Report by Mr Bjӧrn Kümmel, Chair of the WHO Sustainable Financing Working Group, to the Seventy-five World Health Assembly

Chair,

honourable PBAC members,

colleagues,

it is a great pleasure and honour to report on the outcome of the Working Group on Sustainable Financing.

As you know, the working group was established by the EB in January last year, in order to enable the WHO to have the robust structure needed to fulfil the Member States expectations.

Already at the start of this long journey, there were a general notion, that there is a huge discrepancy in between what the world expects from WHO and its de facto financial capacities. 

We have highlighted, that WHO’s budget is to 86 % dependent on generous donors and that only roughly 14 % of WHO’s finances are truly predictable. This situation has put WHO at severe risk, including its independence, its integrity, its agility and certainly also its mandated role to be the world’s leading and coordinating authority in global health.

The challenge of sustainable financing has often been described as potentially the greatest historic challenge that WHO has been facing as an organization, recognizing that many efforts to tackle this issue have been tried but did not solve the issue over the past two decades.

While the chair of the working group has sometimes used the maybe inappropriate words to describe the situation, namely that “WHO’s financing is fundamentally rotten”, there was a clear consensus in the working group, that the status quo of WHO’s financing is unacceptable.

This being said, it is with great pleasure, that I am able to report to you, that we reached a consensus on all of our recommendations. And if implemented, they will certainly change the unacceptable status quo to the better.

So what have we reached a consensus on?

I am not going to read out all recommendations, as you have them before you but I will highlight some key ones:

The WG stresses that Member States as a collective must match their willingness to fund the Organization with the demands that they place on it.

We further stress that any increase in Member States’ assessed contributions needs to be accompanied by appropriate governance reforms, to be agreed by Member States, together with the further strengthening of transparency, efficiency, accountability and compliance within the Organization.

We discussed the severe fiscal constraints and explicitly acknowledge that many Member States face severe financial challenges, including those accentuated by the COVID-19 pandemic.

Regarding the PBAC: We strongly recommend a strengthening of the role of the Programme, Budget and Administration Committee, to make it more effective, robust and transparent, and more engaged with the Secretariat during the budgeting process and potentially through additional deliberations.

A key issue, that was often referred to as the most tricky issue in the debate, namely a potential AC increase: 

We recommend that the Seventy-fifth World Health Assembly, recognizing the important role of assessed contributions in sustainably financing the Organization, should request the Secretariat to develop budget proposals, through the regular budget cycle, for an increase of assessed contributions to contribute to financial sustainability of WHO and with its aspiration to reach a level of 50% of the 2022–2023 base budget by the biennium 2030–2031, while aiming to achieve this by the biennium 2028–2029. 

But the WGSF does not leave this aspiration in abstract terms but proposes very concrete steps to reach this aspiration, namely:

The Secretariat should develop a budget proposal with a targeted first increase of 20% of the assessed contributions assessment for the biennium 2022–2023, as part of the Proposed programme budget 2024–2025, and to be submitted for approval to the Seventy-sixth World Health Assembly.

As recommended already by the IPPPR, in addition to a substantive AC increase, we recommend that the Health Assembly request the Secretariat to explore the feasibility of a replenishment mechanism to broaden further the financing base, in consultation with Member States and taking into consideration the Framework of Engagement with Non-State Actors.

As mentioned already, any substantive AC increase would need to be supported by concrete steps to ensure the agility of WHO.

Therefore, the Working Group on Sustainable Financing also recommends the establishment of an agile Member States task group on strengthening WHO budgetary, programmatic and financing governance to analyse challenges in governance for transparency, efficiency, accountability and compliance, and come up with recommendations.

The establishment of the Task Group, open to all Member States, should be taken up during the 151st session of the Executive Board.

So you may wonder, what should the Assembly do with these recommendations?

We drafted a decision for adoption by the Assembly:

(1) to adopt the recommendations of the Working Group on Sustainable Financing, and

(2) to request the Director-General to put in place measures to ensure the implementation of these recommendations.

So, what does this outcome of the working group mean, outing it into the broader perspective.

To many the financing of the WHO  may seem very technical or complex.

However, what the Working Group has discussed and has found a consensus on is not just a technical issue. This goes far beyond financing some WHO programs.

It was clear for the working group that what we were discussing is nothing less than the future role of WHO in global health and even beyond, namely the question, what kind of global health architecture we envisage: A less fragmented, better coordinated, more efficient and truly inclusive global health governance with a fundamentally strengthened WHO at its centre as the enabled leading and coordinating authority.

The recommendations, if so adopted by the Assembly, will enable WHO to live up to member state’s expectations.

They are a game changer for WHO, for every programme, every country office, every major office and most likely also for the work every single WHO staff member.

Beyond WHO, they are a game changer for global health governance. If implemented, the recommendations will allow WHO to live up to the expectation to be the key convener for global health.

Many of the issues, that the PBAC has discussed over the past decades, namely the unsatisfactory heat map, the unsatisfactory drying out of the enabling functions, putting the entire organization at risk, the main challenges in HR contracts with a growing dependency on non-staff contracts and many other issues, will be positively impacted by these recommendations.

Yes, the recommended steps will be a ground-breaking improvement for WHO.

And, yes, to finalize these recommendations, it took roughly 1 ½ years. But this huge effort by all colleagues involved will prove to be worth it, if we finally adequately address this historic challenge.

The compromise was possible due to the strong commitment by all members of the working group and their will, to strengthen the WHO.

It was possible, because everyone in the room understood, that the window of opportunity to learn one key lesson from this pandemic, might be already closing.

Some commentators have referred to the compromise as “global health diplomacy at its best”.

To me, this was a strong success of what I would call “constructive multilateralism”. This was a truly inclusive process. All MS had the chance to actively shape the outcome and did so. The working group was attended by an outstanding number of delegations throughout its 7 sessions with many delegations having to wake up in the middle of the night, in order to follow the deliberations.

This engagement shows the given true commitment for a stronger WHO.

This was a learning exercise for many of us, in particular the chair.

I would like to sincerely thank all colleagues and members from the working group for allowing this great outcome and for their readiness to compromise.

I would like to thank my co-chairs for their wisdom, leadership and patience with their chair throughout the past 1 ½ years.

I would like to thank the entire Secretariat for its support to this process, despite having to handle an ongoing pandemic, obviously the different teams here in HQ but also the regions and colleagues in the country offices.

A big thank also to the various external colleagues, the high level panels, the independent experts but also civil society and academia who followed the process and pushed us all for an ambitious outcome. 

As you see, at least from the perspective of the chair, this was real team work. 

Thank you for the time to address you and I hope, you will indeed make the recommendations a lasting success of multilateralism.

It is now or never.

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