The Bhutanese Leading the way.
The United States of America (USA) has withdrawn from the World Health Organization (WHO) after President Donald Trump signed an Executive Order to that effect just a few hours after his inauguration on 20th January 2025.
USA, by far, is the bigger donor to WHO, and its withdrawal is already having cascading effects on the international health organization.
One of the impacts that will play out is a tightening of the purse strings, and hence, the various programs WHO supports across the world.
Bhutan will also be impacted as the WHO Representative, Bhupinder Kaur Aulakh, wrote to the Ministry of Health and the Ministry of Finance a few days ago talking about a need to bring about a minimum of 25% efficiency in its funding and programs, and perhaps even more, if needed.
The indicative estimate that MoH requires from the WHO in the 13th Five-Year-Plan is Nu 1.170 billion (bn). So far, the indicative estimate is generally agreed to in five year plans with minor changes, but this time around WHO will be cutting back.
The WHO budget cycle is for two calendar years at a time. Nu 520.62 mn or USD 6 mn ( 1USD = Nu 86.77) had been budgeted for 2024 and 2025 of which Nu 347 mn or USD 4 mn has been spent so far.
This means that the remaining Nu 823 mn will be subject to cuts. A 25% cut of Nu 823 mn is around Nu 205.75 mn.
Health and Education has always been given importance in Bhutan and any major funding cut in health, especially from WHO, will have a significant impact.
To get an idea on the type of programs supported by WHO from 2024 to 2025 they are universal health coverage at Nu 413 mn, health emergencies at Nu 20.82 mn, better health and well-being at Nu 43.38 mn, more effective and efficient WHO better supporting countries at Nu 52 mn and National Influenza Pandemic Preparedness Plan (NIPPP) at Nu 8.67 mn.
Bhupinder said that the US withdrawal will impact funding, and it is not just Bhutan, but the whole WHO has been putting in efficiency measures as directed from the headquarters.
She said that one of the impacts will be that if there are 10 things the WHO is doing in Bhutan then it cannot do all 10 things, and only the important ones will have to be supported. She said each program may argue that they are all important, but when everything is important then nothing is. She said the focus will be more on the dire needs for the health system.
Bhupinder said that the situation is also a golden opportunity to not do business as usual, and for WHO to reform itself, and not be dependent on just one country, and at the same time, find out how efficiently it can work without compromising its main activities it is mandated to perform.
She said, “All said, these things are unexpected, and even now, we are jointly working with MoH to reprioritize activities and we have to plan to see which are a priority and needs attention now and needs to be taken up first.”
One of the ideas from WHO Bhutan is merging various activities and doing more with less money.
She said, “A meeting on XYZ can include other things and we need to break silos. Earlier a village health worker would be called one time for NCDs and another time for reproductive health, etc., when the target audience is the same.”
Bhupinder said that WHO is discussing with MoH and will come up with a plan. One of areas is cutting down on unnecessary travel outside and also having meetings in Thimphu instead of hotels in Paro with a grand lunch, etc. She said there will be no catering, and the aim will be to have meetings in the vacant government halls in Thimphu instead of traveling to hotels in Paro.
She said that like COVID taught lessons on having online meetings, there could be positive side to this in finding new ways of doing things.
While there will be cutbacks, WHO assures that key activities will not get affected though the ways to do them will be more inventive.
In terms of its programs, a major one is on Non Communicable Disease (NCD) with a major screening just done last year. Another is building the capacity of a country to deal with pandemics with pandemic preparedness response by supporting RCDC, testing labs, etc. WHO also supports digital health with programs like the EPIS or the Electronic Patient Information System. WHO will also keep bringing its experts from its regional office. WHO also supports neo natal capacity and reducing maternal mortality and gives some support for traditional medicines.
To save on funds, WHO office in Bhutan will not be doing any more recruitments and will use existing staff for all roles including even merging functions and roles.
Bhupinder said that in other countries, WHO country offices are even laying off people but Bhutan is not doing so as the office staffing is not very big.
According to sources, MoH is not keen on the WHO cutbacks and there is anxiety on what could be cut back.
The cutbacks could not have come at a worse time when Bhutan’s NCD load is increasing (see main story on pg. 1) and there are many health targets and systems that need to be achieved in the 13th FYP.
USA is the biggest funder of WHO whose two year budget for 2024 and 2025 is USD 6.8 bn. Just in 2024 USA provided USD 959 mn in funds.
In the 2022-23 biennial budget cycle, USA was the largest funder followed by Germany, Bill and Melinda Gates Foundation, GAVI vaccine alliance (where USA is a major contributor), EU, UK, Canada, Rotary International, Japan and France.
There was some theory that China, as the world’s second largest economy, would step up, but the Chinese contribution for 2024 at USD 202 mn is nowhere near USA and trails even behind Germany and UK at eight place. China prefers to give medical aid through bilateral models, and especially in countries with which it has economic and other partnerships and where the aid can help mould public opinion in its favor. The US, unlike China, has preferred to use multilateral institution like WHO.
The Executive Order signed by Trump available on the White House website explains why it is withdrawing from the WHO.
It lists reasons like WHO mishandling the COVID-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states (reference to China).
The order says that, “In addition, the WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments. China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.”
The reasons boil down to concerns over China’s influence in WHO, and USA under Trump reluctant to continue being the biggest donor of WHO complaining that China should pay more.
