Reversing the WHO crisis: transparent priority matching of global needs with donor objectives

Since its creation in 1948, the World Health Organization has been involved in a variety of successful global health initiatives. Legge identifies the “substantial shortfall in the funds available for basic administrative functions” that is now limiting WHO’s effectiveness.1 He stresses that the three decade freeze on “assessed contributions” has left WHO beholden to voluntary donors and recommends persuading member states to “untie” their donations to increase WHO’s autonomy.

We believe that this proposal will not improve WHO’s advocacy or budgetary position. The article underemphasises the political pressures that affect WHO’s decision making and action, framing WHO as an “independent” health organisation. The solution of untying funding restrictions from conditionalities is impractical and may cause WHO to lose funding sources. It is perhaps idealistic to suggest that an organisation dependent on donors should not consider its donors’ requests and objectives. This is especially true in today’s climate of “healthconomic crisis,”2 in which governments and institutions are reluctant to fund transnational organisations.

We propose three actions to reverse this crisis:

• 1 WHO must independently establish global health priorities, based on global needs, before engagement with voluntary donors

• 2 Member states and donors must be transparent; motivations and interests should be declared, as proposed in 2000 by the WHO Committee of Experts on the Tobacco Industry.3 As far as is practicable, the priorities of the member states and donors must be clear from the beginning

• 3 The first two recommendations should be considered together to allow funding to be secured. Priority matching may not be seamless, so all global health priorities may not be met.

As argued elsewhere,2 4 global public health has changed radically in recent decades, with transnational companies and market imperatives playing an increasingly important (and sometimes deleterious) role in formulating policy. However, WHO’s response should not be to reassert absolute power by insisting on the unconditionality of aid. Rather, it must work to foster an atmosphere of transparency, allowing differences of opinion to be clearly articulated and resolved with time.