Should we rethink health emergency funding?

Medical supplies are loaded onto an aircraft for delivery to areas affected by the Ebola epidemic. The outbreak has revealed resource mobilization problems at the World Health Organization. Photo by:

The Ebola outbreak has revealed serious resource mobilization problems at the world’s “go-to” response agency, according to some global health experts.

Tackling the disease in West Africa — where ill-equipped national health systems and lack of infrastructure have spurred the rampant spread of the deadly virus — has been a tall challenge for the World Health Organization, and made all the more difficult by the U.N. agency’s funding structure.

“They basically have a begging bowl,” Lawrence Gostin, WHO Collaborating Center on Public Health Law and Human Rights director, said Sept. 3 during a panel discussion hosted by the Center for Strategic and International Studies in Washington, D.C.

Gostin pointed out that two-thirds of the U.N. agency’s budget is in the hands of donors: “It’s not the way to do business.”

Amid the worst Ebola outbreak in history, WHO leaders were in Washington, D.C. in September, appealing to the World Bank and the U.S. government to help them muster resources for a response effort that is expected to cost at least $600 million.

Having the ability to mobilize resources and respond quickly in a global health emergency might seem a basic, essential requirement for an institution like the WHO, but Tim Evans, senior director for the health, nutrition and population global practice at the World Bank, underscored that the global health sector isn’t anywhere close to achieving that sort of mobilization capacity.

“Everybody has an expectation that WHO should be, and they are, the go-to agency to give us advice on what to do and how to respond,” said Evans. “But they have no financial mobilization capability.”

So what’s an alternative?

Gostin suggests establishing what he calls a “health systems fund” that governments can support financially. The fund would have two components: resource mobilization for health emergencies such as an Ebola outbreak and long-term development of health systems in countries where health infrastructure is lacking.

But such a lofty idea — one that Gostin himself admits would be a multibillion-dollar investment — comes at a time when global health agencies have to compete with other large-scale humanitarian disasters for the attention of donors.

“People tell me you can’t do it, but we did it for AIDS. We’ve got PEPFAR. We’ve got the Global Fund,” said Gostin.

The U.S. President’s Emergency Plan for AIDS Relief, a U.S. government initiative to combat AIDS around the world and the Global Fund to fight AIDS, Tuberculosis and Malaria, an international financing institution, were developed to address some of the biggest perceived threats to global health — and their budgets are backed by big governments.

According to Gostin, the most tangible next step in creating a reliable source of flexible health funding would be to expand the reach of these sorts of organizations beyond the limits of a few specific diseases.

“Probably the easiest thing is for the Global Fund to morph into a global fund for health, rather than for just three diseases,” he explained after the panel discussion. “I would say that would be the most obvious way to do it.”

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About the author

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    Jeff Tyson

    Jeff is a global development reporter for Devex. Based in Washington, DC, he covers multilateral affairs, U.S. aid and international development trends. He has worked with human rights organizations in both Senegal and the United States, and prior to joining Devex worked as a production assistant at National Public Radio. He holds a master's degree in journalism from Columbia University and a bachelor’s degree in international relations and French from the University of Rochester.