Improving United Nations Funding to Strengthen Global Health
Governance: Amending the Helms – Biden Agreement
Timothy K. Mackey and Thomas E. Novotny
Global health governance is widely considered fragmented after more
than a decade of inconsistent support for multi-lateral organizations and
faced with the emergence of many new global health donors and non-state
enterprises. This paper addresses a series of events marked by enactment
of the Helms-Biden agreement in 1999. This legislation ensured that
United States funding for the United Nations was to be conditional upon
reforms and reductions of U.S. assessments. Although passage of the
legislation allowed its largest contributor/debtor to pay back arrears and
continue payments going forward, it also represented a growing trend in
U.S. unilateralism and disengagement from support for multi-national
organizations. In particular, continued arrears and budgetary
restrictions have affected specialized U.N. agencies such as the World
Health Organization. This agency has experienced a zero nominal growth
budget that may have impacted its governance capacity. We review the
potential impact of the Helms-Biden legislation on WHO governance, and
suggest that the governance of this important global health agency may
benefit from its timely repeal.
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