A shortage of money to do its work
The WHO’s core budget is paid for by its member states but contributions are too low and unreliable. Since the early 1980s the WHO’s budget, along with other UN agencies, has declined in real terms.
Each member country’s contribution is worked out using a complex formula which takes into account the size of the country’s economy. For example, the USA contributes 25% of the core funding under this equation. Today the WHO’s budget is completely inadequate for its remit. The problems include:
- Countries often fail to pay their dues on time, either deliberately or accidentally, or they do not pay them in full. The USA out of principle only pays 80% of its dues because of dissatisfaction with the WHO and other UN agencies.
- Voluntary donations to ‘extra budgetary’ funds add up to more than double the contributions to the WHO’s core budget. This is because rich countries like to allocate their voluntary donations to specific projects over which they can have more power. This means the WHO’s priorities are too often diverted towards those of its donors.
- Working in this unpredictable and competitive environment diverts the energy of staff, makes it hard to deliver long-term strategies and forces WHO departments to compete with each other for extra funds. If a bid is successful, the WHO is then often under pressure to show quick results to donors.
- The drying up of core funding has contributed to the decline in momentum for the comprehensive primary healthcare approach, and the related rise of ‘vertical’ disease-specific programmes.
What the WHO needs is more funding for its core budget with fewer strings attached by member countries.
Competition from more powerful global bodies
Other global bodies are playing an increasingly decisive – and often damaging – role in health policy-making. This means the WHO can be shut out of crucial decisions affecting health.
Bodies such as the World Bank, International Monetary Fund (IMF) and World Trade Organisation (WTO), which are dominated by rich countries, now wield much greater influence on the health policy decisions of member governments than the WHO. For example, by setting trade policies that determine the availability of essential drugs, WTO rules can stop poor communities getting the medicine they need.
At a country level the WHO’s mandate is too often restricted to working with the health sector, rather than interacting with trade and finance ministers whose decisions may have serious consequences for health. In some countries, the World Bank has been heavily involved in the development of national health policies, such as Sector Wide Approaches (known as SWAps). By capping the spending of developing countries, the IMF can in effect stop countries from recruiting the health workers they urgently need.
Faced by such powerful players, the WHO has too often failed to speak out strongly in defence of poor countries.
An arena for political games
The competition for elected or appointed posts is one of the most obvious examples of countries letting their power games spill over. Powerful countries may use their clout to get their candidate appointed to a post, or to press other member states to vote in particular ways.
The attitudes of powerful countries, whose funding is the lifeblood of the WHO, can also influence its policy positions. US governments have in the past pressed the WHO not to comment on macro-economic and trade issues, for example, and have wanted it to avoid terminology such as ‘the right to health’.
Being too close to private commercial interests
The quest for funds has fed a trend towards ‘public-private partnerships’, exacerbating the fragmentation of institutions and organisations involved in health. Entering into public-private partnerships means that the WHO shares responsibility for funding and implementing health programmes with private partners. Yet these partnerships can risk putting the needs of private partners over those of target populations unless rigorous safeguards against conflicts of interest are put in place.
The WHO has also been criticised for its collaboration with private vaccine manufacturers. Samples of avian flu were voluntarily contributed to WHO collaborating centres by developing countries where outbreaks had taken place. These countries donated their samples in good faith, trusting that the WHO would use them for research that could benefit all. But developing countries later discovered that patents had subsequently been taken out by private companies on parts of the viruses they donated.
This could mean that the countries contributing the samples may not benefit from any resulting vaccines developed if they are sold at commercial rates. Not only did this violate the WHO’s guidelines, but it seemed that the organisation had collaborated in the process – undermining the trust and goodwill of many developing countries
Allegations of poor management and low staff morale
Critics sometimes view the organisation as poorly led and managed. Questions have been raised about its capacity, the level of bureaucracy, the balance of its expertise between medical disciplines and wider disciplines and whether programmes and offices work effectively with each other.
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Last modified: 16/12/2010
