.

It also recommended that the “funding envelope for a replenishment mechanism should be based on the base segment of the programme budget, minus approved assessed contributions”. 

Still up for discussion is whether the fund will be based on the budget over one (two-year) budget cycle or two (four-year).

More money for country offices

PBAC has also recommended that the WHO secretariat consider further increases to its country operations rather than head office and regional structures. However, while the secretariat confirmed its commitment to strengthen country offices, it said that this would only be possible “gradually over time”.

The WHO secretariat told PBAC that the main reason for the uneven financing of its programmes was “the extremely tight earmarking of the funds it received”. Director-General Dr Tedros Adhanom Ghebreyesus told the committee that member states’ agreement to an increase in assessed contributions would “make all the difference”.

In response, the committee proposed that the Secretariat should “improve the persistent uneven financing across programmes, major offices and levels of the organization, including by distributing undistributed funds”.

As far as the 2024/25 WHO budget is concerned, PBAC has recommended that  member states should have until 10 February “to study and provide feedback on the programme budget digital platform” to allow proper consideration of the proposed budget ahead of the World Health Assembly in May.