WHO in 2002: Why does the world still need WHO?

Publisher Website
Google Scholar
Abstract
New money for global health The World Bank has become the largest external financier of health activities in low income and middle income countries.1 In the 1990s its health loans far exceeded WHO's total budget (fig 1), and its health sector activities have continued to grow. Its new Multi-Country AIDS Programme alone provides $500m over three years to Africa—where the prevalence of HIV in adults is now 8.6%—to scale up existing HIV/AIDS interventions.3 View larger version: In this window In a new window Fig 1 The growing role of the World Bank in health1 The Gates Foundation, the largest charitable donor of the 20th century,4 is often called the new “800 pound gorilla” in global health. By September 2002, it had granted $2.8bn in health funding.5 Its biggest donation was $750m over five years as a start up grant to the Global Alliance for Vaccines and Immunisation (GAVI), which aims to increase children's access to vaccines in poor countries. It also pledged $100m to the International AIDS Vaccine Initiative (IAVI), whose mission is the development of and universal access to an HIV vaccine. Gates avoided putting his billions into the United Nations system. He channelled them instead into smaller, independently governed initiatives that focus on “quick fix,” high profile health problems. Gill Walt, professor of international health policy at the London School of Hygiene and Tropical Medicine, said these new initiatives “peeled off bits of the WHO,” forcing the organisation to reflect on what its remaining functions should be. Another source of funding is the Global Fund, an independent financing mechanism that has pledged $2.1bn over five years to country based projects tackling AIDS, tuberculosis, and malaria.6 It was launched with great fanfare and impressive promises from donor governments, who have recently come under pressure to fulfil their pledges.7 “The fund was developed,” said Daniel Tarantola, one of Brundtland's senior policy advisers, “in a spirit of wanting to create something very independent from the UN.” But by establishing the fund outside of the UN, weren't donors expressing a vote of no confidence in the UN's ability to deal with the AIDS epidemic? “That is one interpretation,” said Peter Piot, executive director of the joint UN programme on HIV and AIDS. “But I would say that, with the UN Secretary General, whom I was involved with in negotiations for the fund, we felt right from the start that an investment fund, a financing mechanism, would best be independent.” Piot believes that if the UN had controlled the fund, it would have changed the nature of its work. “I firmly believe,” he said, “that you can do much better normative work, advocacy work, and policy work if you're not the one writing the cheque. That's one of the problems with the World Bank—often the one who writes the cheque determines policy. Will that happen with the Global Fund? It remains to be seen.”