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 non-state actors are growing in size and importance. The World Health Organization (WHO) is an extreme case: voluntary contributions - mostly earmarked for particular purposes - comprise more than 80 percent of its funds. Moreover, non-state actors supply 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 voluntary 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 member states and 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 non-state actors. Collective multilateral decision-making 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 such contributions both in terms of substance and process. The more heavily regulated voluntary contributions are, the more embedded they become in collective decisions, and the less tension there is between multilateralism and reliance on voluntary contributions.