TY - JOUR
T1 - The WHO Foundation in global health governance
T2 - Depoliticizing corporate philanthropy
AU - Ralston, Rob
AU - Wagner-Rizvi, Tracey
AU - van Schalkwyk, May CI
AU - Maani, Nason
AU - Collin, Jeff
N1 - Funding Information:
Launched in May 2020, the WHO Foundation represents a significant institutional development in the politics of the World Health Organisation's (WHO) financing. Operating as an independent legal entity with a separate board and its own policies, procedures and practices, the purpose of the WHO Foundation (hereafter the Foundation) is to increase funding available to WHO from non-state actors, with a particular emphasis on accessing private capital through relationships with business, philanthropic foundations and high-net-worth individuals ( WHO Foundation, 2020a ). The Foundation describes itself as supporting WHO programmes through its relationship with private and commercial actors, with funds generated through new financing mechanisms and partnerships being transferred to WHO. While positioned by WHO as part of its immediate response to the COVID-19 pandemic, the creation of the Foundation begins to realise a long term ambition of WHO leadership to overcome administrative barriers to receiving financial support from private and commercial actors ( World Health Organization, 2021 ).
Funding Information:
Debates about the sustainability and scale of WHO funding have manifested in various forms over the past four decades since the introduction of a ‘zero-real growth policy’ of its regular budget by the World Health Assembly in the early 1980s (Clift, 2013; Reddy et al., 2018). Restrictions on the assessed annual contributions of member states have led to protracted attempts within the WHO leadership to articulate and implement models of funding that widen its donor base. While both extrabudgetary funds from member states and an increase in resources from philanthropic foundations (notably the Bill and Melinda Gates Foundation) have partially mitigated resource issues (Eckl and Hanrieder, 2023; McGoey, 2016; Seitz and Martens, 2017), successive WHO Director Generals (DG) have promoted organisational reform as part of a solution to inadequate and ad hoc funding arrangements. In a 2011 report on WHO's future financing the then DG Margaret Chan advocated for mechanisms to attract voluntary contributions from the ‘private and commercial sector, without compromising independence or organizational fragmentation’ (WHO, 2011). Although Chan's reform agenda did not lead to the creation of such a mechanism, ambition within WHO leadership to develop a new financing mechanism has persisted (Richter, 2012). The Foundation is arguably the most significant institutional development towards realising this aim, described by the current DG Tedros Adhanom Ghebreyesus as a ‘historic step for WHO as an integral part of our resource mobilisation strategy to broaden the contributor base’ (World Health Organization, 2020).This approach to transparency differs markedly from practices within WHO, which provides detailed accounts about the financing of its General Program of Work via interactive dashboards and data visualisations. The WHO Programme Budget Portal provides detailed information on the organization's financing, with an interactive interface allowing users to trace financing from member states, intergovernmental organisations, UN organisations, and non-state actors to specific programs and areas of work. The Dashboard approach of the Portal facilitates comparison of funding from specific non-state actors (for example, the Bill & Melinda Gates Foundation) and how resources have been allocated to individual programs within particular regions and country contexts (World Health Organization, n.d.). A more informal approach has been adopted within the WHO Foundation in comparison, in which donor identity and allocation of funding has remained relatively opaque. This problem of limited transparency has two dimensions. Firstly, it is unclear what types of actor are being granted anonymity as is the scale of their financial contributions. While disclosures made by the Foundation specify the amount donated by named organisations and business actors (e.g. the Bill and Melinda Gates Foundation making a $1 million donation for ‘operational support’), anonymous donations have to date been aggregated. There are, however, indications that the Foundation has granted donor anonymity to at least one petrochemical company, INEOS, which is listed as a corporate partner in the WHO Foundation's 2021 annual report (WHO Foundation, 2021f), but does not appear in its disclosures of financial contributions (WHO Foundation, 2022b). In addition, anonymity may have been granted retrospectively to corporate actors that made financial contributions to the COVID-19 Solidarity Fund, which subsequently transferred to the Foundation (WHO Foundation, 2022b, 2022a). For example, BP described a $2 million donation made through its foundation as ‘contributing to the World Health Organization’ (BP, 2020b), yet this is not visible in disclosures made by the WHO Foundation relating to funds transferred from the Solidarity Fund. This suggests that anonymity may have been granted to other industries that the Foundation had considered to fall under the ‘orange’ category of actor.RR, JC and TWR were supported by the UK Prevention Research Partnership (MR/S037519/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Wellcome.
PY - 2024/3
Y1 - 2024/3
N2 - The creation of the WHO Foundation during the COVID-19 pandemic represents a significant institutional development in the politics of financing the World Health Organization (WHO). In the context of longstanding acute financial pressures, the objective of the WHO Foundation is to widen WHO's resource base by attracting philanthropic donations from the commercial sector. In placing funding decisions ‘at one remove’ from WHO, the stated expectation is that the WHO Foundation will act as an intermediary, insulating the WHO from potential conflicts of interest and reputational risk through a combination of strategic distance from WHO and proximity with its norms and rules of engagement with non-state actors. Yet, whether this model has translated into practice remains understudied. In this article, we focus on emerging institutional practices within the WHO Foundation, highlighting a drift from its stated governance model. Based on analysis of WHO Foundation documents, we demonstrate how due diligence and transparency practices within the Foundation have been redesigned in ways that contradict or subvert its claims to applying alignment with WHO's governance norms, notably relating to its engagement with health harming industries such as alcohol and petrochemical companies. While this situation may seem paradoxical, we argue that, in placing funding decisions ‘at one remove’ from the formal institutions and structures of WHO, the creation of the Foundation has served to displace this issue to a more secluded arena where drifts in practice are less exposed to political oversight and scrutiny. Focusing on the discursive aspects of this process of depoliticisation, we contend that the Foundation has strategically managed ‘fictional expectations’ of accountable and transparent governance in order to mitigate concerns about its mandate and functions. This assessment provides new and important insights into the depoliticizing functions of the WHO Foundation and the significant implications this may have for global health governance.
AB - The creation of the WHO Foundation during the COVID-19 pandemic represents a significant institutional development in the politics of financing the World Health Organization (WHO). In the context of longstanding acute financial pressures, the objective of the WHO Foundation is to widen WHO's resource base by attracting philanthropic donations from the commercial sector. In placing funding decisions ‘at one remove’ from WHO, the stated expectation is that the WHO Foundation will act as an intermediary, insulating the WHO from potential conflicts of interest and reputational risk through a combination of strategic distance from WHO and proximity with its norms and rules of engagement with non-state actors. Yet, whether this model has translated into practice remains understudied. In this article, we focus on emerging institutional practices within the WHO Foundation, highlighting a drift from its stated governance model. Based on analysis of WHO Foundation documents, we demonstrate how due diligence and transparency practices within the Foundation have been redesigned in ways that contradict or subvert its claims to applying alignment with WHO's governance norms, notably relating to its engagement with health harming industries such as alcohol and petrochemical companies. While this situation may seem paradoxical, we argue that, in placing funding decisions ‘at one remove’ from the formal institutions and structures of WHO, the creation of the Foundation has served to displace this issue to a more secluded arena where drifts in practice are less exposed to political oversight and scrutiny. Focusing on the discursive aspects of this process of depoliticisation, we contend that the Foundation has strategically managed ‘fictional expectations’ of accountable and transparent governance in order to mitigate concerns about its mandate and functions. This assessment provides new and important insights into the depoliticizing functions of the WHO Foundation and the significant implications this may have for global health governance.
KW - commercial determinants of health
KW - depoliticisation
KW - global health governance
KW - philanthropy
KW - political determinants of health
KW - WHO Foundation
KW - World Health Organization
UR - http://www.scopus.com/inward/record.url?scp=85186451440&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2023.116515
DO - 10.1016/j.socscimed.2023.116515
M3 - Article
C2 - 38412806
AN - SCOPUS:85186451440
SN - 0277-9536
VL - 344
SP - 1
EP - 8
JO - Social Science and Medicine
JF - Social Science and Medicine
M1 - 116515
ER -