WHO Funding Inequalities Drive African Calls For Change At World Health Assembly World Health Assembly 73 11/11/2020 • Paul Adepoju & Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) WHO Financing by Regional Major Office Despite nearly two years of internal restructuring, WHO’s budget at its Geneva headquarters is still twice the amount spent in all 54 countries of the Organization’s African Region, said the African bloc of stated at Wednesday’s World Health Assembly. Speaking on behalf of the African bloc, Seychelles noted that the most recent WHO financial report highlights the continued trend of disproportionate spending in its Geneva headquarters in comparison to the Organization’s six regional offices and nearly 100 country offices. Under a “transformation” plan announced by Director General Tedros Adhanom Ghebreyesus in 2019 WHO Regional and Country offices, which are maintained in the countries of most low- and middle-income WHO member states, are supposed to be assuming a greater leadership role – with more resources allocated to their needs. But as of end 2020, more of the $US3.7 million annual budget is still being spent at WHO headquarters than anywhere else — including Africa, where WHO teams desperately need more funds to tackle problems associated with the continent’s high disease burden and systemically weak national health systems. “Apportionment of funds to Headquarters remains higher than other regions,” said the Seychelles representative, speaking on behalf of the African bloc during a review of WHO’s 2020-21 biennial budget. “It is twice higher than apportionment to Africa which has weak health systems and burdens. There is the need to shift resources from WHO HQ to where the health issues are, and more can be achieved,” the spokesperson concluded. Rich Countries Call for Greater Investment in Primary Health Care and NCDs Meanwhile, countries ranging from Japan to China and Norway have enjoined the WHO to commit more resources to the prioritisation of universal health coverage and combating the non-communicable diseases – which are a growing problem in poor as well as rich countries today. Japan’s delegate noted that efforts should be made towards ensuring that finance and health ministers of member countries are able to collaborate in order to ensure mutual understanding of national and global health financing priorities, especially in countries that are struggling to meet their financial commitments to the WHO. For the WHO, Japan also urged the global health body to strengthen accountability and enshrine transparency more deeply into its operations. It also called for an independent assessment to ascertain resources were being deployed and used in the most efficient way. The delegate for the People’s Republic of China added that funding gaps exist in non-communicable diseases and such gaps will only be closed when member countries of the WHO pay their contributions on time. LMIC Member States Decry Negative Impact of COVID-19 on their Ability to Contribute to WHO Although WHO’s leadership has also called upon member states to step up to the bat with larger and more predictable funding, Member States said they are already having a hard time paying the current annual assessments to WHO – as a result of the pandemic’s economic fallout. Argentina cited COVID-19 as reason for its delay in paying annual assessed fees to WHO – but pledged to fulfill its commitments. “We are making our payment. We’ve made partial contributions for 2019 and we hope to meet pending balances,” the country’s representative said. Wars and civil conflicts have also compounded pandemic problems for some countries. Libya’s delegate, for instance, pointed to the suspension of oil extraction activities, the country’s major source of revenue generation. “Hostilities have halted oil production but we are working with Tunisia to work out an arrangement. By the end of 2020, we hope to have resumed oil production again and we are asking for global solidarity,” Libya’s representative said. Funding Shortfalls Constrain Operations Funding for the WHO has been a recurring topic at the World Health Assembly. In his opening remarks on Monday, Dr Tedros said that WHO’s member states need to step up to the bat. Dr Tedros Adhanom Ghebreyesus, WHO Director General. Right now, regular “assessed contributions” comprise only 20% of the organization’s budget, and that is a diminishing proportion. The bulk of the money comes from additional voluntary funding provided by countries and other donors. But ‘earmarking’ of those funds often constrains WHO’s ability to spend money according to its own defined priorities. . “Predictable and sustainable funding remains one of the fundamental challenges for the future success of this Organization. For WHO to do its job, we must address the shocking and expanding imbalance between assessed contributions and voluntary, largely earmarked funds,” the DG said. Over the past decade, Dr Tedros said, the world’s expectations of WHO have grown dramatically, but the organisation’s budget has barely grown at all. Those expectations, he said, will only continue to increase in the wake of the COVID-19 pandemic. “Our annual budget is equivalent to what the world spends on tobacco products every single day. If the world can send that much money up in smoke every day on products that maim and kill, surely it can find the funds – and the political will – to invest in promoting and protecting the health of the world’s people,” the DG added. Too Dependent on Handful of Donors Tedros also has admitted that WHO is too dependent on a handful of large donors, and there is need to broaden the donor base overall. WHO funding by fund type and contributor To that end, he last year announced the creation of the WHO Foundation. The Foundation can draw funds directly from the private sector and individual donors – something that WHO’s strict conflict-of-interest rules generally prevent. However less than a year after those moves were put in motion, the COVID-19 pandemic hit – vividly illustrating the shortcomings between expectations and delivery of the WHO’s emergency response in a number of arenas. Particularly evident was the slow scientific response to urgent issues like whether the virus was airborne or not, whether masks were useful, and whether or not travel restrictions would help curb the spreading pandemic. While some of the delays may have been due to the conservative nature of WHO – which simply re-issued the same kind of travel and public hygiene advice that had been a standard for other epidemics – it was also blamed on a lack of in-house scientific know-how. In July, an announcement by the US Administration that it would withdraw its funding – which comprises some 15% of the Organization’s operations, including a significant proportion of resources that go to the African Region and the WHO Health Emergencies Programme. The shock has prompted a rethinking among European donors, led by Germany, about how to improve WHO’s budget and make it more sustainable over time. Speaking Monday at the resumed 73rd WHA, on behalf of the European Union, German health minister Jens Spahn said the COVID-19 pandemic had highlighted “a gap between WHO‘s 194 member states’ expectations and requests vis-à-vis the organization and its de facto capacities to fulfill them.” Jens Spahn, Federal Minister of Health, Germany, speaking at the WHA. Pockets of Poverty While there is a drive to bolster scientific staff and expertise presumably at headquarters in the wake of the pandemic, the underfunded WHO regional and country offices of the low and middle-income countries are also a big donor concern. At a WHA debate over the budget, extending over Tuesday and Wednesday, another German WHA delegate acknowledged the “pockets of poverty” that are often seen in specific programmes or WHO offices. Each year, again and again … with a déjà vu we see pockets of poverty — so specific programs that have not received adequate funding,” the official said of the assembly. “Within the last 10 years, many options have been explored in order to change the situation but the financing challenge has not been properly addressed.” But another problem, said the delegate, is that information provided by WHO, which informs WHA members’ debate, is “often not adequately grounded on a thorough analysis. We are discussing earmarked versus flexible, predictable versus non-predictable funding. But we never discuss what the consequences and implications are for WHO to perform.” As a way forward, Germany has now proposed placing an item on sustainable financing on the agenda of the January 2021 WHO Executive Board – the next meeting of WHO’s 33-member governing body. The “ask” from donors is that WHO provide a coherent account here of its current financial state – and how it affects its capacity to deliver, and what realistic needs it has – as well as alternatives for expanding the overall pool of donors – and money. Image Credits: WHO, WHO. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.