WHO and the effects of extrabudgetary funds: is the Organization donor driven?

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Abstract
The findings and conclusions of an international policy study are presented on the effects of donors and their voluntary financial contributions upon the World Health Organization. Such extrabudgetary funds now account for over a half of the total expenditure of the Organization and more than 80% of these funds come from a small group of 10 industrialized donor countries. This has led to widespread concerns that the Organization is being ‘donor driven’ and that powerful countries are unduly influencing the priorities of the Organization and the management of its programmes. With reference to such extrabudgetary funds, the study concluded that: a) they have given essential support to international health research; b) they have enabled WHO to be a more effective international health development agency; c) these funds are poorly defined and there is a lack of standardized financial information; d) these funds are closely integrated with the regular budget particularly at global programme level; e) they have not unduly distorted the initial setting of WHO priorities; f) they have encouraged vertical management systems; g) they have increased the problems of programme coordination; and h) the WHO World Health Assembly and Executive Board do have sufficient formal authority over such funds and they could exercise more control if they wished to do so. The overall conclusion was that, although there is some truth in the assertion that WHO is being ‘donor driven’, it is also clear that donor involvement has brought many advantages to the Organization as a whole. Despite the general conclusion that extrabudgetary funds do represent value-for-money, many donor countries are reducing their voluntary contributions to WHO, while at the same time the regular budget has also been curtailed by the Assembly. These two trends have clear and important implications for the future of WHO and for all international health activities.

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