Geneva – 13th of October 2011 – The reform of the W HO

1. Geneva – 13th ofOctober 2011 – The reformoftheWHO The financing of the WHO: Current status and proposals for engagement Dr. Remco van de Pas Wemos, The Netherlands Medicus Mundi International network Democratising Global Health coalition

2. Content • Rationale of the WHO reform • Current status of financing of the WHO • Assessment of WHOs performance • The role of the Bill and Melinda Gates foundation • Proposals for engagement

3. Trend financing WHO Last decade • 2 main streams: Core budget and voluntary conytributions • Budget increased from $1.6b (98-99) to $ 4.2b (08-09) • Extrabudgetary budget from 48.8% to 77.3% same period • Initiated via decentralisation and autonomy of resource mobilisation to departments and regional offices • Extrabudgetary funding (VC) skews global health priorities, 60% funding infectious diseases, 3.9% NCD’s.

4. 2010: Future of financing for WHO • Initiated in budget discussionsduring EB and WHA 2009: • Alligningprioritiesbygoverningbodieswithavailablefunding • Greaterpredictabilityandstability of funding • MS consultation Jan. 2010 onward. Report for EB 2011: • 1. More flexibleandun-markedfunding • 2. MS urgedtoincreaseassessedcontributions • 3. WidenWHO’s resource base via a replenishment model • 4. Effective and corporate approach to resource mobilization

5. 2011: WHO reform for a healthy future • Financing part WHO managerial reform paper (Sep. ‘11) • VC are expectedtoremain the main source of income • Imbalancebetweentechnicalworkandnormativework • Needreplenishment model + innovativefinancing model • Increasing full and highly flexible income to 40% • Revised corporate resource mobilization strategy: expand or strengthen the donor base.

6. Reflection by Member States on proposals for financial reforms Consultation Geneva 15 Sep. 2011 and WHO-EURO : • More details requiered; financial health and root causes • Increase budget to 70% predictable fund over –ambitious • VC must be alligned with WHO’s priorities • Replenishiment model: predictabililty? Donor-driven? • Innovative sources of funding: Costs and CoI? • Corporate approach “appropriate for WHO”? • WHA does not distinguish flexible and earmarked funds • Not consistent demanding program support cost donors

8. A64/7 Proposed budget 2012-2013

9. A64/7 Proposed budget 2012-2013

10. A64/7 Proposed budget 2012-2013

11. DFID – Multilateral AID review – March 2011 WHO’s challenge

12. DFID – Multilateral AID review – March 2011 WHO’s challenges

13. DFID’s approach to WHO funding Recommendations: • Focus on it’s comparative advantage, including at the country level. • Improve reporting of resultsand impact of interventions • Improve its cost-effectiveness and better manage poorly performing project. These fields will be closely monitored and within 2 years DFID will decide to increase or decrease its funding.

14. Five areas of core business endorsed by 64th World Health Assemby • Health systems and institutions: PHC as per Alma-Ata • Health and development: Normative function • Health security: Strenghtening the IHR • Evidence on health trends and determinants for Policy • Convening for better health: Coherence, inclusiveness, concensus and partnerships

15. Two big elephants in the room 2. The unproportional, non-mandated influence of the Bill and Mellinda Gates foundation. “This will be the Decade of Vaccines”, “We have a bias towards funding technology based solutions”. • Second largest funder for the WHO • Private foundations share 21% of the budget (2009) Articles: McCoy ea, The Bill and Melinda’s Foundation grant making programme for global health. Lancet. 2009. May 09 Stuckler et all. Global health philanthropy and institutional relationships: how should conflicts of interest be addressed PLoS Med. 2011 Apr;8(4):e1001020. Epub 2011 Apr 12.

16. Proposals for engagement