Belgium leads assessment of the World Health Organization (WHO)

As a member and president of MOPAN – a network that seeks to strengthen the effectiveness of international institutions – Belgium helped to assess the World Health Organization (WHO). The WHO maintains its leading position among global health institutions, but it could raise its profile and needs more guaranteed funding.

The World Health Organization (WHO) is the United Nations (UN) organisation that sets global standards for healthcare in Member States. Founded in 1948 – on 7 April, now World Health Day – it promotes health for all and helps the vulnerable worldwide. Belgium is a founding member and participates through the annual General Assembly among health ministers.

Within the UN and with respect to other global health institutions, the WHO occupies a central position, while as a UN organisation, it not only sets international health standards based on robust data collected on global health issues, but also provides authoritative information. It also provides a forum for scientific and political discussions on health and performs a coordinating role worldwide.
 

Triple Billion targets

The Sustainable Development Goals (SDGs), in particular SDG3 on good health and well-being, provide clear guidance for its activities. In addition, WHO has pinned down 'triple billion targets':

• To achieve universal health coverage – 1 billion more people benefiting from universal health coverage;
• To address health emergencies – 1 billion more people better protected from health emergencies;
• To promote a healthier population – 1 billion more people enjoying better health and well-being.

Complex organisation

The WHO has an ambitious agenda! To achieve these goals, the WHO has grown into quite a complex organisation. In addition to its headquarters in Geneva, Switzerland, six regional offices focus on the health situation, respectively in Africa, the Americas, the Eastern Mediterranean, Europe, South-East Asia and the Western Pacific. Belgian Hans Kluge is director for the 'Europe' region, which, with 50 countries, extends far beyond just the EU.

In addition, there are 152 country offices. The 194 Member States provide funding with both mandatory contributions (calculated on the basis of GDP) and voluntary contributions. But development banks (World Bank, etc.), other UN agencies (UNICEF etc.) and charities (Bill and Melinda Gates Foundation, Rotary International, etc.) also contribute. A total of around 8,800 people work for the WHO.

COVID-19 pandemic

The WHO functions well, and it also proved this during the COVID-19 pandemic. The rapid spread of COVID-19 in 2020 presented WHO with unprecedented challenges, but the organisation managed to act swiftly and deftly, and to strengthen its role as a leading institution. It devoted more energy into partnerships, sought new funding mechanisms, and focused even more on capacity building in developing countries.

At the same time, the pandemic sucked attention away from the usual fields such as access to quality healthcare and routine vaccinations. Positive trends for malaria and tuberculosis were reversed, while fewer people were treated for neglected tropical diseases, not to mention the ongoing negative effects of COVID-19, including a decline in mental health, especially in adolescents. By mid-2023, only 12% of the SDGs' health indicators appeared to be on track.
 

MOPAN assessment

Moreover, we are living in a time with enormous challenges. Climate and environmental issues (heat waves, deforestation, pollution, etc.), increasing conflicts and troubling problems such as antimicrobial resistance and non-communicable diseases (obesity, diabetes, etc.) are just a few of them, so it goes without saying that an institution like the WHO should never rest on its laurels. It must continue to polish its operation in order to act as effectively as possible.

And it has done this: about every five years, it outlines a general programme of work to overcome its weaknesses as best it can. However, it is also extremely useful for outsiders to regularly take a pulse on how the WHO is functioning. Belgium has taken up this role in MOPAN, a network of 22 countries aiming to strengthen the effectiveness of international institutions.

In 2024, our country is chair of MOPAN and it is precisely during its mandate that an assessment of the WHO was completed. Along with Canada and Luxembourg, Belgium had a leading role in this assessment, which takes place every five years; the last one took place in 2018.

Flexible and guaranteed financing

Overall, the assessment sounds quite favourable, but the important thing now is to continue on the path we have embarked on and certainly to step up a gear. Financing, for example, is a major challenge. Currently, the WHO has a budget of $6.83 billion. To function properly, the organisation must have long-term certainty about its income.

However, currently only about 20% of the budget comes from guaranteed assessed contributions. The rest is voluntary, so the WHO is not sure it can count on it every year. Moreover, 88% of these voluntary funds are tied to a specific project ('earmarked') while the WHO in fact needs flexible funding to respond quickly to unforeseen crises.

Although the Member States did agree to gradually increase the share of assessed contributions to 50% of the total budget by 2030-2031, the WHO needs more than half in guaranteed contributions, in addition to much more flexible funding, including from private players. It also needs to further diversify its donors by attracting even more 'non-state actors' such as the private sector and philanthropic institutions.

Valuable learning opportunity

As a leading institution, it needs to work harder on 'health diplomacy'. Its current contacts with the G7 and G20, climate summits and civil society are extremely helpful in this regard. Within a context of an increasing number of health institutions – global, regional and national – it must develop a clearer articulation of its central, leading role. Especially as far as donors are concerned, it is important to be able to quantify the extent to which the WHO's own activities have contributed to positive outcomes such as a decrease in malaria and polio cases.

Recently, there has been much more demand to support individual countries. The WHO will therefore need to increase its capacity at country level, in addition to its coordinating role. Furthermore, the MOPAN assessment notes that the WHO needs to put even more effort into internal evaluation of its effectiveness. Since health evolves so rapidly, WHO must be a learning organisation par excellence that continuously adapts.

MOPAN's critical assessments always offer a valuable learning opportunity for the organisations involved, something that was affirmed by WHO Director-General Tedros Adhanom Ghebreyesus: "I am committed to making use of the insights from this assessment as we work together to build a healthier, safer, and fairer world for all."

Belgium favours strong multilateralism, including in global health. As a pioneer in that domain, our country works closely with WHO to provide equal access to health care for all, especially the most vulnerable. We are therefore pleased that, with this assessment, we have done our part in contributing to a better performing global health institution at a time of pressing challenges.