Filling the need for trusted information on national health issues…

The U.S. Government and the World Health Organization

Key Facts

  • The World Health Organization (WHO), founded in 1948, is a specialized agency of the United Nations with a broad mandate to act as a coordinating authority on international health issues.
  • The U.S. government (U.S.) has long been actively engaged with WHO, providing financial and technical support as well as participating in its governance structure.
  • The U.S. is currently the largest contributor to WHO.
  • The WHO faces numerous challenges and limitations, from funding to organization to poor performance in responding to health emergencies. A reform process has been underway to address some of these issues.
  • A new Director-General of WHO will be named in May 2017.

What is the World Health Organization (WHO)?

The WHO, founded in 1948, is a specialized agency of the United Nations (see Table 1). As outlined in its constitution, WHO has a broad mandate to “act as the directing and coordinating authority on international health work” within the United Nations system. It is made of 194 member states.

Table 1: WHO Basics
Founded: 1948
Headquarters:   Geneva, Switzerland
Regional Offices (Semi-Autonomous): AFRO (Africa)
EMRO (Eastern Mediterranean)
EURO (Europe)
PAHO (The Americas)
SEARO (Southeast Asia)
WPRO (Western Pacific)
# of Member States: 194
Budget: $4.385 billion over two years (2016-2017)*

*Actual revenue and expenditures may differ from budgeted amounts.

Mission

 Its overarching mission is “attainment by all peoples of the highest possible level of health.”1 It supports its mission through activities such as:
  • providing technical assistance to countries,
  • setting international health standards and providing guidance on important health issues,
  • coordinating and supporting international responses to health emergencies such as disease outbreaks, and
  • promoting and advocating for better global health.2

The organization also serves as a convener and host for international meetings and discussions on health issues. For the most part, WHO is not a direct funder of health services and programs in countries.

Achievements

The agency has played a key role in a number of global health achievements, such as the Alma-Ata Declaration on primary health care (1978), the eradication of smallpox (formally recognized in 1980), the Framework Convention on Tobacco Control (adopted in 2003), and the 2005 revision of the International Health Regulations (IHR), an international agreement that outlines roles and responsibilities for WHO, countries, and others in preparing for and responding to international health emergencies.

Organization

WHO has a headquarters office located in Geneva, Switzerland, six semi-autonomous regional offices that oversee activities in each region, and a network of country offices and representatives around the world. It is led by a Director-General (“DG”). The current DG is Margaret Chan, whose term ends in May 2017.  The election process for her successor is already underway.

World Health Assembly

The World Health Assembly (WHA), comprised of representatives from WHO’s 194 member states, is the supreme decision-making body for the agency and is convened annually. It is responsible for selecting the DG, setting priorities, and approving WHO’s budget and programme of activities (or “work plan”). Every six years the WHA negotiates and approves a work plan for WHO (the current work plan is for the period 2014-2019), and every two years it approves a new biennial budget in support of the work plan (the current budget is for the period 2016-2017).  The annual WHA meeting in May also serves as a key forum for nations to debate important health policy issues.

Executive Board

WHO’s Executive Board, comprised of 34 members technically qualified in the field of health, facilitates the implementation of the agency’s work plan and provides proposals and recommendations to the Director-General and the WHA.3 The 34 members are drawn from six regions:

  • 7 represent Africa,
  • 6 represent the Americas,
  • 5 represent the Eastern Mediterranean,
  • 8 represent Europe,
  • 3 represent South-East Asia, and
  • 5 represent the Western Pacific.

Member states within each region designate one regional member to serve on the Executive Board on a rotating basis.  The U.S. is currently designated as a member of the Executive Board representing the Americas for the 2014-2017 period.

Budget

WHO relies on contributions from member states and private organizations for funding to implement its budget and work plan.  The current biennial WHO budget, for 2016-2017, has been set at $4.385 billion. However, actual revenue and expenditures over the budget period may deviate from the budgeted amount.

Revenue

WHO has two primary sources of revenue:

  • assessed contributions (set amounts expected to be paid by member-state governments, scaled by income and population) and
  • voluntary contributions (other funds provided by member states, plus contributions from private organizations and individuals).4

Figure 1: Proportion of World Health Organization Programme Budget Revenue by Type of Contribution, 2014-2015

Most assessed contributions are considered “core” funding, meaning they are flexible funds that are often used to cover general expenses and program activities. Voluntary contributions, on the other hand, are often “specified” funds, meaning they are earmarked by the donor for certain activities.

Several decades ago, the majority of WHO’s revenue came from assessed contributions, but over time, voluntary contributions have come to comprise the greater share of WHO’s budget.5 In the most recently completed budget cycle, the 2014-2015 biennial budget, assessed contributions totaled $955 million (20% of revenue), while voluntary contributions totaled $3.839 billion (80%).6

Activities

WHO’s activities are focused on seven “categories of work,” as identified in the current WHO budget 7 and work plan 8 (see Table 2):

  • communicable diseases;
  • corporate services and enabling functions
  • health systems;
  • non-communicable diseases;
  • preparedness, surveillance, and response;
  • promoting health through the life course; and
  • other areas.

Each of these categories is, in turn, made up of “program areas.” For instance, communicable diseases has six program areas, including HIV/AIDS and tuberculosis. “Other areas” includes polio, tropical disease research, and outbreak and crisis response.

Table 2: WHO Biennial Budget (2016-2017),
by Category of Work9
Category of Work Budget*
(2016-17)

in $ millions
Communicable diseases 765
Corporate services and enabling functions 734
Health systems 594
Non-communicable diseases 340
Preparedness, surveillance, and response 380
Promoting health through the life course 382
Other areas:
  -Polio, tropical disease research 986
  -Outbreak and crisis response 204
TOTAL 4,385
*These are budgeted amounts. Actual revenue and expenditures over the two-year period may differ from these amounts.

Challenges

WHO faces a number of institutional challenges, including: 10

  • a scope of responsibility and activities that has grown over time while its budget has remained flat or been reduced;
  • a budget that has become less flexible with greater reliance on voluntary contributions often earmarked for specific activities;
  • a cumbersome, decentralized, and bureaucratic governance structure; and
  • a dual mandate of being both a technical agency with health expertise and a political body where states debate and negotiate on sometimes divisive health issues.

These and other challenges were particularly evident after the perceived failures of the agency during the response to Ebola in West Africa, and multiple independent reports have called for significant reform of the agency in the wake of Ebola.11 The agency already had a reform effort in place since 2010, but has accelerated the pace of reform since 2015. For example, in 2016 WHO reorganized its approach to outbreaks and health emergencies by creating a new Health Emergencies Programme and standing up new special emergency financing mechanisms.12

U.S. Engagement with WHO

The U.S. government engages with WHO in many ways, as follows:

Financial Support

One of the main ways in which the U.S. government supports WHO is through assessed and voluntary contributions; the U.S. is the single largest contributor to WHO. For many years, the assessed contribution for the U.S. has been set at 22% of all member state assessed contributions, the maximum allowed rate.13 Between FY 2010 and 2016, the U.S. assessed contribution has been fairly stable, fluctuating between $93 million and $114 million (Figure 2).

Figure 2: U.S. Contributions to the World Health Organization, by Type of Contribution, FY 2010-FY 2016

Voluntary contributions for specific projects or activities, on the other hand, have varied to reflect changing U.S. priorities and support during international crises. Between 2010 and 2016, U.S. voluntary contributions were highest in 2015 ($324 million), reflecting additional support for WHO’s response to the West African Ebola epidemic. The next highest amount, in 2010 ($275 million), came during an H1N1 influenza pandemic. U.S. voluntary contributions also support a wide range of other WHO activities such as polio eradication; maternal, newborn, and child health programs; food safety; and regulatory oversight of medicines.

U.S. assessed and voluntary contributions together represented approximately 16% of WHO’s total revenue in the 2014-2015 biennium.14

Governance activities

The U.S. participates in WHO governance in several ways, including through:

  • representation on the Executive Board (a U.S.-selected representative holds the seat for the Americas on the board through 2017) and
  • active participation in the annual World Health Assembly.

The U.S. delegation to the World Health Assembly has usually been led by the Secretary of Health and Human Services, with multiple U.S. agencies and departments represented.

Technical Support

The U.S. provides technical support to WHO through a variety of activities and partnerships. This includes U.S. government experts and resources supporting WHO research and reference laboratory work, and participation of U.S. experts on advisory panels and advisory groups convened by WHO. In addition, a number of U.S. government representatives are seconded or serve as liaisons at WHO headquarters and WHO regional offices, working day-to-day with staff on technical efforts.15

Partnering Activities

The U.S. also works in partnership with WHO before and during responses to outbreaks and other international health emergencies. For example, U.S. government experts often participate in international teams that WHO organizes to investigate and respond to outbreaks around the world. For example, the U.S. worked with WHO and the broader multilateral response to the Ebola epidemic in West Africa that began in 2014.

Key Issues for the U.S.

The U.S. government has long supported WHO and is currently its largest donor.  However, with WHO undergoing major reforms in the midst of a leadership change, and with a new U.S. presidential administration that has thus far expressed some reservation about supporting international organizations, there are several key questions going forward, including:

  • the extent to which the U.S. will continue its financial and other support of WHO and what role it will seek to play in WHO’s governance;
  • the success of WHO and its incoming Director-General in enacting reforms that improve the effectiveness of the organization and address its challenges; and
  • the quality of ongoing technical and governance partnerships between the U.S. and WHO, especially in the event of a new public health emergency or outbreak in the future.
Endnotes
  1. Constitution of the World Health Organization, Chapter 1, Article 1. http://www.who.int/governance/eb/who_constitution_en.pdf.

    ← Return to text

  2. Clift C. The Role of the World Health Organization in the International System. Chatham House Centre for Global Health Security.  http://www.chathamhouse.org/publications/papers/view/189351.

    ← Return to text

  3. World Health Organization website. The Executive Board http://www.who.int/governance/eb/en/.

    ← Return to text

  4. World Health Organization Programme Budget website. http://extranet.who.int/programmebudget.  

    ← Return to text

  5. World Health Organization. A proposal to increase the assessed contribution. 2016 http://www.who.int/about/finances-accountability/funding/financing-dialogue/assessed-contribution.pdf.

    ← Return to text

  6. World Health Organization. WHO Programmatic and Financial Report for 2014-2015 including audited financial statements. 29 April 2016. http://www.who.int/about/finances-accountability/reports/ADVANCE_for_WEB_A69_45-en_290416.pdf.

    ← Return to text

  7. World Health Organization. WHO 2016-17 Approved Programme Budget. http://www.who.int/about/finances-accountability/budget/PB201617_en.pdf

    ← Return to text

  8. World Health Organization. Twelfth General Programme of Work 2014-2019. http://www.who.int/about/resources_planning/twelfth-gpw/en/

    ← Return to text

  9. World Health Organization. WHO 2016-17 Approved Programme Budget. http://www.who.int/about/finances-accountability/budget/PB201617_en.pdf

    ← Return to text

  10. Clift C. What’s the World Health Organization For? Chatham House. May 2014 https://www.chathamhouse.org/sites/files/chathamhouse/field/field_document/20140521WHOHealthGovernanceClift.pdf.

    ← Return to text

  11. Some of the key reports include: WHO’s own commissioned Ebola Interim Assessment Panel http://www.who.int/csr/resources/publications/ebola/ebola-panel-report/en/; Harvard-London School of Hygiene and Tropical Medicine Report http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00946-0/fulltext; National Academy of Medicine, Global Health Risk Framework report https://nam.edu/initiatives/global-health-risk-framework/; and the United Nations High-level Panel on the Global Response to Health Crises report http://www.un.org/News/dh/infocus/HLP/2016-02-05_Final_Report_Global_Response_to_Health_Crises.pdf.

    ← Return to text

  12. World Health Organization. Progress Report on the Implementation of the WHO Health Emergencies Programme, March 2016. http://www.who.int/about/who_reform/emergency-capacities/who-health-emergencies-programme-progress-report-march-2016.pdf.

    ← Return to text

  13. World Health Organization. Scale of Assessments for 2016-2017. 26 May 2015 http://www.who.int/about/finances-accountability/funding/A68_R12_en.pdf?ua=1.

    ← Return to text

  14. Estimate calculated from data provided in World Health Organization’s WHO Programmatic and Financial Report, 2014-2015. http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_45-en.pdf.

    ← Return to text

  15. Centers for Disease Control and Prevention. CDC Global Health Partnerships.  https://www.cdc.gov/globalhealth/partnerships.htm.

    ← Return to text

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/KaiserFamFound

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.