There is broad consensus on the need for the World Health Organization to reform itself so as to remain relevant, be more coherent and more agile in the face of crises.
This was evident in January during the special session of the executive board on Ebola, when member states adopted a resolution that kick-started a series of new — arguably long overdue — reforms at the organization.
At that meeting, they tasked Director-General Dr. Margaret Chan with strengthening the organization’s emergency operational capabilities. This included ensuring an adequate number of dedicated and trained WHO staff members were in place at headquarters — as well as at regional and country offices — on standby to take part in emergency relief programs, including in acute emergencies with health consequences.
In the same resolution, they recognized the need for “adequate resources” for the organization’s preparedness, surveillance and response work.
In response, Chan committed to streamlining the organization’s systems and procedures, speed up the organization’s emergency response by creating a single program for health emergencies that would be directly under her oversight, and putting in place performance benchmarks to ensure actions are taken within the shortest possible timeframe.
She also committed to strengthening the skills of her emergency staff and ensuring the organization has sufficient numbers of logisticians, anthropologists, risk communication experts and emergency coordinators readily available and competent to lead field operations.
But these commitments came with a hefty price tag. In her 2016-2017 budget, Chan proposed an 8 percent increase from the current biennial budget.
Member states welcomed Chan’s announcement for reforms, and before the end of Wednesday’s sessions, approved the director-general’s proposed budget of $4.38 billion for the forthcoming two-year period.
The seal of approval has hardly come as a surprise given the clamor for change among member states, realizing the importance of providing the agency with the resources it needs to be able to better respond to future crises. Indeed, there is common understanding that limited funding, exacerbated by cuts to the organization’s budget in recent years, significantly diminished WHO’s capacity to respond to the Ebola crisis.
But securing approval wasn’t a walk in the park.
On Tuesday, during a session discussing lessons learned from the Ebola outbreak, Dr. Bruce Aylward, WHO assistant director-general on health emergencies and who is currently leading the agency’s overall response to Ebola, commented on the difficulty in getting all member states on board on a specific issue.
“It can sometimes be a little bit of a challenge to get them all [194 member states] to agree on one thing, but I think as you saw yesterday in reaction to the director-general’s speech … member states very much agree on the need for this organization to be capacitated, structured, and operating in a way that it can manage and play that leadership role in health emergency response,” said Aylward. “I think that is very much the vision — not just of the director-general, but also the member states.”
The panel tasked to review the World Health Organization's initial response to the Ebola outbreak released its interim report ahead of the 68th World Health Assembly, which kicks off next week. We highlight the recommendations and remaining questions.
That wide agreement, however, didn’t seem to extend to giving the organization that much-needed financial boost.
Some member states noted that Chan’s proposed budget increase was “reasonable,” “realistic,” closely tied to the resolution they adopted in January, and should therefore be approved.
The representative from Germany argued that the assembly “would have difficulties [in explaining] why we should deny WHO to accept potential funding for priorities set in the assembly.” He added that if the assembly had decided to reject the budget, it should provide clarity on what the agency “should not be doing in the near future.”
He noted though that the German government would like to see better accountability and transparency measures in place.
“Are we happy with it? No. But it is shared responsibility, [and the German government] saw efforts,” he said, noting Germany’s approval was a “signal of trust in WHO,” but also linked to expectations of the secretariat that it would make good its commitments for structural changes within the organization.
The French representative meanwhile noted the decision is a political signal that France wanted “a stronger WHO,” but also a move to be coherent with its position on WHO reform.
“We must be coherent with the need of the organization, with the challenges the organization is facing, and with what we asked for of WHO,” the representative said. “We must give WHO the means to do it.”
Sweden, for its part, noted it wanted the organization to “re-emerge from the crisis, stronger, better and fit-for-purpose,” with its representative confirming that it was willing to support the budget increase — provided WHO could demonstrate “in a clear way” how the budget would be used and its envisioned impact.
The lack of details, such as explanations on some of the decreased budget allocations —the category on communicable diseases will suffer slight cuts, for instance — were some of the issues other member states raised during the session, and which, they argued, prevented them from fully putting their weight behind the proposed budget.
The representative from Norway said the country was willing to support the budget increase, but that it was not entirely satisfied with how it was prepared.
“Without a sufficient level of data, [WHO] loses the ability to get member states [to support] a need for greater resources,” the Norwegian representative said. In the same vein, “unsatisfactory internal controls will in the long run affect member state support for the organization.”
Others, like the United States and Japan, meanwhile, wanted more information on the organization’s resource mobilization strategy, and the likely scenarios or impact had the increase not been approved in terms of what the organization would have not been able to accomplish.
Japan’s representative, delivering a message from his minister, acknowledged Chan’s difficult position.
“Increasing a budget is not popular. As a politician, I fully sympathize with Dr. Chan,” read the letter. “We must recognize this is her last budget to implement, and this assembly must agree the budget for WHO to continue.”
However, he noted the increase must be fully funded by voluntary contributions, as the increase “is not small.” The representative even asked: “To make sure it is fully funded, could there be a room [for a] moderate increase?”
Still, there were others who were adamant that now’s not the time for a budget increase.
“Increasing [the] budget space will not encourage organizations to increase efficiencies,” the representative from the Netherlands argued. “Any budget increase is ambitious and will come with great responsibilities.”
Delegates from Thailand and Venezuela meanwhile cited their current economic woes as the reason they could not support an increase at this time.
“A gloomy economic situation in most countries does not allow such increase; a 5 percent increase in assessed contributions is next to impossible,” the Thai representative said, although she encouraged WHO’s member states and donors to increase their unspecified voluntary contributions instead, so the director-general would have the capacity to prioritize flagship programs.
The Venezuelan delegate meanwhile insisted on a zero nominal growth in WHO’s budget “until the global economy has reached greater stability,” else the increase would “sacrifice” national budgets.
WHO is funded by a mix of voluntary and mandatory contributions. Devex has reached out to the agency to clarify how the additional resources will be financed; at the time of writing, we have yet to receive a response.
Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.
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