Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Globalization and Health
Published in: Globalization and Health 1/2018

Open Access 01-12-2018 | Review

The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals

Authors: Srikanth K. Reddy, Sumaira Mazhar, Raphael Lencucha

Published in: Globalization and Health | Issue 1/2018

Login to get access

Abstract

The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.
Footnotes
1
The RED Partnership was founded in 2006 by Bono and Bobby Shriver to harness the power of people and companies to help fight AIDS. The Global Fund uses 100% of RED partnership money without any overhead charges to finance HIV/AIDS programs.
 
Literature
1.
2.
Forss K, Stenson B, Sterky G. The future of global health cooperation: designing a new World Health Organization. Current issues in public health. 1996;2(3):138–42.PubMed
3.
Yach D. World Health Organization reform—a normative or an operational organization? American Public Health Association; 2016.
4.
Hill PS. Understanding global health governance as a complex adaptive system. Global Public Health. 2011;6(6):593–605.PubMed
5.
6.
WHO. Report of the Executive Board Working Group on the WHO response to global change Executive Board 92nd session. Geneva: WHO; 1993.
7.
Kickbusch I, Reddy K. Global health governance–the next political revolution. public health. 2015;129(7):838–42.PubMed
8.
WHO. Constitution of the World Health Organisation. Geneva: WHO; 1946.
9.
Lee K, Fang J. Historical dictionary of the World Health Organization: Rowman & Littlefield; 2013.
10.
WHO. The First Ten Years of the World Health Organisation. Geneva: WHO; 1958.
11.
Clift C. What’s the World Health Organization for? London Chatham House; 2014.
12.
13.
Clinton C, Sridhar D. Governing global health: who runs the world and why? Oxford: University press; 2017.
14.
Vaughan JP, Mogedal S, Walt G, Kruse S-E, Lee K, Wilde KD. WHO and the effects of extrabudgetary funds: is the organization donor driven? Health Policy Plan. 1996;11(3):253–64.
15.
WHO. The future of financing for WHO- Report of an informal consultation convened by the Director-General. Geneva: WHO; 2010.
16.
17.
18.
19.
20.
Gostin LO. The future of the World Health Organization: lessons learned from Ebola. The Milbank Quarterly. 2015;93(3):475–9.PubMedPubMedCentral
21.
Kickbusch I. Global health security: a cosmopolitan moment? 2015.
22.
Gostin LO, Friedman EA. A retrospective and prospective analysis of the west African Ebola virus disease epidemic: robust national health systems at the foundation and an empowered WHO at the apex. Lancet. 2015;385(9980):1902–9.PubMed
23.
Kirkevold M. Integrative nursing research—an important strategy to further the development of nursing science and nursing practice. J Adv Nurs. 1997;25(5):977–84.PubMed
24.
Kirton J, Kulik J, Bracht C. Generating global health governance through BRICS summitry. Contemp Polit. 2014;20(2):146–62.
25.
Gómez EJ. Exploring the utility of institutional theory in analysing international health agency stasis and change. Health Policy Plan. 2012;28(7):769–77.PubMed
26.
Van der Rijt T, Pang T. Resuscitating a comatose WHO: Can WHO reclaim its role in a crowded global health governance landscape? Global Health Governance. 2013;6(2):1–14.
27.
Pang T, Garrett L. The WHO must reform for its own health. Nat Med. 2012;18:646.
28.
Richter J. WHO reform and public interest safeguards: an historical perspective. Social Medicine. 2012;6(3):141–50.
29.
Hawkes N. “Irrelevant” WHO outpaced by younger rivals. BMJ. 2011;343:d5012.PubMed
30.
31.
Chow JC. Is the WHO becoming irrelevant. Foreign Policy. 2010;8:11–34.
32.
Ermakov V. Reform of the World Health Organization. Lancet. 1996;347(9014):1536–7.PubMed
33.
Graham ER. International organizations as collective agents: fragmentation and the limits of principal control at the World Health Organization. European Journal of International Relations. 2014;20(2):366–90.
34.
Sridhar D, Gostin LO. Reforming the world health organization. JAMA. 2011;305(15):1585–6.PubMed
35.
Richter J. Time to turn the tide: WHO’s engagement with non-state actors and the politics of stakeholder governance and conflicts of interest. BMJ. 2014;348:g3351.PubMed
36.
Gautier L, Harmer A, Tediosi F, Missoni E. Reforming the World Health Organization: what influence do the BRICS wield? Contemp Polit. 2014;20(2):163–81.
37.
Kickbusch I. WHO reform: a personal perspective. J Public Health Policy. 2013;34(3):481–5.PubMed
38.
Frenk J. Finance and Governance: Critical Challenges for the Next WHO Director-General. American J Public Health. 2016;106(11):1906–7.
39.
Mackey TK, Novotny TE. Improving United Nations Funding to Strengthen Global Health Governance: Amending the Helms-Biden Agreement. Global Health Governance. 2012;6(1):1–19.
40.
Viola LA. WHO says competition is healthy-how civil society can change IGOs; 2008.
41.
Ruger JP. International institutional legitimacy and the World Health Organization. J Epidemiol Community Health. 2014:jech-2013-203272.
42.
43.
Cassels A, Smith I, Burci GL. Reforming WHO: the art of the possible. Public Health. 2014;128(2):202–4.PubMed
44.
Van de Pas R, van Schaik LG. Democratizing the World Health Organization. public health. 2014;128(2):195–201.PubMed
45.
Ooms G, Marten R, Waris A, Hammonds R, Mulumba M, Friedman E. Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage. public health. 2014;128(2):173–8.PubMed
46.
47.
Stenson B, Sterky G. What future WHO? Health policy. 1994;28(3):235–56.PubMed
48.
Almeida C. Health sector reform in Latin America and the Caribbean: the role of international organizations in formulating agendas and implementing policies. Well-being and social policy. 2006;2(1):123–60.
49.
Chorev N. Restructuring neoliberalism at the World Health Organization. Rev Int Polit Econ. 2013;20(4):627–66.
50.
The Lancet. The lords of despair. Lancet. 2008;372(9636):346.
51.
Harmer A, Buse K. The BRICS–a paradigm shift in global health? Contemp Polit. 2014;20(2):127–45.
52.
Gostin LO, Sridhar D, Hougendobler D. The normative authority of the World Health Organization. Public Health. 2015;129(7):854–63.PubMed
53.
Gostin LO. Reforming the world health organization after ebola. JAMA. 2015;313(14):1407–8.PubMed
54.
55.
Buse K, Walt G. Global public-private partnerships: part II-what are the health issues for global governance? Bull World Health Organ. 2000;78(5):699–709.PubMedPubMedCentral
56.
Checchi F, Waldman RJ, Roberts LF, Ager A, Asgary R, Benner MT, et al. World Health Organization and emergency health: if not now, when? BMJ. 2016;352:i469.PubMed
57.
Wibulpolprasert S, Chowdhury M. World health organization: overhaul or dismantle? American Public Health Association; 2016.
58.
Lerer L, Matzopoulos R. “The worst of both worlds”: the management reform of the World Health Organization. Int J Health Serv. 2001;31(2):415–38.PubMed
59.
Gómez EJ. Proposing a sequential comparative analysis for assessing multilateral health agency transformation and sustainable capacity: exploring the advantages of institutional theory. Glob Health. 2014;10(1):38.
60.
Robbins A. Brundtland's World Health Organization: a test case for United Nations reform. Public Health Rep. 1999;114(1):30.PubMedPubMedCentral
61.
Collier R. World Health Organization reform languishes Can Med Assoc; 2012.
62.
Miriam S. Upcoming 66th world health assembly: Main topics of discussion. Health Diplomacy Monitor. 2013;4(3):3–5.
63.
Kamal-Yanni M, Saunders P. Urgent need for WHO's reform to prioritise core functions. Lancet. 2012;379(9829):1878.PubMed
64.
Gopinathan U, Watts N, Hougendobler D, Lefebvre A, Cheung A, Hoffman SJ, et al. Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator. Glob Health. 2015;11(1):46.
65.
Missoni E. A long way back towards health for all. MMS Bulletin. 2009;111:1–10.
66.
Kamal-Yanni MM. Action to preserve WHO's core functions cannot wait for organisational reform. Lancet. 2012;379(9813):309.PubMed
67.
68.
69.
Collier R. WHO reform creeps forward Can Med Assoc; 2012.
70.
Collier R. WHO signals intent to trim sails Can Med Assoc; 2012.
71.
72.
Hoffman SJ, Røttingen J-A. Split WHO in two: strengthening political decision-making and securing independent scientific advice. Public Health. 2014;128(2):188–94.PubMed
73.
Dhillon RS. The future of WHO: outsourcing? Lancet. 2015;385(9973):1070.PubMed
74.
Schlein L. WHO's slow road to funding reform American Association for the Advancement of Science; 1998.
75.
Saunders P, Kamal-Yanni M. WHO reforms: on course but core functions still require reliable support world. 2013;382:e11–5.
76.
77.
Moon S. WHO's role in the global health system: what can be learned from global R&D debates? public health. 2014;128(2):167–72.PubMed
78.
Frenk J, Moon S. Governance challenges in global health. N Engl J Med. 2013;368(10):936–42.PubMed
79.
80.
81.
Stuckler D, King L, Robinson H, McKee M. WHO's budgetary allocations and burden of disease: a comparative analysis. Lancet. 2008;372(9649):1563–9.PubMed
82.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2013;380(9859):2095–128.
83.
Tortora P, Steensen S. Making earmarked funding more effective: current practices and a way forward. Better Policies for Better Lives. Report No. 1. OECD. 2014;1:1–45.
84.
Waddington C. Does earmarked donor funding make it more or less likely that developing countries will allocate their resources towards programmes that yield the greatest health benefits? Bull World Health Organ. 2004;82(9):703–6.PubMedPubMedCentral
85.
Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM independent panel on the global response to Ebola. Lancet. 2015;386(10009):2204–21.PubMed
86.
WHO. Report of the Ebola Interim Assessment Panel. Geneva: WHO; 2015.
87.
88.
89.
WHO. WHO Financing Dialogue: Agenda item 5(d) 62nd Session of the WHO Regional Comittee for the Eastern Mediterranean, 5–8 Oct, 2015, Kuwait 2015.
90.
WHO. Investing in the World’s Health Organization Taking steps towards a fully-funded Programme Budget 2016–17.Geneva: WHO; 2015.
91.
92.
93.
Navarro V. Neoliberalism as a class ideology; or, the political causes of the growth of inequalities. Int J Health Serv. 2007;37(1):47–62.PubMed
94.
Mackey TK, Liang BA, Pierce JP, Huber L, Bostic C. Call to action: promoting domestic and global tobacco control by ratifying the framework convention on tobacco control in the United States. PLoS Med. 2014;11(5):e1001639.PubMedPubMedCentral
95.
96.
97.
WHO. WHO’s Financing Dialogue 2016 -A proposal for increasing the assessed contribution ensuring sustainable financing for WHO. Geneva: WHO. p. 2016.
98.
Barnett M, Finnemore M. Rules for the world: international organizations in global politics. Ithaca: Cornell University Press; 2004.
Metadata
Title
The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals
Authors
Srikanth K. Reddy
Sumaira Mazhar
Raphael Lencucha
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2018
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-018-0436-8

Other articles of this Issue 1/2018

Globalization and Health 1/2018 Go to the issue

Debate

Incorporating a structural approach to reducing the burden of non-communicable diseases

Commentary

The health of workers in the global gig economy

Editorial

Reprising the globalization dimensions of international health

Research

Transnational pharmacogovernance: emergent patterns in the jazz of pharmaceutical policy convergence

Research

The effect of sugar and processed food imports on the prevalence of overweight and obesity in 172 countries

Review

Best practices in scaling digital health in low and middle income countries