WHO Pressured to Shift Spending from Geneva Headquarters to Countries
WHO EB 2023

One by one, countries demanded the World Health Organization (WHO) spend more on their countries’ needs while debating a proposal to shore up the U.N. health agency’s finances through a replenishment fund, that would be filled by periodic donor drives.

The discussion, which centred around demands to shift spending from WHO’s Geneva headquarters to budget-strapped WHO offices in over 100 low- and middle-income countries  dominated Tuesday’s morning session of its Executive Board (EB) meeting.

For the first time, more than half of WHO’s 2024-25 budget is earmarked for country offices. Despite an overall budget shortfall, African delegations want this increased to 75%. Historically, the region which bears the world’s biggest burden of many diseases, has also suffered from the biggest lack of resources. 

“The uneven funding of this biennium seems to be a repeat of the uneven funding from the previous biennium,” said Mahlet Hailu Guadey, Ethiopia’s Deputy United Nations Ambassador in Geneva, representing the African Union.

Guadey called for the WHO’s Secretariat to review what she described as uneven funding amongst priorities and regions.

The United States, one of WHO’s biggest financial backers, also repeated its conditional approval for increasing WHO’s assessed fees to countries, as long as those increases are  accompanied by new processes ensuring more internal controls and accountability.

Other nations, however, such as Poland, tried to put the brakes on more spending given the financial drain of global crises and conflicts, ranging from the COVID-19 pandemic to Russia’s war in Ukraine.

Flexible funding

Tuesday morning’s EB session was dominated by debate over a plan by WHO’s Programme, Budget and Administration Committee (PBAC) to support a ‘replenishment fund’ for urgently needed flexible funding. The fund would be modelled on the successful funds managed by agencies like The Global Fund and Gavi, the Vaccine Alliance, which succeed in raising billions of dollars through high-profile pledging events, staged every three to four years. 

While expressing support for WHO’s overall goals, EB delegates criticized a system they characterized as a top-heavy bureaucracy that spends too much money on its own divisions and processes instead of in-country programmes.

The EB’s chair, Slovenia’s Dr Kerstin Vesna Petrič, noted the prevailing sentiment to support the use of a replenishment fund filled by voluntary donations from both member states and philanthropies at high-profile events.

EB’s chair, Slovenia’s Dr Kerstin Vesna Petrič

“I can see we all agree that more money should be given to the member states, but by this, we should all bear in mind that more responsibility will be given to the member states,” Petrič told the meeting.

Put on the defensive, Raul Thomas, WHO’s Assistant Director-General for Business Operations, told delegates that “every $1 invested in the World Health Organization results in a $35 return on investment” and asserted “this is the most heavily consulted budget ever.”

WHO’s Director-General Dr Tedros Adhanom Ghebreyesus tried a bit of diplomacy to bridge the gap between the main funders and those feeling their needs were not getting met. He began by agreeing with the general assertion that countries must be the main focus.

“I think if we’re going to raise the capacity of our programs it will depend on the strength of our country offices,” he said. “We have to equip them with everything.”

Tedros outlined a funding strategy ranging from an immediate focus for the next 100 days to more mid- and long-term planning, with the ultimate goal of turning country office heads into true leaders.

“We cannot use them as messengers, which very often happens,” he said. “Resource allocation is at the center; it’s one of the areas where we said we must make significant progress. And it will be a game changer.”

Tedros explained, as he often has in the past, that WHO’s income comes from two principal sources. One is assessed contributions, which comprised only around 14% of the last budget. These are the annual, compulsory dues that 194 member nations pay, using a formula based on each nation’s GDP.

Members’ dues provide a stable, predictable source, and the funds can be used as needed for global health priorities.

The other 86% of the budget comes from voluntary contributions by member nations, philanthropic foundations and other donors, and usually covers only short-term projects meaning that funding is less flexible because it’s earmarked and is also not guaranteed.

“What we’re saying now cannot happen if we’re going to rely on 86% of contributions from voluntary and earmarked where it should be spent,” Tedros told the EB. “This is a very opportune time but it’s also a crossroads.”

Only 14% of budget covered by members’ dues

The proposed 2024-25 budget being considered by the EB emphasizes the need for sustainable financing.

“The pandemic highlighted WHO’s longstanding challenge of sustainable financing. The organization’s ability to make an impact is limited by a funding model in which only 14% of WHO’s funding is fully flexible and predictable (while the remaining funds are dependent on generous donors, heavily earmarked and arrive at unpredictable times),” the budget says.

In May 2022, it notes, WHO’s member nations made a landmark decision to increase assessed contributions to represent 50% of the base programme budget by 2030–2031.

The draft proposed programme budget for 2024–2025 “benefits from this decision – it has been developed on the expectation of a 20% increase of assessed contributions (from the approved levels of 2022–2023), marking a historic move towards a more empowered and independent WHO,” it says. “This development reflects the increased trust in WHO to serve its member states.”

Rather than complaining about WHO’s funding, nations can make recommendations for fixing the system by engaging in efforts to “help us see whether the formula we’re using is wrong or not,” Tedros suggested. “If the formula – the allocation mechanism – is faulty, then definitely the sharing will not be right and you will not have a right to complain.”

The EB is expected to discuss the PBAC proposal further this week, before deciding whether to pass the initiative to a vote by the World Health Assembly in May.

Currently, member state assessments cover only about 16% of WHO’s budget needs. At last year’s World Health Assembly, nations agreed to cover half of WHO’s core budget through assessed contributions from member states by the year 2030, with an initial stepwise increase of 20% for this budget year.  That, however, still leaves a major shortfall in the agency’s annual budget of about $3 billion annually, underlining the need for a replenishment fund, proponents say.

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