WHO launches first investment round, asking for $11 billion

The World Health Organization officially kicked off its first investment round at the 77th World Health Assembly in Geneva. It’s asking for $11.1 billion overall to fund its work over the next four years — of which it expects the world’s countries will pay $4 billion in membership dues, leaving $7.1 billion for it to fundraise from governments and the private sector. This is a new approach for the world’s leading public health agency. It’s never bundled its fundraising like this into a four-year package. It will host a fundraising event to usher in this finance in November. It’s trying out something new because the old system hasn’t worked. For decades, the organization has been at the mercy of donor funds flowing in unpredictably and tied to certain projects, meaning WHO hasn’t been able to engage in long-term planning nor direct money to the areas it deems most pressing based on priorities set by the world’s governments. Donors, instead, have an oversized role in decision-making. This is problematic for an agency tasked with being the leading authority on health, which is expected to be nimble enough to coordinate global emergencies such as pandemics. During the COVID-19 emergency, inadequate levels of flexible funding hindered the agency's ability to respond. In its appeal for these new funds, WHO Director-General Dr. Tedros Adhanom Ghebreyesus wrote that “health is arguably under more threat now than at any time since WHO’s founding,” citing severe health care access inequalities as a key driver. He added that more than half the world’s population isn’t covered by essential health services and 2 billion people face financial hardship from out-of-pocket spending to access health services. The agency forecasts that by the end of 2028 this $11.1 billion could result in at least 40 million lives saved through its work in areas such as in increasing vaccinations, protecting people from the health impacts of climate change, preventing the spread of antimicrobial resistance, and strengthening maternal and child health. Flexible and predictable When WHO was founded in 1948, it received almost all of its funding from “assessed contributions” — yearly membership dues paid in by countries that can be flexibly deployed depending on the agency’s needs. But this pot of money has declined in relative terms. National government dues only covered 13% of WHO’s two-year budget for 2022 and 2023. In addition to membership dues are sporadically donated “voluntary contributions” — which can come from governments in addition to what they pay in dues, or from the private sector. During WHO’s two-year budget for 2022 and 2023, 87% of funds were voluntary contributions, which mainly come from a small number of donors. These are often short-term grants that are partly earmarked toward specific programs or country offices. This leaves WHO’s workforce in a precarious position. Over 60% of country office staff are on short-term contracts and the agency often can’t make long-term plans that ensure its impact is sustainable. And even when the agency has approved activities, this work has sometimes gone unfunded. There are criticisms that the trend toward an increase in earmarked funds has left WHO with less autonomy to follow its own strategies, hampered its ability to effectively coordinate, undermined its democratic structures, and concentrated power in the hands of a few wealthy donors. Last year, in a historic move, world governments agreed to increase their yearly dues by 20%, thus upping the amount of flexible funds. They have also agreed to gradually increase this so that by 2030, such dues will cover 50% of WHO’s base budget. But to increase its flexibility, the agency is not only targeting increasing membership dues. It’s also working to ensure that the money coming in through “voluntary contributions” is more flexible and pledged for the full four years, rather than the short-term. In the previous four years from the start of 2020 through the end of 2023, only seven donors pledged funds for the full four years. The relatively newly created WHO Foundation, which was launched in 2020, has been tasked with broadening the private donor funding base and will raise private capital for the investment round. Reporting to donors has also been a hassle for WHO. It must write more than 3,000 reports to donors each year, consuming a lot of its staff’s time. The agency is working to create a harmonized reporting process and encouraging donors to accept this.This would include WHO creating reports focused on certain areas of work, as opposed to for specific donors. Between 2020 and 2023, only nine donors agreed to harmonized reporting. ‘Investment in humanity’ The agency presented an investment case on Tuesday to governments and other potential donors, promising $35 worth of health gains for each $1 invested. The $11.1 billion is actually a humble ask, it says. The four-year ask is one-thousandth of the $9 trillion the world spends each year on health, the agency wrote. In an event on Sunday, Tedros noted that the world also spent $717 billion last year on cigarettes. “In return for that investment [in WHO], the world gains authoritative, evidence-based norms and standards on every facet of health, a framework for access to quality-assured health products, early warning of outbreaks, support to national health systems in every country, and health workers and supplies on the ground when crises hit,” the agency wrote in its investment case. Some examples of the plans WHO aims to fund over the next four years include creating 10,000 solar-powered health facilities designed to be resilient in the face of climate change and disasters, training 3.2 million health workers, and analyzing more than 9 million pieces of surveillance information monthly to identify health threats — such as a potential new outbreak resulting from the spillover of a virus from animals to humans. WHO is currently operating on an annual budget of $2.75 billion, which amounts to less than $0.35 per person on Earth. “Investment in WHO is an investment in humanity,” the agency wrote in its investment case published on Tuesday, “an investment that makes the world a healthier, fairer and safer place.”