Subject: WHO's Budget 'Crisis' Date: Published: 5/5/88 122 lines Source: WALL STREET JOURNAL. Copyright Dow Jones & Co. Inc. WHO's Budget 'Crisis' --- By Paul Dietrich The World Health Organization, which is holding its annual assembly in Geneva this week and next, is crying budget crunch. According to a WHO assistant director general, Warren Furth, because of the financial crisis, "millions of children will not be immunized and many will die." Though the U. S. is the main supporter of WHO, it is being charged with stifling the organization by not paying its dues. Is the 40-year-old agency really constrained from its mission because of a U. S. -induced budget shortfall? Or is WHO a victim of the vagaries of its own fiscal priorities and mismanagement? First, let's take a look at the "budget crisis." The proposed budget for 1988 and 1989 represents only a 0.1% decline in real resources; the individual country programs are even scheduled for a 1% increase; and WHO has proposed an increase in staffing equivalent to 186 full-timers a year. Does this sound like an agency with its budgetary back to the wall? As for U. S. contributions to WHO, the U. S. provides some $75 million a year to the regular budget. The next largest contributor is Japan, which gives less than half as much. While it has been reported that the U. S. owes WHO about $113 million in back dues, that amount is wrong. Some $75 million of that figure constitutes 1988 dues that will be paid, as always, in October. The only other amount the U. S. owes is $17.7 million from past dues as a result of congressional budget limitations. WHO has long known about this and already adjusted for it. All this makes the current cries of sudden budget disaster a bit hollow. AIDS and immunizations, as well as most of the other important disease programs, aren't even funded out of the regular WHO budget. They are funded from WHO's extrabudgetary account, to which the U. S. contributed $29.8 million during 1986-87. This direct contribution was about 15% of the total account. U. S. funds funneled through other agencies may boost the U. S. contribution to WHO's extrabudgetary account to 25% of the total. The U. S. and other countries fund this extrabudgetary account to the tune of about a half-billion dollars every two years -- almost as much as the regular WHO budget of $636.9 million. The two sources combined provide more than a billion dollars to WHO. In addition to the money the U. S. gives to WHO is about $600 million to be distributed this year through U. S. foreign aid channels to health, population and nutrition programs throughout the world. Any notion that the U. S. is abrogating its financial commitment to dying children is just plain wrong, whether measured in terms of its WHO contribution or in terms of overall U. S. development assistance. How does WHO manage all this money that the U. S. and others contribute? The largest increase in the 1988-89 budget was in support services, up a whopping 34% from the previous two-year period. Another big winner was the budget for the annual meetings in Geneva, up 38%. The total spent on these World Health Assemblies is now more than $2.7 million a year. This is more than the proposed annual expenditure for health programs for the elderly and three times as much as is budgeted for blindness programs. In these times of "budget crisis," WHO proposes a net loss of only two staff positions at its headquarters; staff salary costs are up 23% and staff allowances, 26%. A former U. S. government official, John Bryant, who also worked for WHO, describes WHO's philosophy as "grounded in equity, to each according to their needs." It is difficult to see how such a philosophy is consistent with a budget that emphasizes Geneva expenses and administration rather than primary health-care programs in developing countries. Sadly, there are real losers in the budget. Disease prevention and control, WHO's ostensible purpose, has been reduced from 16% of the regular budget to 14% in 1988-89, a loss of $8 million. And then there are the budget mysteries. For example, the regular budget subcategory "all purposes" accounts for some $8.5 million, or 77%, of the category "other expenditures." Nowhere is there any description of the purposes of this amount -- which seems small in light of the budget as a whole but is more than WHO's entire proposed central planning and management budget for primary health-care systems, $6.7 million. When WHO was created, it suited the needs of the developing world, then burdened with infectious and parasitic disease. Many of these countries have now passed through an epidemiologic transition. People are living longer, and are dying from disease patterns more akin to those of the U. S. than of Uganda. Expansion in health services has moved away from publicly sponsored initiatives to alternative delivery systems in the semi-public and private sectors. Ministries of finance in the developing world have recognized this transition and have used the power of the purse to reduce public-health budgets. Doesn't it make sense, therefore, for the world's premier health institution to take a careful and critical look at its own priorities and finances? WHO has gone through a lot of controversy over the past decade, with dissension on infant formula, on drug policies that limit the number and kinds of pharmaceuticals available to developing countries, and on its slowness to develop AIDS policies. It can regain its once-deserved high respect by going back to basics -- providing health care to meet the real health needs in developing countries, not what they used to be -- and organizing its budget according to current needs. --- Mr. Dietrich, ex-publisher and editor of Saturday Review, is chairman of the International Hospital Committee of the Order of Malta-Federal Association, in Washington. The order is one of the world's largest charitable hospital associations. [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]