Björn Kümmel, chair of the World Health Organization’s (WHO) working group on sustainable financing, wants to complete two marathons this year: an actual road race in Berlin – and the adoption of proposals to improve the WHO’s financing at the World Health Assembly (WHA) currently in session.

For 18 months, Germany’s Kümmel has steered discussions aimed at reforming the WHO’s finances as chair of the working group on sustainable financing. 

Only around 16% of the WHO budget is predictable, derived from member states’ fees, called “assessed contributions”. The other 84% comes from grants and voluntary contributions from members, skewing the global body’s programmes and making it hard to respond with speed and flexibility to health emergencies.

‘Severe risk’

“This situation has put WHO at severe risk, including its independence, its integrity, its agility and certainly also it’s mandated role to be the world’s leading and coordinating authority in global health,” Kümmel told the WHA’s meeting of Committee A on Monday.

He was reporting on the consensus reached by the working group last month on a package of measures, including that 50% of the WHO’s budget should come from assessed contributions by 2030, starting with an increase to 20% by next year’s WHA.

This is not a technical issue but a “gamechanger”, Kümmel told the committee. 

“It was clear for the working group that what we were discussing is nothing less than the future role of the WHO and global health and even beyond. Namely, the question, what kind of global health architecture do we envisage: a less fragmented, better coordinated, more efficient and truly inclusive global health governance with a fundamentally strengthened WHO at the centre as the enabled, leading and coordinating authority.”

History in the making as @WHO Member States discuss recommendations of the Sustainable Financing Working Group.

Björn Kümmel 🇩🇪 perseverant Chair of the Group, presents the report with delegations behind, supporting#WHA75 https://t.co/n6lAYS0BYY

pics:@MrGabrielValdes pic.twitter.com/yS5Iti1DrW

— Marta (@MartaSeoaneWHO) May 23, 2022

WHO staff tied up with grant management

Earlier in the day, WHO Africa director Dr Matshidiso Moeti told a WHA roundtable meeting on WHO financing that the global body was managing around 3,000 grants.

“Many of our staff members are spending a disproportionate amount of their time processing these grants,” said Moeti. 

In addition, said Moeti, Africa was seen by donors as being “overwhelmed by communicable diseases” and this has resulted in a lack of funds for non-communicable diseases.

If there was more flexibility in funding, the WHO could “address the health systems needs of the countries for preparedness, for providing essential health care services, for being resilient when we have to encounter such a problem as the pandemic we’re experiencing now”, she added.

She compared WHO’s funding model to that of “an average African country, which is highly dependent on donor funding” and “structured in this very vertical fragmented manner”.

This was inefficient, and made countries vulnerable rather than resilient to a pandemic, she said, appealing to member countries to support the changes being proposed by the working group.

Supporting her in the session, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that it was “not about the money” as the WHO had received significant donations during the pandemic – but rather the flexibility to spend the money where it was most needed.

‘Constructive multilateralism’

Describing the process of reaching consensus in the working group as “constructive multilateralism”, Kummel told the WHA committee that “any substantive AC increase would need to be supported by concrete steps to ensure that agility of the WHO, therefore the working group on sustainable financing also recommends the establishment of an agile member states task group”.

This was well-received by member states, with unanimous support for the financial reforms – to the relief of Kummel who described the process as “a marathon run” at the roundtable event before the committee.

“But it was a good run because we ran as a team, and we are still running as a team. There are two things on my to-do list for this year. The one is the Berlin marathon that is in September. The other one is to get this over the finish line and we will have the chance to get this over the finish line, most likely this afternoon,” he told the roundtable.

The WHA will vote on a resolution based on the working group’s decision later in the week.

Image Credits: WHO.