In January 2021, the World Health Organization’s Executive Board established a Working Group on Sustainable Financing with the following mandate:
(a) to develop a high-level, systemic approach to identify the essential functions of WHO that should be funded in a sustainable manner;
(b) to assess the level of costing of the essential functions identified in (a);
(c) to identify and recommend the appropriate sources for their funding and options to improve sustainable financing and alignment in support of the essential functions, including possibilities for cost saving and efficiencies;and
(d) undertake any additional work, as appropriate, to enable sustainable financing.
As set out in the Director-General’s report on sustainable financing (EB148/26), “the COVID-19 pandemic has highlighted the discrepancy between what the world expects of WHO and what it is able to deliver with the resources/capacity it has at its disposal.” The Director-General’s report noted that in 2000 to 2001, WHO’s program budget was US$1939 million; by 2018-2019, WHO’s program budget expanded to a total of US$4422 million. The report highlighted WHO’s over-reliance on voluntary funding which now forms 80% of WHO’s total income. The Director-General’s report states that the “[t]op five donors of voluntary contributions represent between 30% and 60% of the financing for Programme budget outcomes in the Programme budget 2020–2021.” As WHO wrestles with the challenges of providing the gold standard in normative guidance while leading the Covid-19 response, the WHO’s Working Group on Sustainable Financing is charged with identifying pathways to finance the “essential functions of WHO” in a sustainable manner. Given the vicissitudes of WHO’s top donors (with one Member State recently threatening to withdraw from the Organization and another major foundation going through a potential custody battle), the work of the WGSF is timely.
Working Group on Sustainable Financing (WGSF)
Since its inception, the WGSF has met three times – 29-31 March 2021, 28-30 April 2021, and 23-25 June 2021; the WGSF will prepare an interim report to be considered at the regional committee meetings in 2021. The final report with recommendations will be presented to the 150th session of the WHO Executive Board in January 2022. The WGSF is identifying options to determine what constitutes the essential functions of the organization including an “elaboration of the contents of normative functions, including public health goods” (Source: Draft programme of work, Third meeting of the Working Group on Sustainable Financing, 23 – 25 June 2021). The WGSF is chaired by Björn Kümmel of Germany with the following Vice-Chairs: Mr Iddrisu Yakubu of Ghana, Mr Raúl Vargas Juárez of Mexico, Ms Mouna Mcharek Hadiji of Tunisia, Ms Meutia Hasan of Indonesia, and Ms Bronwyn Field of Australia (Source: Meeting Report of the Working Group on Sustainable Financing, 15 April 2021).
In the 1990-1991 biennium, assessed contributions formed 46% of WHO’s program budget and voluntary contributions made up 54% of the program budget; in the 2020-2021 biennium, assessed contributions formed only 16% of WHO’s program budget while voluntary contributions accounted for up to 84% of WHO’s program budget (Source: Report by the Director-General, Sustainable Financing, 11 January 2021).At the WGSF’s first meeting in March 2021, the WHO Secretariat provided a briefing which highlighted the chronic underfunding of areas including noncommunicable diseases, emergency preparedness, and data and science functions intimating a mismatch between donor priorities and areas of high priorities to Member States.
The WGSF examined the following options for developing a systematic approach to identify essential functions of the Organization that should receive sustainable financing.
The options included: (1) considering the entire base segment to be essential; (2) defining essential functions based on their content or purpose; (3) defining essential functions based on principles established by the Working Group; and (4) a numerical approach. It was also noted that some approaches could be blended or combined (Source: Ibid).
In terms of approaches, “option 2b. Devising a must-have list of WHO essential functions” received much attention during the WGSF’s third meeting in June 2021. The secretariat proposed the following list of essential functions:
- functions that support countries in preventing, detecting and responding to disease outbreaks and that coordinate international assistance (WHO World Health Emergencies Programme and the interrelated triple billion targets 1 (e.g. health systems) and 3 (e.g. antimicrobial resistance), including data and science);
- functions that fulfil Member States’expectations to deliver normative functions (public health goods)
- functions that are essential to maintaining and strengthening public health in countries, including those to maintain a polio-free world (immunization, surveillance, laboratory networks and services);
- functions that advance research and innovation for global health; and
- enabling functions that provide greater focus on transparency and accountability to mitigate severe corporate risks.
The WGSF will prepared its interim report for the WHO regional committees in 2021 and its final report with recommendations and findings to the 150th session of WHO Executive Board in January 2022. The sustainable financing of the WHO hinges on the Working Group’s and Member States’ elaboration of the contents of the normative functions of the organization, including public health goods.
Dr. Ellen ‘t Hoen (Director, Medicines Law & Policy) provided the following reflection: “There should be a very simple and short pathway. Member states need to fully finance the WHO and leave their hobby horses at home.”
Dr. Tim Reed, (Executive Director, Health Action International) shared these perspectives: “How is it possible that in a time of global health crisis, WHO member states continue to rearrange the deckchairs? They must make good on their commitments and resource WHO, so it can do its job and lead as only they can.”