Just three years ago, the World Health Organization (WHO) was in deep financial trouble, with a US$300-million deficit. Today the agency’s future looks healthier. Last week, the World Health Assembly — the annual gathering in Geneva, Switzerland, of health ministers of the WHO’s 194 governing member states — voted in favor of major budgetary reforms that look set to put the agency on a firmer financial footing.
The agency has also taken action to prune and prioritize its work, which critics say has long been spread too thinly. Taken together, the budget and streamlining reforms “are clearly an effort, that is visible and tangible, to get their house in order at multiple levels”, says Barry Bloom, a global-health expert at the Harvard School of Public Health in Boston, Massachusetts, and an ardent advocate of WHO reform.
The $3.98-billion budget approved by the assembly for 2014–15 shows zero growth on the WHO’s $3.96-billion budget for 2012–13, and marks a slight decrease when inflation is taken into account. The numbers are in line with a worldwide flatlining of spending on global health after a decade of rapid growth that saw much public-health spending shift to new players (see ‘Peak health’).
This freeze has forced the agency to make some hard choices. The budget breakdown shows a shift away from infectious diseases — with a $72-million cut, taking expenditure down to $841 million — towards work on non-communicable disorders such as cardiovascular disease and cancer. These received a $54-million increase, to $318 million. The changes correct what experts say has long been an inappropriate skew in the organization’s budget. They also tie in with UN-wide plans for a global push to reduce the burden of non-communicable diseases, in particular by reinforcing health-care systems in poorer countries where these ills are often neglected. But with no increase in the budget, cuts in some sectors are inevitable if other sectors are to grow.
In a world facing outbreaks of H7N9 influenza in China and a novel coronavirus in the Middle East — both potential pandemic threats — some public-health experts are concerned by a 51% spending cut for the WHO’s ‘outbreak and crisis response’ — from $469 million to $228 million. Gaudenz Silberschmidt, a senior adviser to WHO director-general Margaret Chan, says that this cut mainly reflects the difficulty of predicting the spending needs for such outbreak-response work. He adds that when crises occur, the WHO will seek emergency funding from member states. “If H7N9 or coronavirus turn nasty, it’s obvious that member-state donors will be ready to give more,” he says.
The WHO is in fact expanding its work to prepare for, and respond to, outbreaks and other global-health threats, adds Silberschmidt. It is shifting towards helping countries to respond for themselves, rather than depending on the WHO as a global fire brigade. A separate budget line devoted to this — ‘preparedness, surveillance and response’ — will increase by 32% to $287 million.
The shift stems from a 2007 agreement by the WHO’s member states to have a legally binding set of rules on handling outbreaks or other public-health threats of potential global significance: the International Health Regulations (IHR). These rules, which are largely a response to weaknesses seen in some countries’ responses to the outbreaks of SARS and H5N1 flu in the early 2000s, oblige countries to put in place a series of measures to enable adequate action when outbreaks occur. The measures include establishing disease-surveillance networks and reporting mechanisms, and installing lab and other core infrastructure.