Future of WHO hangs in the balance

BMJ 2012; 345 doi: (Published 25 October 2012) Cite this as: BMJ 2012;345:e6877

Re: Future of WHO hangs in the balance

Since its creation in 1948, the World Health Organization (WHO) has been involved in a variety of successful global health initiatives. Legge’s article identifies the “substantial shortfall in the funds available for basic administrative functions” that is now limiting the WHO’s effectiveness [1]. The article stresses that the three-decade freeze on “assessed contributions” has left the WHO beholden to the objectives of voluntary donors. The article recommends that “member states [should] be persuaded to “untie” their donations” in order to increase the WHO’s autonomy.

We believe that this proposal will not improve the organisation’s advocacy or budgetary position in coming years. The article underemphasises the political pressures to which the WHO is exposed in its decision-making and action, framing the WHO as an “independent” health organisation. The solution of untying funding restrictions from conditionalities is impractical and may cause the WHO to lose funding sources. It is perhaps idealistic to suggest that an organisation dependent on donors should not consider its donors’ requests and objectives. This is especially true in today’s climate of “healthconomic crisis” [2], where governments and institutions are particularly reluctant to fund transnational organisations.

We propose a tripartite set of actions to reverse the WHO crisis:

i) Global health priorities must be established independently by the WHO, prior to engagement with voluntary donors, based on global needs.

ii) Member states and donors must be transparent; motivations and interests should be declared, as proposed in 2000 by the WHO Committee of Experts on the Tobacco Industry [3]. As far as is practicable, the priorities of the member states and donors must be clear ex ante.

iii) Recommendations i) and ii) should be considered together to permit securement of funding. Priority matching may not be seamless, and so all global health priorities may not be met.

As argued elsewhere [2, 4], the landscape of global public health has been radically altered in recent decades, with transnational companies and market imperatives playing an increasingly important (and sometimes deleterious) role in formulating policy objectives. However, the WHO’s response should not be to reassert absolute power by insisting on the unconditionality of aid. Rather, it must work to foster an atmosphere of transparency, allowing differences of opinion to be clearly articulated and with time resolved.

Mahiben Maruthappu
Kennedy Scholar, Harvard University

Callum Williams
Joseph Hodges Choate Memorial Fellow, Harvard University

[1] Legge D. Future of WHO hangs in the balance. BMJ. 2012 Oct 25;345:e6877.

[2] Williams C, Maruthappu M. 'Healthconomic crises': public health and neoliberal economic crises. Am J Public Health (forthcoming)

[3] Zeltner T, Kessler DA, Martiny A, Randera F. Tobacco Company Strategies to Undermine Tobacco Control Activities at the World Health Organization. World Health Organisation, 2000.

[4] Maruthappu M, Williams C. The Biomarket. Glob Public Health. (forthcoming)

Competing interests: No competing interests

11 November 2012
Mahiben Maruthappu
Kennedy Scholar
Callum Williams
Harvard University
Harvard University, Cambridge, MA 02138, USA