A blessing or a curse? The role of money in shaping international health governance

Funding problems are increasingly affecting major international organizations (IOs). From the World Food Programme (WFP) to the United Nations Educational, Scientific and Cultural Organization (UNESCO), many IOs are today forced to rely on closely earmarked and unpredictable sources of funds, with negative implications for their functioning. However, these challenges are neither unprecedented nor uniform in their causes and consequences. Drawing on literature on delegation, performance, and the earmarked funding of IOs, we propose a sequential process whereby preference heterogeneity among an IO’s stakeholders leads to heightened donor control through funding, which, in turn, reduces IO autonomy and performance. Empirically, we illustrate how major state and non-state actors have often used money as a control mechanism in the absence of influence via weighted voting or formal voting rights. With a longitudinal case study of international health institutions spanning from the 1920s to the 2010s, we examine—drawing from primary including archival sources—how the League of Nations Health Organisation (LNHO) and the World Health Organization (WHO) have repeatedly had to contend with irregular and conditional funding. We also investigate how this has undermined their autonomy and to what extent it has impaired their performance. The article contributes to the literature by offering a clearer understanding of the causes and consequences of IO funding practices, providing an in-depth, longitudinal analysis of IO funding in global health, and elucidating the sustained impact of non-state actors as influential sources of funding.