This was revealed in a paper published in the journal Lancet on "WHO and the future of disease control programmes". The paper authored by several employees of the WHO stated that the DAH has increased by five times, reaching at least $27 billion in 2010. International health spending has also increased, made possible by a huge proliferation in donors, global funds and partnerships, non-governmental and civil society organisations, philanthropists, commercial investors, and the engagement of the pharmaceutical industry. This channeling of available resources through a multitude of organisations has raised questions about the focus of health spending and the role of WHO.
The income received by the WHO over the two decades was entirely based on voluntary grants and donations which are unpredictable and often earmarked by donors to address topical health issues such as emerging pathogens and new technologies. Hence, WHO's core budget to carry out key functions such as providing leadership on crucial health matters, shaping the research agenda, setting norms and standards, promoting and monitoring their implementation and assessing health trends has slowly decreased.
Though national governments, civil society, financial donors, private foundations, the corporate sector, and technical agencies seem to be channeling funds through various alliances, funds and organizations, according to the Lancer paper, they turn to WHO for impartial, authoritative guidance on all aspects of health. "Accountable to member states and to its donors, WHO is the principal agency charged with convening interested parties, in a disinterested way, to determine the best possible approaches to improving health, and with monitoring success as an independent scorekeeper," the paper stated.
Yet, not only WHO, but other "accountable and international organisations" such as the United Nations too seem to get a diminishing share of the growing DAH funds. Even development banks get a small share in comparison to bilateral alliances and funds and NGOs whose share has grown phenomenally in the same period.
This trend was documented in an earlier Lancet paper of 2009 by researchers from the Institute for Health Metrics and Evaluation, University of Washington and the Harvard Initiative for Global Health. The paper observed that "the proportion of DAH channeled via UN agencies and development banks decreased from 1990 to 2007, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunization ( GAVI), and non-governmental organisations became the conduit for an increasing share of DAH. "To sustain their present role, the UN agencies—especially WHO and UNICEF—have to compete with recipient countries, NGOs, and other organisations for available DAH funds. This steady shift to a competitive model of funding runs the risks of undermining their crucial role as trusted neutral brokers between the scientific and technical communities on the one hand, and governments of developing countries on the other," stated the paper.
In the current Lancet paper, the authors stressed the need for WHO to expand its role as convenor, coordinator, and monitor in international health by working as a part of the growing family of collaborators. It remains to be seen whether WHO-like organisations with shrinking funds to maintain their existence and lighter purses to fund any project will have any say in international health priorities compared to global funds, alliances and NGOs with deep pockets who are increasingly cornering most of the increasing DAH funds.
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