WHO AND THE EFFECTS OF EXTRABUDGETARY FUNDS - IS THE ORGANIZATION DONOR DRIVEN

The findings and conclusions of an international policy study are pres ented on the effects of donors and their voluntary financial contribut ions upon the World Health Organization. Such extrabudgetary funds now account for over a half of the total expenditure of the Organization and more than 80% of these funds come from a small group of 10 industr ialized donor countries. This has led to widespread concerns that the Organization is being 'donor driven' and that powerful countries are u nduly influencing the priorities of the Organization and the managemen t of its programmes. With reference to such extrabudgetary funds, the study concluded that: a) they have given essential support to internat ional health research; b) they have enabled WHO to be a more effective international health development agency; c) these funds are poorly de fined and there is a lack of standardized financial information; d) th ese funds are closely integrated with the regular budget, particularly at global programme level; e) they have not unduly distorted the init ial setting of WHO priorities; f) they have encouraged vertical manage ment systems; g) they have increased the problems of programme coordin ation; and h) the WHO World Health Assembly and Executive Board do hav e sufficient formal authority over such funds and they could exercise more control if they wished to do so. The overall conclusion was that, although there is some truth in the assertion that WHO is being 'dono r driven', it is also clear that donor involvement has brought many ad vantages to the Organization as a whole. Despite the general conclusio n that extrabudgetary funds do represent value-for-money, many donor c ountries are reducing their voluntary contributions to WHO, while at t he same time the regular budget has also been curtailed by the Assembl y. These two trends have clear and important implications for the futu re of WHO and for all international health activities.