If you’ve been reading the budget documentation prepared for WHO’s Executive Board meeting next week, you may have noticed that the base segment of WHO’s 2024-25 program budget will be increasing by precisely no $. Why is that, and does it matter?
The justification for this is provided in para 102 of the draft proposed program budget:
In May 2022, the Seventy-fifth World Health Assembly approved an increase for the revised Programme budget 2022–2023 of US$ 604.4 million in the base budget segment (an increase of 14% over the levels originally approved for the biennium 2022–2023). Given this recent budget revision, it is proposed to keep the base budget segment of the draft Proposed programme budget 2024–2025 at the same level as that of the revised Programme budget 2022–2023 (US$ 4968.4 million).
EB152_27 Para 102, p28
To get a sense of perspective, it’s worth comparing increases in the program budget’s base segment across the biennia:
| Biennium | Total ($m) | per year ($m) | increase on previous budget ($m) |
| 2012-2013 | 2626 | 1313 | |
| 2014-2015 | 2958 | 1479 | 331 |
| 2016-2017 | 3194 | 1597 | 236 |
| 2018-2019 | 3400 | 1700 | 206 |
| 2020-2021 | 3769 | 1884 | 369 |
| 2022-2023 | 4968 | 2484 | 1200 |
| 2024-2025 | 4968 | 2484 | 0 |
For the sake of argument, let’s say the usual increase biennium on biennium is a conservative $300m. If there had been no pandemic, we would expect the program budget to increase to around 4069 for the 2022-23 biennium and then to 4369 for 2024-25. But there was/is a pandemic and, thankfully, member states agreed to increase the program budget to reflect that to $4968. That’s an increase over and above what might ordinarily have been expected of $900m.
However, it now looks as though the extra money is being clawed back. With no increase at all for the 2024-25 biennium, what was $900m becomes $600m in real terms. And what was presented last year as additional money for the 2022-23 biennium is now being stretched over four years to include the 2024-25 biennium.
With such relatively small sums of money, we can have a bit of ‘fun’ trying to guesstimate the financial impact that the pandemic has had on WHO’s base segment. One way to do that would be to add the two biennia (2022-23 and 2024-25) base segments together (4968 + 4968 = 9936) and subtract from that what we would expect the two base segments to be under normal (non pandemic) conditions (4069 + 4369 = 8438). If we do that calculation (9936-8438) we get $1498m. $1498m is the additional money that WHO has received to the base segment of its program budget over and above what we might ordinarily have expected. This is now stretched over two biennia, so if we divide it by 4 we get $375m per year. Does that sound like a lot to you, bearing in mind that the base segment is all the money WHO gets to fulfil its ‘triple billion’ global health commitments (UHC, health emergencies, and well-being) and to support all of its ‘enabling functions’ (staff costs, etc)?
It’s important to emphasise that we’re just talking about the base segment of WHO’s program budget. As you can see from Table 2 of the program budget above, WHO’s 2020-21 approved program budget was $4840m plus a nominal $1000m for Emergency Operations and Appeals. Because of the pandemic, the EOA swelled the WHO’s coffers to a total of $8365m – the highest ever level of contribution (see WHO’s Audited financial statement for year ended Dec 2021, A75/33) for a biennium. So WHO does have more money to play with, it’s just likely that the extra funding it’s received is earmarked by the donors.
I don’t know whether the $0 increase in the base segment of the program budget for 2024-25 is disappointing for WHO’s Secretariat or the result of a carefully constructed plan – so much of the budget decision-making is completely opaque and there is no-one at WHO you can contact to ask! But let’s hope that the 2026-27 program budget doesn’t also remain at $4698.
Andrew
It will be interesting to see how much MS agree to increase their ACs to – remember that the WGSF linked the proposed increases to the baseline figure from the base segment of the 2022-23 PB. That figure is $4364, which is the amount before the additional increase to $4968 (see my previous post on this https://andrewharmer.org/2022/01/22/sustainably-financing-the-world-health-organisation/). It should be obvious that this proposed increase in ACs while welcome does have some limitations. As I mention in the post linked above, because of the link to a fixed baseline, we could imagine a scenario where, in the future, and depending on how much VCs increase to fund the base segment (if the replenishment mechanism comes into effect and is successful, then VCs won’t increase, but let’s leave that aside for now), you could find that ACs decline further as a % of the overall base segment. So don’t assume that the plan to increase ACs to 50% of the 2022-23 ($4364) by 2030-ish would necessarily mean an increase in the proportion of fully flexible (ACs) funding the base segment. Hopefully, that would be the case, and that certainly is the intention, but it’s not a mathematical inevitability.
The other thing to bear in mind is that the sustainability agenda is not really about the money per se. The principles guiding it are 1. flexibility and 2. priority setting. Flexibility is important because of the ‘pockets of poverty’ across the triple pillar priorities of the GPW (see my post on the replenishment mechanism). The Secretariat is desperate to fill those pockets and so wants more flexibility. More flexibility means it can move money around better. Priority setting is important because of the ‘logic’ expressed in EB/WGSF/1/4: “Setting priorities is not a realistic exercise if it is done by one party while financed by another at the latter’s discretion. As a result, the setting of priorities in a meaningful manner must be accompanied by a discussion as to how these should be financed in a realistic manner that can be determined by those setting the priorities”. Here the discussion is about ‘who’ pays and ‘how’ they pay it, and also about the conversations that go on between the Secretariat and the donors about what gets funded and what doesn’t. The principles of flexibility and priority setting is what is underpinning interest in a replenishment mechanism.