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World Health Organization (WHO): Background and Issues
Background
initiative designed to improve global health and
Established in 1948, the World Health Organization (WHO)
humanitarian response capacity. While some progress has
is a policy making body that directs and coordinates health
been made in improving operational capacity and instituting
efforts within the United Nations system. The WHO also
reforms, some work remains, as discussed below.
establishes norms and guidelines, monitors global health
trends, and provides technical support to member states.
Structure
Perceptions about WHO capacity, particularly around
WHO is headquartered in Geneva, Switzerland, and relies
preventing and controlling the spread of disease, are mixed.
on six regional offices to implement WHO policy within
Examples of WHO accomplishments in disease control
countries. Each regional office is led by a regionally elected
include global immunization campaigns that have eradicated
director. Regional directors have a high degree of autonomy
smallpox and significantly reduced the presence of wild
over the administration of resources. Some critics think that
polio in the world. On the other hand, some criticized
this structure has hindered accountability, fostered wasteful
WHO’s handling of the H1N1 Influenza Epidemic and the
redundancies, slowed policy implementation and reform,
2014 West Africa Ebola outbreak.
and resulted in inconsistent program quality. Others argue
that WHO needs strong regional and country offices
On July 1, 2017, Dr. Tedros Adhanom Ghebreyesus became
because budgetary and operational capacities vary across
the first African to be elected the Director-General of WHO.
countries and regional directors best understand how to
His five-year term includes a mandate to improve
carry out WHO policy under each unique circumstance.
effectiveness, transparency, and accountability. In addition,
Dr. Tedros has set four goals: ensure universal access to
WHO Structure
health care; respond quickly and effectively to health
The World Health Assembly (WHA) is made of 194
emergencies; secure the health, dignity, and rights of
member states that meet each May to set WHO policies and
women, children, and adolescents; and decrease the health
priorities. The WHA also appoints the Director-General (DG),
impacts of climate and environmental change.
reviews and approves the budget, and considers reports of the
The leadership transition happens amid questions regarding
Executive Board.
the WHO’s capacity to meet its priorities and raise revenues
The Executive Board is an advisory body composed of health
to support those efforts. Some observers believe that the
experts from 34 member states. Board members serve three-year
terms, with annual meetings in January and May to develop the
WHO should strengthen partnerships with the private sector
agenda and draft resolutions for the forthcoming WHA.
and other nongovernmental donors to increase financial
The Secretariat is the organization’s technical and
support for the organization. Other groups are concerned
administrative staff composed of the DG, six Regional Directors,
about how increased funding from non-state actors might
and more than 7,000 people who implement WHO policy and
influence WHO policy recommendations. This In Focus
programs worldwide.
discusses selected issues currently facing WHO, including
The Director-General leads the Secretariat over five-year
reform and funding issues of ongoing interest to Congress.
terms after being nominated by the Board and appointed by the
Key Priorities
WHA. Dr. Tedros Adhanom Ghebreyesus, the first DG from
The WHO has made progress in its reform agenda. In 2016,
Africa, assumed his role on July 1, 2017.
the organization adopted a framework to regulate
The rise and spread of infectious disease has reinvigorated
engagements with non-state actors and launched an online
calls for a quicker and more agile WHO. For instance,
repository that provides information about such
groups criticized the WHO consensus-building process and
engagements (see “Transparency”). In addition, the WHO
internal procedures for its slow response during the Ebola
created a portal with data about access to health services and
outbreak. Amid the crisis, the WHO deliberated for more
health equity globally and in each member state.
than four months before declaring the Ebola outbreak a
Public Health Emergency of International Concern under
The organization also adopted a two-pronged strategy to
the International Health Regulations (IHR)—an
bolster revenue streams through increased engagement with
international agreement aimed at strengthening global
non-state actors and member states, particularly middle-
capacity during public health events with potential
income countries. In June 2017, the new Director-General
international impact. CRS In Focus IF10022, The Global
toured the United States and visited key funders, including
Health Security Agenda and International Health
the Bill and Melinda Gates Foundation and the World Bank.
Regulations.
In May 2017, the 70th World Health Assembly (WHA)
approved a 3% increase in assessed contributions for the
The Ebola crisis exposed the frailty of country health
2018–2019 budget. The WHA adopted a $554 million
systems and showed that the world is generally unprepared
budget for the Health Emergencies Program—a new
to control infectious disease outbreaks in low-resource
https://crsreports.congress.gov
World Health Organization (WHO): Background and Issues
settings. In response, the WHA established the Health
WHO Budget
Emergencies Program (HEP) and the Contingency Fund for
WHO’s program budgets are financed through a mix of
Emergencies (CFE), earmarked for early response activities.
assessed and voluntary contributions. The latter are
The HEP and CFE were used during the 2016 Zika outbreak
earmarked funds that come from countries and non-state
to convene experts and provide $3.2 million toward Zika
donors. Until the late 1990s, assessed contributions
control.
constituted the majority of WHO funding. Over time, the
proportion of the budget financed through voluntary
Some question the viability of the CFE. In May 2017, an
contributions has increased, while assessed contributions
independent panel remarked that the organization’s
have remained stable. In 2017, roughly 80% of the nearly $4
administrative systems and business processes “remain the
billion budget was provided through voluntary contributions
main challenge” to overcome. The fund was designed to
(Figure 1). Almost 60% of all voluntary contributions come
front-load resources and then fundraise to repay expenses.
from 10 donors, half of which are nongovernmental entities.
Donors, however, have hesitated to replenish the CFE and to
establish an annual pledging cycle for the fund. As of June
Some observers are concerned that reliance on voluntary
2017, the CFE’s funding gap neared 60%.
contributions exposes WHO to uncertainty and forces it to
spend inordinate time on fundraising and related activities.
Transparency
Supporters of expanding such partnerships argue that
In late April 2009, WHO announced the emergence of an
assessments (member states’ membership dues) are not
influenza virus that had not previously circulated in humans.
sufficient to support WHO operations and that collaborating
Within the same month, the Director-General had declared
with non-state actors can enhance WHO capacity by
the outbreak a PHEIC and by early June had confirmed the
expanding revenue streams and leveraging nongovernmental
existence of an influenza pandemic. Some groups asserted
resources and expertise.
that WHO’s response was exaggerated due to influence
from some pharmaceutical groups and urged greater
Conclusion
transparency in the policy recommendation process.
Ongoing reform efforts may improve WHO operations,
including its emergency response capacity, but other
The WHO has engaged in intense discussions and
external factors could also influence its effectiveness. WHO
negotiations around increasing transparency, and the new
lacks any enforcement authority and cannot compel member
Director-General has prioritized the issue. In 2016, the
states to implement IHR requirements, cannot fully support
WHA adopted the Framework of Engagement with Non-
others to do so, and lacks the financial and operational
State Actors (FENSA), the first regulatory framework
capacity to carry them out. Actions by member states that
within the United Nations system that covers interactions
contravene WHO recommendations in a declared
with non-state actors, including private sector entities and
emergency can also hinder WHO response capacity. WHO
foundations.
effectiveness in addressing future outbreaks might depend
not only on internal factors but also on actions of member
Supporters praise FENSA as a major step toward
states in support of and in opposition to WHO policy.
transparency and a safeguard against undue private
CRS fellow Dr. Giorleny Altamirano contributed to this In
influence. Critics, however, warn that its equal treatment of
Focus.
public interest and for-profit interest groups encourages,
rather than thwarts, stronger private sector involvement in
WHO governance and policy formulation.
Source: Created by CRS from WHO budget portal at http://open.who.int/, accessed on July 6, 2017.
IF10289
Tiaji Salaam-Blyther, Specialist in Global Health
https://crsreports.congress.gov
World Health Organization (WHO): Background and Issues
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