Future of WHO hangs in the balance

BMJ 2012; 345 doi: (Published 25 October 2012) Cite this as: BMJ 2012;345:e6877
  1. David Legge, scholar emeritus
  1. 1School of Public Health, La Trobe University, Bundoora, Victoria 3086, Australia
  1. d.legge{at}

WHO is in crisis. Unless member states can be persuaded to “untie” their donations and give the organisation leeway to control its budget and set priorities WHO will slide further into irrelevance with disastrous consequences for global health, warns David Legge

A substantial shortfall in the funds available for basic administrative functions led WHO’s director general, Margaret Chan, to initiate another reform of the WHO in 2010. Although the reform programme has expanded to include priority setting, governance, and management,1 financing is the fundamental problem. The process of reform is also bedevilled by the same problem that led to the funding crisis in the first place—a switch in power from the assembly of member states to donors (including some member states as well as other donors) with specific interests. This article outlines the problems and what the reforms are trying to achieve.

When WHO was formed in 1948 its main funding came from its member states, who paid according to the size of their population and economy (their “assessed contributions”),2 but since its founding the large rich countries (the United States in particular) have sought to control WHO’s agenda by restricting its funding.3 Since the 1980s assessed contributions have been frozen, and the WHO has become increasingly reliant on voluntary contributions from member states, intergovernmental bodies, and various philanthropists. Assessed contributions as a proportion of total revenues have declined from 80% in 1978-79 to 25% in 2010-11. The budgetary gap has been met through the growth in voluntary contributions, 91% of which are earmarked for particular projects and programmes. As a consequence, WHO’s work is controlled by the donors rather than by its assembly of member states, distorting priorities and the coherence of its programmes.

Success of the current reform programme depends on resolving the contradiction between …

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