A recent AP article (carried by The Washington Post) grabbed widespread attention with the charge that the “World Health Organization [WHO] routinely spends about $200 million a year on travel — far more than what it doles out to fight … AIDS, tuberculosis [TB] or malaria.” At face value, this is an alarming statistic. As the AP points out, the United Nations health agency is perpetually “cash-strapped” and “pleads for more money.” And it feeds into more general condemnation of international bureaucratic practices — President Trump, for example, calls the United Nations “a waste of time and money”.
Criticisms such as this are facile. Of course, bureaucratic dysfunction and waste are real, but much alleged waste is not really as wasteful, nor problems as problematic, as critics suggest. More importantly, complaints about U.N. spending and priorities tend not to understand how U.N. agencies such as the WHO work, and who gets to decide what these agencies do and how they spend money. Here’s what’s really going on.
WHO is doing what states want it to do
Claims that the WHO secretariat spends $200 million annually on staff travel are a misrepresentation. Staff travel accounts for about 40 percent of that figure. About 60 percent of the budget pays for WHO member state representatives to attend biannual governance meetings, and for experts from around the world to serve on advisory panels and provide technical assistance to governments.
All this travel is the direct byproduct of the many roles that states want the agency to play.
First, WHO is the chief normative and convening authority in global health. It develops global strategies, regulations, standards and technical recommendations, and it coordinates collaboration and knowledge-sharing among all types of global health actors. This work requires hosting dozens of expert advisory committees, review panels, planning meetings, intergovernmental working groups and other consultations every year.
Why does WHO pay for government representatives and expert committee members to attend meetings? Technically, it does it because member states tell it to. Substantively, WHO does it because this allows both rich and poor states to participate. Some states would otherwise not be able to afford to participate in WHO governance — giving them help provides the WHO with international legitimacy, and inputs and perspectives that it otherwise would not have.
Second, WHO is also the leading technical agency in global health, assisting states with surveillance, strengthening health systems and preparing grant applications. To do this effectively, the agency dispatches staff and external experts to address regional needs or respond to state requests.
WHO needs to know what is happening in the world.
Without travel, WHO would have a hard time knowing what is happening on the ground. WHO headquarters is often accused of being out of touch, because most of the information that its staff receives comes through official channels (i.e., health ministries, country and regional offices). Vital data are routinely delayed, incomplete, or inaccurate. Fundamental problems — for example, in medicine and vaccine supply chains — may escape attention until they become crises. Sending headquarters staff (or experts who report back to headquarters) into the field provides an alternative to official channels and helps improve information quality.
An even bigger problem is the disconnect between Geneva and WHO’s regional and country offices. As in any organization, personal relationships among staff at different levels are how things really get done, allowing staff to cut through red tape and work around turf wars. There is no substitute for face-to-face interaction when it comes to building relationships.
Finally, WHO’s travel spending is occasionally driven by circumstances. For example, the AP reports that during the Ebola crisis, Assistant Director-General Bruce Aylward “sometimes [flew] by helicopter to visit clinics instead of traveling by jeep over muddy roads.” But while this might sound like luxury travel to U.S. or European audiences, Aylward wasn’t taking a helicopter to avoid traffic. The truth is that during the rainy season in West Africa, “muddy” often means “nearly impassable.” So taking a helicopter was the most efficient and effective way for the official directing WHO’s Ebola response to do his job.
The WHO secretariat doesn’t set its own priorities or budget
Criticisms comparing WHO’s travel expenses with its spending on HIV/AIDS, tuberculosis and malaria create the impression that the agency’s priorities are severely off-base. After all, as former U.S. vice president Joe Biden said, “show me your budget, and I’ll tell you what you value.” But in this case, Biden’s axiom does not hold, because WHO’s overall budget and spending limits are set by member states, including the United States.
Additionally, 80 percent of WHO’s funding comes from voluntary contributions by states and private donors (as opposed to the “assessed contributions” that all states have to pay). Donors almost always earmark their contributions for particular purposes. For example, in 2016, the United States gave $381 million, of which 85 percent was voluntary and earmarked. Consequently, the vast majority of WHO’s spending is dictated by donors and directed toward the diseases/issues on which they choose to focus through WHO.
That last part is key. Donors sometimes work through WHO and other times prefer to give bilaterally or through specialized partnerships, often depending on the issue (Check out IHME’s visualizations.) For example, based if you look at IHME data, 80 to 90 percent of all multilateral funding for HIV, tuberculosis and malaria goes through the Global Fund — meaning that WHO is not the only agency on the sidelines. In contrast, 60 percent of funding for polio ($670 million) goes to WHO.
The upshot is that WHO’s budget says much less about the secretariat’s independent priorities than about state and donor priorities for the agency. The real choices about how WHO does or does not spend money are made by those who cast votes and write checks. People who are unhappy with WHO’s spending priorities shouldn’t blame the bureaucrats. They should blame the politicians.
To be clear, the WHO secretariat does have its own agenda priorities and voice and, as Nitsan Chorev shows, it is able to push these even against the preferences of major donors. It just does so using nonfinancial strategies.
Of course, there is still some waste
The big sweeping claim, that WHO’s travel spending epitomizes bureaucratic waste and warped priorities, is wrong. That said, the AP report raises important issues. Staffers do sometimes buy more expensive tickets than they’re entitled to (although the article doesn’t say how common this is). And perceived extravagance, such as the organization’s director-general flying business class, can make a donor-dependent organization look bad, even if it’s not strictly against the rules.
All the same, these problems are not unique to WHO — all organizations, including private sector businesses, have to deal with them around the edges. Nor are they breaking news. Senior WHO officials have acknowledged and are attempting to curb these problems (with limited success). Most important, they represent bad individual behavior, not bad policies. In other words, they do not alter the fact that, on the whole, WHO’s travel spending is a basic feature of its mandate as an international organization, not a symptom of bureaucracy run amok.
Mara Pillinger is a PhD candidate in political science at George Washington University. Follow her on Twitter @mplngr.