Encouraging donors that make voluntary contributions to the World Health Organization’s (WHO) budget to enable these to be flexibly allocated rather than ringfenced for specific programmes might be more effective to “resolve the structural defect of WHO’s funding model than periodically calling for more assessed contributions from member states”.

This is according to a new paper published in the BMJ, which reveals that 88% of WHO’s biennial programme budget comes from “voluntary contributions” – almost 10% higher than the four-fifths that the organisation claims on its website.

WHO gets its money from two main sources – the assessed contributions (ACs) of member states, which are flexible, and voluntary contributions (VCs) from member states and non-state actors that are “overwhelmingly earmarked” for specific programmes and projects.

“While ACs remain at their mid-1990s levels because of the zero growth policies of the 1980s and 1990s, VCs have increased over the last decade from 75% to 88%,” the UK-based authors note, based on WHO figures from between 2010 and 2021.

Researchers Obichukwu Iwunna, Jonathan Kennedy and Andrew Harmer note that, as voluntary contributions are earmarked for donor-specified programmes and projects, “there are concerns that this trend has diverted focus away from WHO’s strategic priorities, made coordination and attaining coherence more difficult, undermined WHO’s democratic structures and given undue power to a handful of wealthy donors”.

“Surprisingly, the share of voluntary contributions provided by upper middle-income countries was consistently less than the share by lower-middle-income countries. Furthermore, in terms of their share of voluntary contributions, we found that upper middle-income countries contributed the least proportion of their gross national income to WHO.”

“Conversely, ACs have fallen gradually, from 25% of WHO’s biennial programme pudget in the 2010–11 biennium to 12% in 2020–21. As a percentage of WHO’s total revenue, VCs to the General Fund constituted 60% in 2010–11, increasing to 84% in 2020–21.”

The researchers urge the Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance to “broaden its focus on VCs to include research to better understand why donors prefer to voluntarily fund WHO”, focusing on “the incentives that determine donor support for specified and flexible voluntary contributions”.

Image Credits: Germany's UN Mission in Geneva .