| The World Health Organization (WHO) is
in trouble. Its leader is accused of failing to lead, and as the
organization drifts, other bodies, particularly the World Bank, are setting the
global health agenda. Western governments want the WHO to set realistic
targets and focus its energy on tackling major killers such as childhood
diseases and tobacco. The WHO clearly needs to set priorities. Its total budget of $0.9 billion--around 10 percent for each man, woman and child in the world--cannot solve all the world's health problems. Yet its senior management does not seem willing to narrow the organization's focus. Instead it is trying to be all things to all people and losing dependability. Unfortunately, the argument for priority setting is being seriously undermined by the US, one of the chief advocators of change. The US is trying to reduce its contribution to the WHO's regular budget from a quarter of the total to a fifth. That would leave the organization $ 20 million short this year, on top of the substantial debts the US already owes. The WHO may need priorities, but it certainly doesn't need budget cuts. Thanks to the US' failure to pay its bills, many of the poorer nations see priority-setting as merely a cover for cost-cutting that would hit their health programs hard. The WHO would not serve poorer countries any worse if it sharpened its focus. It would probably serve them better, in any case, a sharper focus should not mean that less money is needed. When the US demands cuts, it simply fuels disputes between the richer and poorer countries and gives the WHO's senior management more time to postpone. The American action is not confined to the WHO. It wants eventually to cut its contributions to the Food and Agriculture Organization and the international Labor Organization too. But it knows' that dissatisfaction with the WHO and its leadership has made the organization vulnerable. If it wins against the WHO, the rest will lose out in their turn. America's share of the budget is already a concession. Each nation's contribution to the UN agencies is calculated according to its wealth, and by that measure the US should be paying about 28 percent of the WHO budget. But over the past three decades the US has gradually reduced what it pays the organization. The US should not ask for further cuts. Until it pays its full share of money, it will hold hack the organization's much needed reforms. The world needs the WHO. The World Bank may have a bigger budget, but it sees improved health as just one part of economic and social development. The WHO remains the only organization committed to health for all, regardless of wealth. |