By Mara Pillinger By Mara Pillinger June 22 at 8:00 AM

A recent AP article (carried byThe Washington Post) grabbed widespread attention with the charge that the World Health Organization [WHO] routinely spends about $200 million a year on travel far more than what it doles out to fight AIDS, tuberculosis [TB] or malaria. At face value, this is an alarming statistic. As the AP points out, the United Nations health agency is perpetually cash-strapped and pleads for more money. And it feeds into more general condemnation of international bureaucratic practices President Trump, for example, calls the United Nations a waste of time and money.

Criticisms such asthis are facile. Of course, bureaucratic dysfunction and waste are real, but much alleged waste is not really as wasteful, nor problems as problematic, as critics suggest. More importantly, complaints about U.N. spending and priorities tend not to understand how U.N. agencies such asthe WHO work, and who gets to decide what these agencies do and how they spend money. Heres whats really going on.

WHO is doing what states want it to do

Claims that the WHO secretariat spends $200 million annually on staff travel are a misrepresentation. Staff travel accounts for about 40 percentof that figure. About60 percent of the budget pays for WHO member state representatives to attend biannual governance meetings, and for experts from around the world to serve on advisory panels and provide technical assistance to governments.

All this travel is the direct byproduct of the many roles that states want the agency to play.

First, WHO is the chief normative and convening authority in global health. It develops global strategies, regulations, standards and technical recommendations, and it coordinates collaboration and knowledge-sharing among all types of global health actors. This work requires hosting dozens of expert advisory committees, review panels, planning meetings, intergovernmental working groups and other consultations every year.

Why does WHO pay for government representatives and expert committee members to attend meetings? Technically, it does it because member states tell it to. Substantively, WHO does it because this allows both rich and poor states to participate. Some states would otherwise not be able to afford to participate in WHO governance giving them help provides the WHO with international legitimacy, and inputs and perspectives that it otherwise would not have.

Second, WHO is also the leading technical agency in global health, assisting states with surveillance, strengthening health systems andpreparing grant applications. To do this effectively, the agency dispatches staff and external experts to address regional needs or respond to state requests.

WHO needs to know what is happening in the world.

Without travel, WHO would have a hard time knowing what is happening on the ground. WHO headquarters is often accused of being out of touch, because most of the information that its staff receives comes through official channels (i.e., health ministries, country and regional offices). Vital data are routinely delayed, incomplete, or inaccurate. Fundamental problems for example, in medicine and vaccine supply chains may escape attention until they become crises. Sending headquartersstaff (or experts who report back to headquarters) into the field provides an alternative to official channels and helps improve information quality.

An even bigger problem is the disconnect between Geneva and WHOs regional and country offices. As in any organization, personal relationships among staff at different levels are how things really get done, allowing staff to cut through red tape and work around turf wars. There is no substitute for face-to-face interaction when it comes to building relationships.

Finally, WHOs travel spending is occasionally driven by circumstances. For example, the AP reports that during the Ebola crisis, Assistant Director-General Bruce Aylward sometimes [flew] by helicopter to visit clinics instead of traveling by jeep over muddy roads. But while this might sound like luxury travel to U.S. or European audiences, Aylward wasnt taking a helicopter to avoid traffic. The truth is that during the rainy season in West Africa, muddy often means nearly impassable. So taking a helicopter was the most efficient and effective way for the official directing WHOs Ebola response to do his job.

The WHO secretariat doesnt set its own priorities or budget

Criticisms comparing WHOs travel expenses with its spending on HIV/AIDS, tuberculosisand malaria create the impression that the agencys priorities are severely off-base. After all, as former U.S. vice president Joe Biden said, show me your budget, and Ill tell you what you value. But in this case, Bidens axiom does not hold, because WHOs overall budget and spending limits are set by member states, including the United States.

Additionally, 80 percent of WHOs funding comes from voluntary contributions by states and private donors (as opposed to the assessed contributions that all states have to pay). Donors almost always earmark their contributions for particular purposes. For example, in 2016, the United States gave $381 million, of which 85 percentwas voluntary and earmarked. Consequently, the vast majority of WHOs spending is dictated by donors and directed toward the diseases/issues on which they choose to focus through WHO.

That last part is key. Donors sometimes work through WHO and other times prefer to give bilaterally or through specialized partnerships, often depending on the issue (Check out IHMEs visualizations.) For example, based if you look at IHME data, 80to 90 percent of all multilateral funding for HIV, tuberculosisand malaria goes through the Global Fund meaning that WHO is not the only agency on the sidelines. In contrast, 60 percent of funding for polio ($670 million) goes to WHO.

The upshot is that WHOs budget says much less about the secretariats independent priorities than about state and donor priorities for the agency. The real choices about how WHO does or does not spend money are made by those who cast votes and write checks. People who are unhappy with WHOs spending priorities shouldnt blame the bureaucrats. They should blame the politicians.

To be clear, the WHO secretariat does have its own agenda priorities and voice and, as Nitsan Chorev shows, it is able to push these even against the preferences of major donors. It just does so using nonfinancial strategies.

Of course, there is still some waste

The big sweeping claim, that WHOs travel spending epitomizes bureaucratic waste and warped priorities, is wrong. That said, the AP report raises important issues. Staffers do sometimes buy more expensive tickets than theyre entitled to (although the article doesnt say how common this is). And perceived extravagance, such as the organizations director-general flying business class, can make a donor-dependent organization look bad, even if its not strictly against the rules.

All the same, these problems are not unique to WHO all organizations, including private sector businesses, have to deal with them around the edges. Nor are they breaking news. Senior WHO officials have acknowledged and are attempting to curb these problems (with limited success). Most important, they represent bad individual behavior, not bad policies. In other words, they do not alter the fact that, on the whole, WHOs travel spending is a basic feature of its mandate as an international organization, not a symptom of bureaucracy run amok.

Mara Pillinger is a PhD candidate in political science at George Washington University. Follow her on Twitter @mplngr.

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The World Health Organization spends more on travel than on key diseases. That's actually okay. - Washington Post