Ensuring a well-funded World Health Organization is one of the biggest responsibilities — and headaches — Tedros Adhanom Ghebreyesus will have to bear in the next five years when he officially takes over as director-general of WHO in July.
WHO’s budget has been problematic for years, to say the least. While voluntary contributions to the organization have been increasing, a huge bulk of it, over 80 percent, has largely been earmarked to a limited set of programs, leaving others such as the new health emergencies program to suffer from underfunding. In 2016, outgoing Director-General Margaret Chan reprioritized $130 million in funding for the program to ensure it “doesn’t go under.”
Tedros has repeatedly mentioned the need to expand the WHO’s donor base, and he reiterated this during his first press conference as the newly elected director-general on Wednesday at Palais des Nations in Geneva, where the current 70th World Health Assembly is held. WHO’s funding unit requires upsizing in terms of size and skills of human resources, he said. WHO should look into what it can learn from other United Nations agencies, such as UNICEF, on the issue of fundraising.
But he also emphasized the need to look at a “bigger envelope.”
“When we talk about budget issue, most of the time we raise the WHO budget only. But that’s not the right way of thinking about financing [the] Global Health Agenda,” he told a packed room of journalists.
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WHO, he said, is the “leader of the global health agenda” and therefore should look at raising funding not just for its own programs, but also for multilateral institutions such as the World Bank, GAVI, the Vaccine Alliance, and the Global Fund to Fight HIV and AIDS, Tuberculosis and Malaria, whose programs help fill gaps in health financing and service delivery in countries.
“I will help Global Fund, the World Bank and GAVI to really raise funding, which will really be channelled to the countries, and which I believe should be significantly increased. And WHO should believe that even if the money’s not in its cover, it’s money,” he said.
By expanding the donor base, he said, global health financing then builds a “kind of shock absorber” when things go rough and traditional sources of health financing become unreliable and unpredictable. Looming cuts to global health programs in the latest budget proposal by the current United States administration, a huge player in global health financing, sets the stage for such kind of preparation, he suggested.
“We have to learn from this and do something to really address, so we prevent any future shocks because of surprise,” Tedros said, adding that he nevertheless doesn’t see the current budget discussions as final.
“I have always seen contribution from the U.S., actually, always as a bipartisan position. I have worked with both Republicans and Democrats. And if we can communicate with them the right way, and know how to effectively communicate, I think we can also address that,” he said.
“Whatever funding we have, we have to start using it in a way that adds value and focus on the priorities.”— Tedros Adhanom Ghebreyesus, incoming WHO director-general
WHO’s assessed contributions — the more flexible funding stream — has remained the same for the past decade, although on Wednesday, the World Health Assembly finally approved a budget that reflected a 3 percent increase in member states dues. This is lower however than Chan’s original ask for a 10 percent increase in contributions. It is also likely to still be insufficient to meet WHO’s increasing requirements, and significantly lower than the 51 percent increase the newly elected director-general would have wanted, as told to Devex in an interview during the WHO election campaign period.
The question then is how Tedros will be able to convince member states to contribute larger shares of flexible and predictable funding to the aid agency’s budget.
Build confidence by showing results, he said, the way the Global Fund did when he sat as its chair from 2009 to 2011. The Global Fund, then, was reeling from the effects of donor suspensions, after internal investigations revealed millions of dollars lost to grant mismanagement and fraud. But after introducing major reforms in grant disbursement and governance, the fund started to regain donor confidence. In its fifth replenishment conference in September 2016 in Montreal, Canada, the fund raised $12.9 billion.
“Whatever funding we have, we have to start using it in a way that adds value and focus on the priorities. And that can help us also to save some unnecessary, you know, expenses,” Tedros said.
On the issue of WHO’s travel expenses, which came under fire this week following an AP report, Tedros said it has to be justified in terms of program costs.
“As long as they can be justified because of the program, it’s fine,” he said. “If it’s really unnecessary expense, then it has to be stopped.”
WHO should also continue to advocate for member states to make more of their voluntary contributions flexible, he said.
But Tedros also floated the idea of discussing the issue of assessed contributions, and making the case for increasing them beyond and before formal institutional events, such as the World Health Assembly.
“I think one thing what we haven’t tried before, and what we should try [is] start discussing at the sub-regional, regional, political organizations,” he said. “We have to make our case, of course, if we’re going to convince anybody. So we have to put together our, you know, stories why. Why it should increase, bring that compelling story to these political organizations. It could be in [WHO] AFRO [region], it could be in the Asian countries. It [could] be [WHO] EMRO [region], or it could be the Caribbean community, or it could be in the Pacific community.”
WHO should also gather its own “champions” that would help countries understand the “benefits” of increasing contributions to the U.N. aid agency.
“It has to go into why. Why it’s important? And are we asking that question in the right place? Why do we ask it in Geneva? … And have we really articulated enough why we are asking that?” Tedros said. “So we have to be prepared, I think, just like a court case. And we need to have the issues at hand properly.”