Vertical Funds: New Forms of Multilateralism
| Published date | 01 August 2017 |
| DOI | http://doi.org/10.1111/1758-5899.12456 |
| Date | 01 August 2017 |
| Author | Stephen Browne |
Vertical Funds: New Forms of Multilateralism
1
Stephen Browne
City University of New York
Abstract
The United Nations and other multilateral organizations have always been prominent in the health field. UN agencies like the
World Health Organization (WHO), however, have come increasingly under the influence of major individual donors which pro-
vide earmarked funding. Since 2000, two major vertical funds in the health field –the Global Fund and the GAVI Alliance –
provide new models of multilateralism and their funding patterns, together with those of WHO, are examined in some detail.
We review the extent to which the two new funds and WHO conform to traditional definitions of multilateralism by reference
to several test areas: degrees of concentration of funding sources; the influence of individual funders; sustainability; and trans-
parency. We also draw lessons from the analysis for the UN development organizations.
Policy Implications
•Patterns of funding in international organizations are a principal determinant of multilateralism.
•The earmarking of donor funding in international organizations undermines multilateral principles.
•New funding mechanisms in the health field compete with the operational roles of UN organisations, but can provide les-
sons for the UN’s operational role.
Evolving multilateralism
Multilateralism has been defined as ‘the practice of coordi-
nating national policies’among several states in order to
achieve goals of common interest (Keohane, 1990 p. 731),
and ‘an institutional form that coordinates relations among
three or more states on the basis of generalized principles
of conduct’(Ruggie, 1993, p.11). Historically, multilateral
arrangements have been designed to subsume one or more
stronger powers in a cooperative relationship in which all
member states are given a voice and voting capacity which
they would not otherwise have.
Multilateralism has its roots in the discussions that led to
the Peace of Westphalia in the seventeenth century, but first
achieved political meaning in 1802, with the territorial sover-
eignty of the Valais. Treaty law before this date pertained to
conditions of peace, but Valais independence, concluded
between France, Italy and Switzerland, included provisions
for the construction of roads. Other multilateral arrange-
ments followed, reaching well beyond communications
infrastructure to encompass industrial standards, intellectual
property, trade, agriculture, and health (e.g. the International
Office of Public Hygiene, founded in 1907) as well as inter-
state conflict (the Permanent Court of Arbitration, 1899).
These intergovernmental organizations have been called
public international unions (PIU), of which more than 30
were founded between 1864 and the First World War (Mur-
phy, 1994). In addition, several significant regional bodies
came into being, notably the Pan-American Sanitary Bureau
(PASB) in 1902 designed to promote health standards in
that hemisphere. The League of Nations, which had its own
Health Organization, replaced the failed Concert of Europe
in the wake of the First World War and was in turn replaced
by the United Nations in 1945, representing the largest mul-
tilateral organization of its kind, in terms of both member-
ship and scope. The full UN ‘system’is based on common
values, but is in reality a large family comprising more than
a dozen ‘funds and programmes’(such as the UN Develop-
ment Programme, UNICEF and the World Food Programme)
and 16 specialized agencies (including WHO) ‘brought into
relation with the United Nations’as prescribed in the Char-
ter (UN, 1945, Article 57). Many of its agencies are the suc-
cessors of the PIUs of the nineteenth and early twentieth
century and they have achieved their own identities under
the broad UN tent. The World Health Organization itself sub-
sumed the PASB, but since the governments of the Ameri-
cas wished to assert the continuing independence of the
Bureau, it became WHO’s Regional Office of the Americas.
Today, WHO is still the UN agency with the most autono-
mous regional structure, which has proved to be both a
source of strength –in bringing the organization closer to
and more representative of its member-states –but also of
weakness –in diluting and dispersing its centrally-deter-
mined norms and practices (Lee, 2009).
Bø
as and McNeill (2003) and Krause (2001) claim that
multilateralism in development has become less ‘rationalist’
in the sense described by Keohane and Ruggie above, and
more ‘critical’, with institutions reflecting the influence of
inherent power relations. In the realm of health, WHO has
been supplemented –and partially supplanted –as a pur-
veyor of assistance by two relatively new major funding
mechanisms, the Global Fund (GF) and the GAVI Alliance
©2017 University of Durham and John Wiley & Sons, Ltd. Global Policy (2017) 8:Suppl.5 doi: 10.1111/1758-5899.12456
Global Policy Volume 8 . Supplement 5 . August 2017
36
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