PHM-Exch> WHO’s efforts to justify health protection

[Claudio Schuftan]

 EQUINET NEWSLETTER 216 : 01 March 2019
*CONTENTS*: 1. Editorial
<http://www.equinetafrica.org/newsletter/issue/2019-03-01#1>,

1. Editorial
The Price of Life – WHO’s efforts to justify health protection
Leslie London, University of Cape Town, Sofia Gruskin, University of
Southern California, Sharon Fonn, Witwatersrand University, South Africa


In the same month that it reaffirmed the 1978 Alma Ata Declaration’s
commitment to “the fundamental right of every human being to the enjoyment
of the highest attainable standard of health” in its October 2018
Declaration of Astana, the World Health Organisation (WHO) launched, with
much fanfare and hubris, its “first investment case” for 2019-2023, as a
proposal that could “save up to 30 million lives”.

Despite the rhetoric of the Astana Declaration, the WHO appears to be in a
political moment where it is under pressure to justify, in economic terms,
its existence as a global governance structure for health. To convince the
doubting reader, the investment case promised “economic gains of US$ 240
billion” as the return to be made on increasing annual country
contributions by US$10 billion to enable the WHO to meet its annual budget
of US$14 billion.

Two things are striking. Firstly, the investment case purports to lay the
basis for “a stronger, more efficient, and results-oriented WHO …and …
highlights new mechanisms to measure success, ensuring a strict model of
accountability and sets ambitious targets for savings and efficiencies.”
This is the language of the private sector.

There is nothing wrong with working more efficiently, but the WHO should be
placing health equity and human rights at the centre of its work and should
guard against efficiency and managerialism coming at the expense of equity
and social justice. The bureaucracy and inefficiency of the WHO needs
addressing, but the idea that the solution lies in the application of New
Public Management is a political choice, rather than a necessary outcome of
clear analysis.

Secondly, the parlous state of WHO funding is not a coincidence. It is the
result of a systematic decline in assessed contributions by member states,
particularly the United States, over past decades. Whereas assessed
contributions were 75% of WHO’s budget in 1971, the Peoples Health Movement
and others showed in 2017 that this is now about 25% of the institution’s
budget and that countries that do pay, choose to put most funding into
voluntary contributions. Voluntary contributions can be tied to particular
programmes, meaning countries can determine the work of WHO through funding
dependence. WHO’s budget has also been stagnant for the past eight years,
which is why the organisation now has to go cap-in-hand, clutching a
seemingly miraculous investment case argument, to beg for the budgets it
has been starved of for the past decade.

It is astonishing, but deeply revealing, that the WHO has to justify human
life in monetary or investment’ terms. Who would have thought the
Constitution of the World Health Organization which 70 years ago heralded
the enjoyment of the highest attainable standard of health as one of the
fundamental rights of every human being would end up in such abysmal
decline?

Please send feedback or queries on the issues raised in this oped to the
EQUINET secretariat: admin at equinetafrica.org. The WHO Investment case
referred to in the editorial can be found at https://tinyurl.com/yavqzjvk
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