World Health Assembly Approves $6.83 Billion Budget for WHO

Member states of the World Health Organization approved a $6.83 billion budget for the next two years. The new programme budget signifies a 20% increase in the mandatory fees member states pay to the World Health Organization.

The proposal for the 2024-2025 budget passed with no objections and was met with lengthy applause. Director-General Dr Tedros Adhanom Ghebreyesus described the step as “historic and a big milestone,” according to Reuters.

Dr. Tedros highlighted that this is the first time in WHO’s 75-year history that such a significant increase in assessed contributions has been approved.

It’s a major step toward reforming the way WHO is financed to make it more sustainable — which global health experts have spent years calling for.

The groundbreaking reform aims to have one-half of WHO’s spending financed more sustainably by fixed member states contributions by 2030. It was principally approved in at the last year’s World Health Assembly (WHA), as Health Policy Watch reported. But it still required a decision from member states for the raised assessed contributions to commence this year.

The WHO budget for the previous biennium 2022-23 was $6.12 billion. 

Rising assessed contributions

The gradual increase in so called assessed contributions aims to correct WHO’s current dependence on earmarked “voluntary contributions” – funding that is donated by a member state or philanthropy with a specific purpose and that does not allow the WHO Secretariat to invest where the biggest needs and returns on investment for global health could be made. 

Assessed contributions are annual fees that member states provide to WHO. They form part of WHO’s flexible funding. This allows the organization to allocate resources across its programs as it sees fit. 

For example, the WHO work on non-communicable diseases (NCDs) in general and alcohol harm in particular is dramatically underfunded.

However, this kind of funding has long covered only a small portion of WHO’s overall funding — 22% of WHO’s $4.4 billion base budget approved last year. The rest is covered by earmarked contributions, or those that donors provide for specific WHO activities. That means some WHO programs that do not generally receive significant donor support, such as noncommunicable diseases, are often left with limited resources.

Voluntary contributions currently make up around 84% of the WHO’s total budget. Such designated funding makes strategic planning difficult, according to WHO officials.

We agreed upon an aspiration to reach 50% of the currently approved program budget to be financed through … 50% assessed contributions by 2030-2031, but potentially even one biennium earlier,” Björn Kümmel, chair of a member state-led working group on sustainable financing, told Devex.

Björn Kümmel, Deputy Head, Division of Global Health, Federal Ministry of Health of Germany

The group put together the recommendations and reached consensus after 18 months of negotiations.

But for the recommendations, the real test will come at next year’s WHA, when the first proposed increase in assessed contributions will be put on the table for the 2024-2025 biennium, according to Devex.

Urgent need to better fund WHO’s work on alcohol

Together with member states, Movendi International succeeded in 2019 to put alcohol policy on the agenda of the 72nd World Health Assembly. Discussions in 2019 and 2020 led to a member states request to WHO Director-General, Dr. Tedros, to “adequately resource the work on [alcohol harm].”

Current funding levels are remarkably small at global, regional, and country levels.

Only an estimated US$1 million per year was allocated for the WHO Secretariat efforts to develop capacity, instruments, and technical advice for the implementation of the Global Alcohol Strategy, write Bakke et al.

In contrast the assessed funding for the implementation of the Framework Convention on Tobacco Control in 2018-2019 was about US$8.8 million.

The funding WHO allocates for the response to alcohol harm and support to members states to protect their people from alcohol harm is clearly falling short of needs, urgency, and magnitude of the alcohol burden worldwide.

Alcohol remains one of the leading risk factors contributing to the global burden of disease. It is the eight leading preventable risk factor of disease. The contribution of alcohol to the global disease burden has been increasing from 2.6% of DALYs* in 1990 to 3.7% of DALYs in 2019.

In high income countries alcohol use is the second fasted growing risk factor and in LMICs it is the fourth fastest rising risk factor for the global disease burden.

Alcohol is the second largest risk factor for disease burden in the age group 10-24 years. Alcohol is the largest risk factor for disease burden in the group 25-49 years.

Modelling forecasts that global targets to reduce alcohol use and harm will not be met.

Overall, trends in alcohol consumption, alcohol’s contribution to the global burden of disease, and progress towards global targets are all pointing the wrong direction. 

1. Without action, Africa could see an increase in both the absolute number and proportion of people consuming alcohol, the amount consumed per capita and heavy episodic alcohol use.
2. Southeast Asia has seen a 29% increase in per capita alcohol use since 2010.
3. Out of 51 countries in the WHO European Region, only 16 reached the target of a 10% reduction of overall alcohol consumption between 2010-19. But 17 countries saw increases in alcohol use. Almost no progress was achieved since 2016 in the implementation of Best Buys alcohol policy solutions.
4. Alcohol remains highly affordable in the WHO Americas region. Between 2012-16, per capita consumption among alcohol users only increased, with 1 in 5 alcohol users consuming heavily.

New budget increases focus on country impact

Roughly $2 billion of the 2024-25 budget will go towards furthering WHO’s goal of Universal Health Coverage, and around $1.33 billion will be channeled into a “more effective and efficient WHO”.  

The latter includes greater support to countries, including co-financing for United Nations Resident Coordinators.  While WHO will continue to maintain its own country offices in over 100 developing countries, the UN-wide Resident Coordinator system, aims to improve coordination between UN-affiliated tasks at country level.  

But the new 2024-25 budget allocation to countries and regions is, in fact, only marginally larger than the allocation of $1.25 billion from the previous 2022-23 biennium.   

Countries welcomed the gradual increase in country allocations, however modest. But , African member states re-asserted demands that at least 75% of the budget should go to offices outside of the Geneva headquarters, as per Health Policy Watch reporting. 

We wish to see the efforts to continue increasing the share of countries and regions from the program budget according to an agreed phased timeline for 2024 to 2027 with an aspiration to reach at least 75% budget allocation to countries and regions,” said the delegate from Ethiopia, speaking on behalf of the group of 47 sub-Saharan African member states, according to Health Policy Watch.  

Ethiopia statement on behalf of the group of 47 sub-Saharan African member states, World Health Assembly 76 (2023)

In it General Program of Work, WHO is focusing on three strategic priorities – the “triple-billion targets”:

• helping 1 billion more people benefit from universal health coverage;
• ensuring 1 billion more people are better protected against health emergencies; and
• helping 1 billion more people enjoy better health and well-being.

WHO’s Special Programmes (for Research and Training in Tropical Diseases, the Special Programme of Research, Development and Research Training in Human Reproduction, and the Pandemic Influenza Preparedness Framework) received an allocation of $0.17 billion as against the allocation of $0.19 billion the previous time, as per Health Policy Watch. 

The programme budget represents a plan for WHO’s anticipated resources, but actual resources may deviate from the initial budgeted amounts over the course of the biennium due to changing or unexpected circumstances, such as additional resources (revenue) provided to WHO for emergency responses or lower levels of support than expected, according to KFF.

For example, in the current biennium WHO expects (as of April 2023) that programme resources will total more than $10 billion, due to additional funding being received or directed in support of emergency operations, including COVID-19 response, and polio eradication activities. See Table 1 for more details.

Main ask: flexible funding and transparency in spending

Member states strongly emphasized the need to continue working for a flexible funding mechanism that prioritizes the causes of spending based on specific situations. 

Calls for greater transparency in WHO spending also rang across the World Health Assembly meeting room. Countries such as Philippines, Namibia and Brazil demanded that WHO disclose more specific details about projects and programmes in which it is engaged at country-level. 

Improvements in transparency, accountability and administrative measures are essential. In the absence of clear improvements in those areas, it will be impossible to adopt, let alone justify any increase in assessed contributions,” the delegate for Brazil told the floor, as per Health Policy Watch reporting. 

The practice of complete disclosure of information on expenditures of member states to member states in order to ensure transparency is not only indispensable, but also something customarily adopted by the UN agencies, and it is high time the WHO follows this path.” 

Brazil at WHA76

Sources

Devex: “Countries agreed to sustainable financing for WHO. What’s next?“

PAHO: “Member States approve 20% increase in assessed contributions for WHO“

KFF: “The U.S. Government and the World Health Organization“

Health Policy Watch: “WHO Member-states Greenlight $6.83b Budget for 2024-25; Countries Demand More Transparency”