Geneva – 13th of October 2011 – The reform of the WHO Geneva – 13th of October 2011 – The reform of the WHO

Dr. Remco van de PasDr. Remco van de Pas

Wemos, The Netherlands Wemos, The Netherlands

Medicus Mundi International networkMedicus Mundi International network

Democratising Global Health coalition Democratising Global Health coalition

The financing of the WHO: Current status and proposals for engagement

• Rationale of the WHO reform

• Current status of financing of the WHO

• Assessment of WHOs performance

• The role of the Bill and Melinda Gates foundation

• Proposals for engagement

Content Content

Trend financing WHO Last Trend financing WHO Last decadedecade

• 2 main streams: Core budget and voluntary conytributions

• Budget increased from $1.6b (98-99) to $ 4.2b (08-09)

• Extrabudgetary budget from 48.8% to 77.3% same period

• Initiated via decentralisation and autonomy of resource mobilisation to departments and regional offices

• Extrabudgetary funding (VC) skews global health priorities, 60% funding infectious diseases, 3.9% NCD’s.

• Initiated in budget discussions during EB and WHA 2009:

1. Alligning priorities by governing bodies with available funding

2. Greater predictability and stability of funding

• MS consultation Jan. 2010 onward. Report for EB 2011:

1. More flexible and un-marked funding

2. MS urged to increase assessed contributions

3. Widen WHO’s resource base via a replenishment model

4. Effective and corporate approach to resource mobilization

2010: Future of financing 2010: Future of financing for WHO for WHO

2011: WHO reform for a 2011: WHO reform for a healthy future healthy future

Financing part WHO managerial reform paper (Sep. ‘11)

•VC are expected to remain the main source of income

•Imbalance between technical work and normative work

•Need replenishment model + innovative financing model

•Increasing full and highly flexible income to 40%

•Revised corporate resource mobilization strategy: expand or strengthen the donor base.

•

Reflection by Member States Reflection by Member States on proposals for financial on proposals for financial

reformsreformsConsultation Geneva 15 Sep. 2011 and WHO-EURO :

• More details requiered; financial health and root causes

• Increase budget to 70% predictable fund over –ambitious

• VC must be alligned with WHO’s priorities

• Replenishiment model: predictabililty? Donor-driven?

• Innovative sources of funding: Costs and CoI?

• Corporate approach “appropriate for WHO”?

• WHA does not distinguish flexible and earmarked funds

• Not consistent demanding program support cost donors

A64/7 Proposed budget 2012-2013A64/7 Proposed budget 2012-2013

A64/7 Proposed budget 2012-2013A64/7 Proposed budget 2012-2013

A64/7 Proposed budget 2012-2013A64/7 Proposed budget 2012-2013

WHO’s challenge WHO’s challenge

DFID – Multilateral AID review – March 2011DFID – Multilateral AID review – March 2011

DFID – Multilateral AID review – March 2011DFID – Multilateral AID review – March 2011

WHO’s challenges WHO’s challenges

DFID’s approach to WHO funding DFID’s approach to WHO funding

Recommendations:

• Focus on it’s comparative advantage, including at the country level.

• Improve reporting of resultsand impact of interventions

• Improve its cost-effectiveness and better manage poorly performing project.

These fields will be closely monitored and within 2 years DFID will decide to increase or decrease its funding.

Five areas of core business endorsed Five areas of core business endorsed by 64th World Health Assemby by 64th World Health Assemby

• Health systems and institutions: PHC as per Alma-Ata

• Health and development: Normative function

• Health security: Strenghtening the IHR

• Evidence on health trends and determinants for Policy

• Convening for better health: Coherence, inclusiveness, concensus and partnerships

Two big elephants in the room Two big elephants in the room

2. The unproportional, non-mandated influence of the Bill and Mellinda Gates foundation.

“This will be the Decade of Vaccines”, “We have a bias towards funding technology based solutions”.

- Second largest funder for the WHO

- Private foundations share 21% of the budget (2009) Articles:

McCoy ea, The Bill and Melinda’s Foundation grant making programme for global health. Lancet. 2009. May 09

Stuckler et all. Global health philanthropy and institutional relationships: how should conflicts of interest be addressed PLoS Med. 2011 Apr;8(4):e1001020. Epub 2011 Apr 12.

Proposals for engagement Proposals for engagement