The 70th World Health Assembly that concluded this week has at least one good news to share, though with riders. Since 2006, for the first time core funding of World Health Organization saw an increase. Core funding or assessed contributions in technical jargon is the money that is in control of the Director General (DG) of WHO and helps in the independent functioning of the Organization. However, the meagre increase of 3 per cent is much lower than the receipts increase of 10 per cent expected by the DG.
Worryingly, we might not see a similar increase in the near future. People in the know have indicated that many developed countries allowed the increase only on the condition that this will not be used as a precedent in the future.
This development needs to be put in perspective. WHO is finding it difficult to run its core operations and country offices, relying increasingly on interns for its work rather than the regular staff of experts. The main task of the WHO, which leads global health governance, is to set norms for action in the field of health. But as the funding pattern has been changing over the past decades, it is unable to implement or work on its own decisions.
At the heart of the crisis is the freeze on funds by member states. Termed assessed contributions (ACs), these are mandatory contributions by the member states which are determined based on their population and GDP (gross domestic product). The other form of funding is voluntary contributions (VCs), most of which is earmarked for specific projects. ACs give flexibility to the WHO administration to carry out its tasks, depending on the need judged independently. VCs are tied to projects, decided mainly by the donors instead of the WHO.
The proportion of VCs has been increasing with the freeze on ACs. The proportion of WHO’s revenue from ACs fell from 80 per cent in 1978-79 to less than 30 per cent in the current decade.
WHO’s financial statement for 2014-15 (January 2014 to December 2015) shows that out of the total revenue of US$ 4,794 million, only US$ 955 million came as ACs. The statement noted with concern that flexible VCs decreased by 7 per cent from 2012–2013 to 2014–2015, while specified VCs increased by 12 per cent over the same period. Many of the specified voluntary contributions were related to individual projects.
While the change in the funding pattern has been questioned by health experts for long, the Ebola outbreak in West Africa, which claimed more than 11 thousand lives between 2013 and 2016, gave it fresh impetus. WHO’s role came under severe criticism, especially for its late response. According to Financial Report 2014-15 of the WHO, an important financial lesson learnt was “the need for the Organization to have a source of flexible funding for rapid disbursement at the beginning of any crisis.”
People’s Health Movement, a global network of health activists, civil society organisations and academic institutions, has urged the WHO to lift the freeze on ACs and untie VCs to ensure independent decision-making.
The lack of independence in allocating funds has had an adverse impact on long-term projects of the WHO which are considered vital for public health delivery. Issues surrounding access to medicines, their pricing, and need for research and development of new drugs is an essential component of WHO. However, WHO’s Essential Drugs Programme is badly underfunded. There are no donors and the Organization does not have enough money to research, update, and implement it.
The increase in ACs this year marks a U-turn and gives some hope. It has been added on account of Health Emergencies Programme (US$ 69.1 million) and combating antimicrobial resistance (US$ 23.2 million). Needless to say, that the increase is too little to make much difference. It is to be seen where financing goes the next year.
The author is a Delhi-based public health researcher and journalist, currently working on a fellowship from WHO on National Health Policy
