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Does WHO indirectly incentivise the kind of funding it wants to avoid?

The Geneva Observer

November 26, 2020


This article was first published as part of our newsletter briefing sent out on Tuesday November 24, 2020. Sign up to our newsletter to get our content the moment it's published, straight in your inbox.

Since the COVID-19 pandemic, WHO has been omnipresent on the world stage. But it's worth remembering that its budget is small when compared to its lofty ambitions: it's constitution states that WHO will be “the directing and co-ordinating authority on international health work” with the objective of helping all peoples attain the highest possible level of health, no less. It has become a bit of a cliché whenever discussing WHO's financing, to explain that it functions with a budget smaller than most university hospitals (the specific hospital is generally chosen on the basis of the writer’s locality—for our purposes, Geneva’s HUG).

Over the last year, WHO has been calling for an increase in flexible funding, money that it has full discretion over to use and that it says allows it to be more "agile and strategic" in achieving its targets and set its own working priorities. But a recent working paper from the Graduate Institute's Global Health Centre has found that there seems to be structural incentives on giving earmarked rather than flexible funding.

A major issue, stated over and over again, is the discrepancy between funding that comes into WHO for specific projects, and money that WHO is able to do what it wants with. Around eighty percent of the money coming into WHO is voluntary (ie not membership fees), so WHO can't necessarily rely on it for long-term planning. On top of that, only about four percent of those voluntary contributions are fully unconditional, meaning WHO has full discretion on how to use them. The result is that the proportion of its funding WHO has full control over is just over 20 percent.

It is an issue that is garnering more and more visibility. Global health policy experts have long been vocal that reducing WHO's reliance on earmarked contributions is critical for it to move forwrd. At the WHA in May, Swiss President Sommaruga explicitly said that one of the issues was its arbitrary mode of payment to WHO. She asked: “Is it decent to demand so much from WHO and to pay so arbitrarily?” WHO seems to agree, expressing its clear preference for flexible funding and praising loudly countries that give more flexible funding.

All that being said, however, a recent working paper published by the Graduate Institute’s Global Health Centre's findings imply that WHO’s structures incentivise precisely the opposite type of funding.

Written by co-director of the Global Health Centre Suerie Moon and researcher Fumi Kurihara, the paper suggests that countries that do not earmark their contributions are actually less able to wield influence on specific issues. One of the global health policy makers they interview highlighted that if you don’t earmark your contribution—that is to say if you haven’t specifically funded a project—“you tend to know less about what’s going on, you tend to have less access to the Secretariat information,” and you are not necessarily invited to the meetings related to that project.

The paper concludes: “As long as earmarking comes with certain informal but substantive privileges and benefits within the organization, there is and will be an incentive for governments to continue providing earmarked contributions.”

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