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

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 Content

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.

Initiated in budget discussions during EB and WHA 2009: 1.Alligning priorities by governing bodies with available funding 2.Greater predictability and stability of funding MS consultation Jan onward. Report for EB 2011: 1. More flexible and un-marked funding 2. MS urged to increase assessed contributions 3. Widen WHO’s resource base via a replenishment model 4. Effective and corporate approach to resource mobilization 2010: Future of financing for WHO

2011: WHO reform for a healthy future Financing part WHO managerial reform paper (Sep. ‘11) VC are expected to remain the main source of income Imbalance between technical work and normative work Need replenishment model + innovative financing model Increasing full and highly flexible income to 40% Revised corporate resource mobilization strategy: expand or strengthen the donor base.

Reflection by Member States on proposals for financial reforms Consultation Geneva 15 Sep 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

A64/7 Proposed budget

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

WHO’s challenges

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.

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

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 May 09The Bill and Melinda’s Foundation grant making programme for global health. Stuckler et all. Global health philanthropy and institutional relationships: how should conflicts of interest be addressed PLoS Med Apr;8(4):e Epub 2011 Apr 12.PLoS Med.

Proposals for engagement