Financing the World Health Organization: What Lessons for Multilateralism?

When it comes to financing the work of international organizations, voluntary contributions from both state and nonstate actors are growing in size and importance. The World Health Organization (WHO) is an extreme case from this perspective, with voluntary contributions - mostly earmarked for particular purposes - comprising more than 80 percent of its funds. Moreover, nonstate actors are by now supplying almost half of WHO’s funds, with the Bill and Melinda Gates Foundation ranking as the second-highest contributor after the United States. A number of public-health and international relations scholars have expressed alarm over these trends, arguing that heavy reliance on multilateral contributions is inconsistent with genuine multilateralism. Relying on interviews with current and former WHO officials, our study explores the causes and consequences of these trends, and recent efforts by the WHO secretariat to reconcile growing reliance on voluntary contributions with multilateral governance. We describe the headway WHO has made in mitigating the risks associated with heavy reliance on voluntary contributions—as well as the challenges that persist. Most importantly, we argue that multilateralism is not categorically incompatible with reliance on voluntary contributions from both state and nonstate actors. Collective multilateral decisionmaking is not a binary feature, either present or absent. Even if the final decision to provide voluntary contributions is up to individual donors, international institutions have opportunities to regulate them both in terms of substance and process. The more heavily regulated voluntary contributions are, the more embedded they become in collective decisions, the less tension there is between multilateralism and reliance on voluntary contributions