WHO s Financing Dialogue 2016

Transcription

1 WHO s Financing Dialogue 2016 WHO s financial situation as at 30 September 2016 INTRODUCTION 1. In May 2015, the Sixty-eighth World Health Assembly adopted resolution WHA68.1, approving a total of US$ 4385 million for the Programme budget , comprising a base programme component (US$ 3194 million) and a component on polio eradication, outbreak and crisis response, tropical disease research and research in human reproduction (US$ 1191 million). 2. Subsequently, in May 2016, the Sixty-ninth World Health Assembly adopted decision WHA69(9) approving an increase of US$ 160 million for the Programme budget for the new WHO Health Emergencies Programme. This increase was made in the base programme component of the programme budget and brings the total budget for that component to US$ 3354 million; accordingly, WHO s revised total budget for is US$ 4545 million. Overall financial status as at 30 September Overall, the financing situation for the third quarter of 2016 is US$ million (96%) against the total approved programme budget. This situation appears relatively healthy, and is due to a higher level of funds for the component on polio eradication, outbreak and crisis response, tropical disease research and research in human reproduction. 4. However, the base programme component of the programme Budget is only 86% financed, which is significantly less than in the previous biennium. Figure 1 provides a comparison of the financial situation in the third quarter of 2014 and the third quarter of 2016 for the base programme component. This shows an overall increase in the financing gap from US$ 88.5 million to US$ million at the same time in the biennium. The higher gap is attributable to two factors: (a) an overall increase in the base programme component of US$ million, mainly due to the new WHO Health Emergencies Programme; and (b) a decrease in the overall level of flexible fund financing due to a lower level of financing received through the core voluntary contribution account in 2016 compared to that received in

2 5. The current financing for the component on polio eradication, outbreak and crisis response, tropical disease research and research in human reproduction is US$ 1,465 million, which is US$ 274 million over the approved programme budget. The governance and resource mobilization mechanisms of the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction had to increase the Special Programme s budget level by US$ 25 million in order to accommodate increased financial flows and to allow the Special Programme to incur increased expenditures. Similarly, in recent months, the budget levels for polio eradication and outbreak and crisis response have had to be increased by US$ 598 million and US$ 381 million respectively to deal with recent crises. Overview of the financing situation within the base programme component 6. Figure 2 shows the financing of the categories of the base programme component of the programme budget. 2

3 7. It is noted that the financing within the base programme component ranges from 55% for the noncommunicable diseases category to 83% for the promoting health through the life course category. The WHO Health Emergencies Programme has only 56% financing. This highlights the disparity in financing across the categories. 8. There are three kinds of underfinanced programme areas: (a) programme areas where the budget had been increased because of emerging or increased needs, most notably the WHO Health Emergencies Programme and antimicrobial resistance; (b) chronically underfinanced programme areas, including noncommunicable diseases, social determinants of health and food safety; and (c) programme areas with a significant decrease of financing, due to contributors being unable to maintain their existing financing levels (most notably the contribution by UNAIDS to HIV and hepatitis). 9. Even within the best financed category (Category 3 - Promoting health through the life course), there are underfinanced programme areas (ageing and health and social determinants of health). Table 1 presents the uneven financing situation among the programme areas. Category Programme area name Approved Programme budget Total financing (incl. projections) Financing Gap 01 HIV and hepatitis % Tuberculosis % Malaria % Neglected tropical diseases % Vaccine-preventable diseases % Antimicrobial resistance % 02 Noncommunicable diseases % Mental health and substance abuse % Violence and injuries % Disabilities and rehabilitation % Nutrition % Food safety % 03 Reproductive, maternal, newborn, child and adolescent health % Ageing and health % Gender, equity and human rights mainstreaming % Social determinants of health % Health and the environment % 04 National health policies, strategies and plans % Integrated people-centred health services % Access to medicines and health technologies and strengthening regulatory capacity % Health systems information and evidence % % gap 3

4 Category Programme area name Approved Programme budget Total financing (incl. projections) Financing Gap WHE Infectious hazard management % Country health emergency preparedness and the International Health Regulations (2005) % Health emergency information and risk assessment % Emergency operations % Emergency core services % 06 Leadership and governance % Transparency, accountability and risk management % Strategic planning, resource coordination and reporting % Management and administration % Strategic communications % Total base % Well-financed programmes: where the gap is lower than 25% Moderately-financed programmes: where the gap is between 25% and 50% Under-financed programmes: where the gap is higher than 50% % gap 10. The consequence of the uneven financing is that some critical work is at serious risk of not being implemented. This major concern is illustrated through the examples below of areas which represent major priorities for the Organization. 11. WHO Health Emergencies Programme: The examples of the Ebola and Zika virus disease outbreaks demonstrate that preparedness means addressing the root causes of vulnerabilities and also ensuring readiness to respond. The new programme is aimed at increasing capacities for risk detection and assessment and emergency operations, the development of standardized strategies and service packages for emergency response, helping vulnerable countries develop the core capacities needed to implement the International Health Regulations (2005) and the Sendai Framework for Disaster Risk Reduction and strengthening partnerships for more effective implementation of preparedness and response efforts. To ensure that these changes continue to move forward, adequate financial support is required. Currently, the areas of infectious hazards management, health emergency information and risk assessment and emergency operations are at serious risk due to insufficient resources. 12. Emerging priorities such as antimicrobial resistance: The rise of antimicrobial resistance is a global crisis, recognized as one of the greatest threats to health today. After the adoption of the global action plan on antimicrobial resistance in May 2015, a year of intense awareness-raising among political leaders culminated on 21 September 2016 at the high-level meeting of the United Nations General Assembly on antimicrobial resistance. Some progress has already been made across Member States, as 32 countries have established a national action plan in line with the global action plan. However, a lack of financing is now putting at risk country support activities in respect of the development of policies, action plans and regulatory systems and the strengthening of infection prevention and surveillance. WHO will not be able to sustain global action to raise awareness, encourage behavioural change and build the systems necessary to collect and interpret data, including the monitoring of consumption and use of antibiotics. WHO s capacity to develop a stewardship framework in response to paragraph 4(7) of resolution WHA68.7 (2015), and to track the research and development pipeline and make a case for increased investment in diagnostics, vaccines and new antibiotics, are all compromised. 4

5 13. Scaling up of the response to noncommunicable diseases: The Sustainable Development Goals give governments a mandate to take the response to noncommunicable diseases out of its isolation and unleash its potential to deliver on global collective action. WHO has played a major role in elevating the importance of the noncommunicable disease agenda at both the global and the regional levels. At the country level, WHO is developing an acceleration framework to provide a systematic way for Member States to develop their own action plans for these areas and supports the further scaling-up of interventions. Work at risk of not being implemented due to inadequate financing includes the implementation of the workplan for the global coordination mechanism on the prevention and control of noncommunicable diseases covering the period , the intensification of support to countries to meet time-bound commitments on noncommunicable diseases and capacity building at the national level for the development of action plans, programme management and surveillance. 14. Health and the environment: The Twelfth General Programme of Work recognizes the importance of linking the health agenda with the sustainable development agenda and with policies aimed at improving the environment. WHO is focusing on monitoring and reporting in the context of the Sustainable Development Goals, particularly for Sustainable Development Goal indicators that fall outside the health Goal. In this context, WHO is also the formal custodian for 10 environment-related Sustainable Development Goal indicators which significantly influence public health. Lack of financing will put at risk actions required in well-established programmes, such as those relating to water, sanitation and hygiene, occupational health, chemical safety, and climate change, for example to respond to new priorities established in response to resolutions WHA64.24 (2011) (to scale up action on drinking water, sanitation and health), WHA67.11 (2014) (addressing the role of WHO and ministries of public health in the implementation of the Minamata Convention on mercury) and to support the implementation of the road map to enhance health sector engagement in chemicals management which is to be presented to the Seventieth World Health Assembly. A significant scaling up of institutional capacity is also needed to respond to resolutions WHA68.8 (2015) and WHA69.18 (2016), which seek to address the 7 million deaths per year attributed to air pollution. 15. HIV and hepatitis: In 2013, viral hepatitis was the seventh highest cause of mortality globally, but until recently it has been largely ignored as a health and development priority. In May 2016, the Sixty-ninth World Health Assembly adopted in resolution WHA69.22 the first global health sector strategy on viral hepatitis Yet the Global Hepatitis Programme remains severely underfinanced. Without additional financing, WHO will not be able to develop critical normative guidance or provide technical support for the development and implementation of national hepatitis action plans. 16. Financing for HIV has also been considerably reduced. WHO normally receives nearly a third of its financing for HIV through the UNAIDS Secretariat. In 2016, these funds were reduced by 50% and the 2017 allocation will be further reduced to only 15% of the previous amount. The reduced financing is expected to result in a loss of about 50% of country and regional staff working on HIV. WHO will be unable to update normative guidance and will be forced to drastically reduce technical assistance to countries for HIV testing, treatment and combination prevention, as well as support for other important areas such as service delivery for key affected populations, young women and adolescent girls, the provision of strategic information, and the integration of HIV into health systems. WHO will also find it difficult to continue to provide support to countries on the effective use of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President s Emergency Plan for AIDS Relief and other donors. 5

6 Conclusion 17. The current resource mobilization efforts are not sufficient to reach to objective of a fully financed Programme budget Therefore, in addition to the financing dialogue, efforts are needed both from the Secretariat and from contributors. First and foremost, the Secretariat will increase its fundraising efforts at all levels in order to motivate current contributors to increase their contributions and to encourage new contributors to support WHO. 18. Second, without further efforts from contributors, the Programme budget cannot be fully financed and therefore not fully implemented. This would be particularly felt by the WHO Health Emergencies Programme, as outlined in a separate paper, but would have a negative impact across the Organization in other programme areas. = = = 6