Table 1 Thematic overview of funding proposals and stated rationale
Reform proposal (s) and/or recommendations | Key arguments for reform proposal (s)/ challenges/ risks |
|---|---|
Theme 1: Predictability and Sustainability of Organizational Funding | |
Set higher member state ACs [29, 34,35,36]; Double the WHO’s overall budget, with ACs comprising at least 50% of budget within 5 years [53] **Since the Biennium 2014–2015, WHO gained the power to approve the full budget, enabling strategic allocation of flexible resources [52] | Sustainable financing needed to address WHO’s capacity to respond and nation’s preparedness [54] Member states reluctant to increase respective ACs and support increased VCs over ACs [36, 39, 50, 51] |
Replace zero-nominal growth of ACs with zero-real growth policy [36, 39] | Zero-nominal growth policy restricted WHO’s budget growth [13, 38, 39], increased WHO’s reliance on EBFs [40] |
Attract new donors (foundations, emerging economies, private and commercial sector) to broaden funding source for WHO’s flexible and unearmarked funds [26, 28, 29] | Tensions between financing from non-state actors/ private sector and WHO’s autonomy [34]; ‘trading off the soul of WHO’ [28] |
Establish Ethics Committee to oversee WHO engagement with non-state actors [36] | BRICS countries asked WHO to ensure supremacy of member states and manage conflict of interests [36] |
Charge overhead to VCs [47] | Might risk losing donors to other organizations [34] |
Practice ‘currency hedging’ to manage currency risks [27] Establish endowment fund, a multiyear financing framework, or use Robin Hood tax [27] | |
Theme 2: Improve Transparency and Accountability in (Financial) Governance | |
Increase transparency in disbursements of funds to WHO regional offices & disclose its utilization [26, 30, 34] | |
Build strategies for WHO’s rigorous external evaluations [27] | |
Establish independent governance committees on the lines of Independent Monitoring Board [56, 57] | Towards transparency enhancement mechanisms [56] |
Establish ‘WHO financing dialogue’ making the opaque process of multilateral negotiations more open and transparent, involving an inclusive discussion [43, 44] **In 2013, the World Health Assembly resolution 66(8) established the Financing dialogue [43] | Member states skeptical over the procedures of establishing WHO financing dialogue [62]; BRICS countries support to financing dialogue [36]; financing dialogue is ‘smoke screen exercise’ without resolving Zero-nominal growth policy [44] |
Theme 3: Organizational Function and Financial Autonomy | |
Narrow focus and concentrate resources on lesser health issues [61, 63, 66, 70] | |
Decentralized governance through smaller independent organizations to bring efficiency and optimal use of funds [46, 68] | |
Create discretionary fund’ for global health emergencies [26] | |
Convene regularly a new multi-stakeholder forum to address critical global health issues [28] | This reform was argued as a way to better align WHO’s income and work [29, 43] |
Greater autonomy for technical function of WHO through protected and adequate budget, with flexibility over its allocation [72] | |
Acquire greater independence from its largest donors in order to coordinate with Research and Development (R&D) actors [77] | |
Outsourcing of key activities, thus leveraging the expertise of global health organizations beyond WHO [67, 71,72,73] | |
Taxation of global resources and global activities to supplement WHO funding [68] | |