Intended for healthcare professionals


New approaches to WHO financing: the key to better health

BMJ 2018; 361 doi: (Published 22 May 2018) Cite this as: BMJ 2018;361:k2218
  1. Charles Clift, senior consulting fellow1,
  2. John-Arne Røttingen, chief executive2
  1. 1Centre on Global Health Security, Chatham House, London, UK
  2. 2Research Council of Norway, Lysaker, Norway
  1. Correspondence to: C Clift cclift{at}

Dr Tedros’s plans to reverse the trend towards earmarked funding are important but challenging, say Charles CliftandJohn-Arne Røttingen

If the World Health Organization is to become more effective it needs to have greater flexibility on how it spends its funding. This is the argument that the organisation’s director-general, Tedros Adhanom Ghebreyesus, has made repeatedly since taking office in July last year. Speaking at the WHO executive board meeting in January 2018, he said: “If we continue to operate under the same funding restrictions, we will produce the same results. No organisation can succeed when its budget and priorities are not aligned.”1 In his opening speech at the 71st World Health Assembly he reiterated the call to reduce earmarking and avoid internal competition for donor funding.2

Currently around 80% of the funds WHO receives are earmarked for projects specified by the donor (box 1). The result is that many of its programmes are seriously underfunded, including those for non-communicable diseases and maternal and child health.3 Tedros is not necessarily asking for more money, but he believes the current system hampers WHO in meeting its members’ aims. The reliance on voluntary contributions means fundraising is essentially devolved to individual departments and offices within WHO, stopping the organisation from operating as a coherent whole. The individual departments inevitably become more accountable to their external donors, who provide most of their funding, than to the management and leadership at WHO.4 As Tedros said last year: “By not working together we lose the synergy that is gained through joint working. But also, what one department does can actually undermine what another is trying to achieve.”4

Box 1

WHO financing

  • WHO has always been funded by a mixture of mandatory assessed contributions from member states and voluntary contributions from member states and other …

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