GENEVA — Global health actors are on wait-and-watch mode to see on how the World Health Organization’s “transformation” will unfold, with varying levels of interest and approval.
Some member states Devex has spoken to find the transformation agenda moving in the right direction so far.
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Päivi Sillanaukee, permanent secretary at the Ministry of Social Affairs and Health of Helsinki, told Devex she finds the director-general’s emphasis on “strategic partnerships” to achieve the "triple billion” targets set out in WHO’s new program of work as a positive part of the transformation.
Precious Matsoso, director general for South Africa’s National Department of Health, shared the same interest in WHO transforming its partnerships — but raised the question of where that money will come from.
The organization’s triple billion target is a “big number” and will require a huge amount of resources. “But is it about money or is it about how partnerships are organized differently, so that we leverage the capacities that exist and the knowledge that exists across the world?” Matsoso asked.
That includes rebuilding partnerships with the private sector, as well as civil society, an area where WHO still has a lot of work. At the executive board meeting in January, civil society actors felt “squeezed” in their participation at WHO governing body meetings, with suggestions to limit their slots and time for interventions. The issue is yet to be resolved, said Loyce Pace, president and executive director of Global Health Council, a membership advocacy organization that has official relations with WHO.
Proposals since the January board meeting continue to focus on the idea of having a separate meeting — a “world health summit of sorts” — to accommodate civil society voices, Pace said.
“What is the answer to this question? Does it mean that civil society is pulled out of the WHA entirely and there's a whole separate session that convenes us? I think that's dangerous because, what is the incentive really for member states to attend that sort of event and incorporate our language and opinions?” she asked.
Budget negotiations at the World Health Organization have traditionally been a challenge. Devex speaks with WHO Director-General Tedros Adhanom Ghebreyesus and two of his directors for details, including what the organization plans to do differently.
But the WHO reform serves as a “great opportunity” to rethink how WHO and its governing bodies engage civil society, she said. “More than tweaking things by looking at quantity, we have to look at the quality of the engagement, more importantly,” she explained.
Funding is a similarly important area of discussion. As WHO seeks to deliver on an ambitious agenda, it will require a huge amount of resources — more than $14 billion, to be exact, according to its investment case.
But the organization’s reliance on voluntary funding, most of which is not flexible, will prove to be a challenge.
During an event last Sunday at the Graduate Institute of Geneva, Chris Elias, president of the Global Development Program at the Bill & Melinda Gates Foundation, said that ideally member states would agree to double their assessed contributions to WHO, which are entirely flexible but cover less than 20 percent of WHO’s budget.
“I've seen over the last decade that member states add mandate after mandate to the World Health Organization's job, and they haven't added very much financing. Their assessed contributions [have been] flat, [with] big fights over inflationary increases of 3%. And so the organization is highly dependent on external voluntary contributions,” he said.
He acknowledged how the Gates Foundation has a “highly earmarked support” for WHO, but noted that it has started providing some $10 million to $15 million a year in flexible funding to both the director-general’s office and regional director’s offices to support some of the important transformational processes happening within the organization, including in Africa.
Stating that some Latin American countries don’t feel very supported by WHO, Ambassador Socorro Flores Liera from Mexico explained why negotiations regarding raising assessed contributions to the organization aren’t easy.
“I wish it was only one organization. But if you look at the kind of contribution that our country needs to make to the whole system and also to the regional system, it forces you to be very selective in increases,” she said during the same event.
That selection process involves discussions over organizational efficiencies, but also the support they’re getting from the organization they are funneling contributions.
“Very honestly, Latin American countries feel that the WHO is not all the time ... there,” she said.
“I'm saying this because this is part of the dynamics and the politics that countries take into account when accepting to provide new financing. And in the Latin American region, there is always this reluctance because of the difficult relationship that countries have with [Pan American Health Organization], but also with the support they feel from the WHO, ... not as strong as it is felt in other regions,” she said.