With member states of the World Health Organization divided over a proposed 10 percent contribution increase and an expected funding cut to the United Nations by the Trump administration, the next director-general will have to quickly decide which programs to cut or place at the bottom of the health agency’s priority list.
The three nominees vying to become the next director-general of the organization — David Nabarro, Sania Nishtar and Tedros Adhanom Ghebreyesus — are well aware of the organization’s budget constraints, but they exercised caution when asked to identify which programs they envision deprioritizing if they become director-general.
“This is critical. It has to be done. And as somebody coming from the background where I’ve had no choice but to think in terms of value for money and results and priorities, I’ve realized how critical it is to dig your teeth into this,” Sania Nishtar of Pakistan told members of the press during her press conference on Thursday.
But Nishtar demurred from detailing the cuts she would consider making, saying instead that she was committed to honing the WHO’s mandate and leveraging partnerships so that the organization will not need to “recreate everything on its own.” She also reiterated her own programmatic priorities, such as focusing on the organization’s operational readiness in outbreaks and emergencies, technical and political activism in support of the SDGs, and assisting countries to build more resilient health systems as a means of mitigating the effects of climate change.
In a separate press conference, Ethiopian candidate Tedros Adhanom Ghebreyesus agreed there’s a need for the WHO to apply focus in its programmatic priorities, but said he prefered to tackle the issue through inclusive discussions with partners and staff, rather than be prescriptive about it.
“Of course I know the priorities now, but I would prefer to keep that until I get in, listen, go through a very inclusive process both internal and external, identify, and then decide,” Tedros said. “We have to be decisive on this. We have to cut some of the areas which are least priority or not high impact, or something that WHO should not do.”
Read our extended Q&As with the top 3 WHO director-general candidates:
Already, outgoing Director-General Margaret Chan has reprioritized $130 million of the WHO’s budget to ensure the new health emergencies program “doesn’t go under.” The program remains the most severely underfunded, with a shortfall of more than $196 million, according to the WHO’s program budget web portal.
In the proposed 2018-2019 budget, Chan is asking member states for an increase of $93 million in assessed contributions. Without it, the organization will face constraints in continuing reforms in its work on health emergencies.
She already warned member states of the consequences of a persistent funding gap during the financing dialogue in October.
Some member states such as the United Kingdom have thrown their support behind a proposed 10 percent increase, but others have balked, saying the WHO hasn’t done enough to hunt for funds within the agency.
U.S. funding threats
The WHO’s budget woes have been compounded by expected U.S. funding cuts to U.N. agencies. This week, news circulated that the Trump administration is working on an executive order that would cut or reduce U.S. funding to international organizations, including the United Nations.
The U.S. currently provides the biggest assessed and voluntary contributions to the WHO. For the biennium 2016-2017, U.S. assessed contributions amount to $227 million, while its specified voluntary contributions are at $482 million, according to the WHO’s online budget portal.
David Nabarro, Britain’s director-general candidate, said he’s read “a lot about Trump” and talked to people coming to the new administration. He said in a press conference that he believed the Trump administration was not adverse to international bodies but instead sought clarity on the purposes of international organizations’ work, how in line they are with the country’s national objectives, and whether they are “working for impact in the most effective, efficient and transparent way.”
“I think the nervousness that sometimes people feel is that the transparency is just not up to the level they want, that efficiency is again not to the level they require, and if effectiveness could be increased,” he said.
If the WHO is able to meet these transparency requirements and show clear evidence of impact, then he doesn’t think the organization “will necessarily be cut off from money,” especially as health security matters across the world.
“So I’m not sitting here thinking that the noises that are coming from not the actual new administration but from a number of people in the legislature are not actually thinking that these are going to lead to terminal problems for WHO in the coming weeks or months,” Nabarro said. “Instead I think they are an invitation to dialogue, an invitation to openness, and I am totally up for that and look forward to it.”
All nominees have commented on the need for the organization to expand its donor base, explore innovative sources of financing, and focus on results as a means to attract investments from both current and new donors. But the challenge will be turning those visions into action.