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Redistributing Power in Global Health: a Survey of Options for Donors
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Beyond unilateral reform, donors can also act jointly through multilateral channels. This can be thought of in three parts: the UN system, including the World Health Organization (WHO) ($7.1 billion, 17 percent), the development banks such as the World Bank ($3.4 billion, 8 percent), and global health initiatives, especially the Global Fund and Gavi, which notably include a greater degree of philanthropic funding ($6.1 billion, 14 percent). Although predominantly Geneva- and DC-based, these mechanisms do include LMIC governments in their governance structures, and so, to an extent, decision-making is joint between donors and recipients. The ability of each multilateral agency to truly redistribute power depends on both its governance and funding arrangements. For example, WHO is directed by the World Health Assembly, using a “one country, one vote” system that is a relatively equal and democratic approach to tackling global challenges. This is in direct contrast to the World Bank, which has been
criticised by the UN secretary general
for giving donors more votes than recipients. Around 75 percent of WHO funding, however, is restricted by donors for specific projects that they define. This substantially distorts both the resources and whole agenda at WHO, undermining its democratic governance.
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