One chart that explains why the WHO is actually in crisis

Throughout the recent Ebola outbreak, the World Health Organization has been universally admonished for being too slow to respond to the crisis. And one of the key reasons cited for the delay is that the WHO is underfunded, understaffed, and underpowered.

But as this chart from the Institute for Health Metrics and Evaluation shows, that’s only part of the story. Though funding for the WHO has leveled off in recent years, that only came after more than 20 years of massive increases. Overall funding for development assistance for health also increased dramatically in the period.

What changed, however, is the WHO’s relative influence in the global health landscape. The organization’s slice of the funding pie has been dramatically reduced over the past two decades — while other health organizations and bodies showed up on the scene and grew.

As the chart shows, in the 1990s the WHO (in dark blue) was one of only a few key players in global health, alongside organizations like the World Bank and other health-related UN organizations.

Since then, American NGOs (the largest green slice) like the Gates Foundation have stepped in. So have public-private partnerships (represented in purple on the chart) such as the Gavi Alliance (focused on expanding access to vaccines) and the Global Fund (which finances treatment and prevention for infectious diseases like HIV/AIDs, TB, and malaria).

The world’s wealthiest nations — the US and UK (the “bilateral agencies” in red and pink hues) — have also prioritized funding for global health through their government agencies and departments.
This increase from other players shifted the balance of power away from the WHO — the only global health organization when it was founded 70 years ago. And in a world where the key players in global health are rapidly changing, the WHO’s role in this new landscape is less clear.

That’s not to say the WHO isn’t still hugely important. It has a monopoly on legitimacy, and is the normative body when it comes to health. That monopoly, for right now at least, just isn’t being backed by dollar figures, and the organization is trying to find its way. Yet, as public expectations of the organization during the Ebola epidemic made clear, it’s still the body the world looks to in times of global health crisis.

That disconnect between perception and reality is something the organization is now grappling with.

Dr. Margaret Chan, WHO director general, explained in an address at the World Health Assembly today that the arrival of Ebola forced the conversation about internal reform and the organization’s role in the world.

“The Ebola outbreak shook this organization to its core,” she said. “This was a defining moment for the work of WHO and an historic political moment for world leaders to give WHO new relevance and empower it to lead in global health.” Whether the organization remains the leader in global health — with Gates and other players rising — remains to be seen.

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