Can WHO find a concrete solution to its funding woes?

After hours of deliberation, World Health Organization member states agreed on Monday to establish a working group to tackle the issue of sustainable financing of the organization.

WHO proposed the creation of a working group led by member states from across WHO regions that would help tackle the following questions: What should be funded sustainably? How much funding should be provided sustainably and why? Who should provide this funding?

The working group is to come up with a proposal on how WHO can secure sustainable financing, including an increase in assessed contributions, which would be presented and decided upon on at the 75th World Health Assembly in 2022.

While a few member states have expressed support for addressing the aid agency’s financial challenges, discussions regarding WHO’s funding have to date “remained rather abstract,” according to a report by WHO’s director-general Tedros Adhanom Ghebreyesus delivered at the 148th session of its executive board, which took place from Jan. 18 to Jan. 26.

The effort to find a concrete solution is expected to be prolonged and contentious, with member states already in disagreement on how to move forward with the process.

How to proceed?

Member states had differing opinions on the process, from the set up of the working group to the questions it would tackle. Some expressed support for an open-ended working group while others favored a smaller, more agile working group, but with representation from the different WHO regions, for the initial discussions. Some urged that the discussions be open to all member states to ensure consensus and transparency.

There were suggestions too about the questions the working group should tackle.

“Instead of asking, ‘who should provide this funding?,’ we suggest that the working group ask, ‘what are the sources or mechanisms for this funding?’” the representative from Australia said.

After hours of debate on Saturday, member states reached a consensus. The board will establish a “time-bound, results-oriented” working group on sustainable financing that is open to all member states, with their first meeting taking place in March 2021.

There will be six officers, one from each WHO region, to facilitate the group’s work. An interim report will be submitted to the 74th World Health Assembly in May 2021, as well as regional committees of the WHO, with the final report and recommendations submitted in a year’s time at the 150th session of the WHO executive board in January 2022.

The working group will “develop a high-level, systemic approach” to identify WHO’s essential functions that should be sustainably funded, assess cost of each, and identify and recommend “the appropriate sources for their funding and options to improve sustainable financing and alignment in support of the essential functions, including possibilities for cost saving and efficiencies.”

Further debates are expected, however. 

“The process of determining which WHO functions will receive sustainable financing, versus which will not, will also likely prove highly contentious given that the health priorities of one government are often not the health priorities for another,” Adam Kamradt-Scott, director of the Global Health Security Network, a network of global health security experts that have called for doubling of WHO’s flexible funding in the form of assessed contributions, told Devex over email.

“That simple fact has led to robust disagreements in years past when there were proposals to narrow down the WHO’s duties,” he added.

Efforts to solve WHO’s funding challenges

WHO has been asking for a more predictable, flexible funding that is not dependent on a small donor base.

Since taking office in 2017, WHO’s chief Tedros has prioritized improving WHO's resource mobilization and expanding its donor base. The aid agency launched an investment case in 2018 highlighting WHO’s critical work and unique role in the global health space. In 2020, Tedros announced the launch of the WHO Foundation to help fundraise for the organization. The foundation aims to raise $1 billion in three years.

As the novel coronavirus started spreading globally last year, WHO also partnered with the U.N. Foundation and the Swiss Philanthropy Foundation to mobilize resources from the general public to help the aid agency sustain its response to the pandemic under the COVID-19 Solidarity Response Fund.

Expanding the donor base has been a priority for Tedros, who sees this as a means to prevent WHO from suffering potential shocks in the event donors withdraw financing from the organization — as former U.S. President Donald Trump attempted to do last year.

“The various initiatives taken by WHO in recent years have contributed to a significant increase in both the quantity and quality of the resources available but the underlying long-term challenges remain,” WHO Spokesperson Fadéla Chaib wrote to Devex over email.

WHO needs a greater proportion of its budget to be financed from sustainable and predictable sources to allow it to plan ahead, address long underfunded programs such as noncommunicable diseases and mental health, and invest in long-term priorities such as pandemic preparedness, she said.

At present, the aid agency continues to deal with highly earmarked voluntary contributions, which account for over 80% of WHO’s income for 2020-2021. This leads to an unbalanced program portfolio, in which some technical areas of the organization are left underfunded. It also has an impact on the organization’s ability to keep and attract talent.

“The Organization has thus increasingly had to rely on larger numbers of short-term staff and consultants, which results in higher administrative and transaction costs and increased employee/employer dissatisfaction, and is not sustainable in the long run,” according to the report.

The aid agency tries to fill funding gaps by using its flexible funding, such as member states’ assessed contributions, but that’s in limited supply. WHO assessed contributions have remained flat at about $1 billion for over two decades. At present, it accounts for less than 20% of the organization’s income.

While WHO receives other forms of flexible funding in the form of core voluntary contributions and program support costs, they are not fully predictable and oftentimes subject to particular conditions, such as parliamentary approval, according to the report.

Chaib said member states are aware of the issue and are the ones that asked the WHO Secretariat to put forward a paper on sustainable financing.

“Tackling the sustainable financing challenge is not a quick-fix but Member States have signaled that they want to maintain momentum over the coming year,” she wrote.

Assessed contributions are an important part of those discussions, but it remains to be seen to what extent member states will consider increasing their assessed contributions, particularly given the budgetary impact of the COVID-19 pandemic.