Humanitarian Health Action

Purpose statements for panels and sessions

WHO Conference on the Health Aspects of the Tsunami Disaster in Asia

Panel 2.4: Funding policies and practices


The tsunami that struck on December 26 2004 caused massive damage and destruction. Governments of affected countries immediately sprung into action and launched a massive relief effort supported by the UN and other development agencies as well as local NGOs. A rapid assessment was done which culminated in the launching of the UN Flash Appeal on January 6, 2005.

The total figure in the FA was 977 m of which 121 m was earmarked for health. This represents 12.5% of the total appeal. The WHO component of 66.7 m (including 3 m for water and sanitation for Indonesia) was 52 percent of the total for the health sector. Within the South-East Asia Region, the 3 most affected countries, viz, Indonesia (33 m); Sri lanka (12.5 m) and Maldives (6 m) together accounted about 81 percent of funds for WHO.

International response too, has been overwhelming. According to the mid-term review of the FA, about 80 percent of the total was funded but for the health sector as a whole, less than half has been funded. The UN has, at various fora, voiced its concern about converting pledges to cash and this has helped the process. But even as efforts continue to meet the challenges posed by the unprecedented scale of disaster, the first four months of the crisis has thrown up some issues that donors and recipient countries must address, both at the policy level as well as the operational level. These are summarized below:

From the donor’s perspective

Time is of essence during such emergencies and the effectiveness of response is directly correlated with the timelines of the response. The time gap between the disaster and aid inflow, in most case, would make the critical difference between life and death for millions of people. To see whether the aid was effective, the first question we have to ask is : Was the response immediate?

Before we go on to ask the related question: Was the response adequate?, there are some practice issues that require more careful analysis.

What is needed at the time of emergencies is unspecified funding, to the extent possible. Policy makers need to make it easier for functional managers to deliver more effectively. This means a certain autonomy and flexibility to the fund manager to use the fund in places and for projects that require priority attention. Tied funding restricts such need-based deployment of aid in an efficient manner. How much of funding was unspecified and what kind of autonomy existed to facilitate this?

During this crisis, new phenomenon emerged, perhaps for the first time in the SE Asia – that of a Member State (India) emerging as a major donor within the Region to help neighbouring countries affected by tsunami. This has had major net incremental consequences for the funding pool-it not only freed funds that would have otherwise gone to India bit also made available additional resources. What implications does this have for the diversion of bilateral funding to underfunded multilateral channels? And how is this going to affect future funding policies?

From the recipient's perspective

Two key issues are those of aid absorptive capacity and organizational effectiveness in managing the funds.

The on-going crisis has thrown up the question of the capacity of recipient countries to handle large volume of funds. Instances are known where medical supplies have been left unattended at the airport for logistic reason. Does the aid handling capacity of the country commensurate with the funding requirements and inflow? More specifically, does the country and/or organization to which the funding is directed have the necessary systems and infrastructure in place to deal with the quantum of funds? The other question stems from the fact that what was done at the country level was a rapid needs assessment. As countries head to the rehabilitation phase, their needs are also evolving. The situation is quite fluid as countries come to terms with the real extent of loss. How would the changing needs be articulated and what mechanism would ensure that funding policies and practices are dynamic enough to respond to those needs?


To bring together the supply (donors) and the demand (recipient) side of the equation requires massive coordination. Despite best efforts, this is being increasingly seen as the weak point to emerge out of the crisis. One needs not only internal and external coordination but also coordination between the policy and practice and across sectors and agencies. Strategically speaking, was the need for coordination understated or underestimated? Would it not be a sound strategy to invest a small amount for resource coordination?


Humanitarian response in a sympathetic human rights paradigm has demonstrated to have quite a few takers. The dangers of the crisis also present an opportunity – that of rebuilding better, more responsive health systems, stronger emergency preparedness and better capacity for donor-donee coordination. These are long-term tasks and require long-term commitments. What funding policies and practices can foster that spirit which takes us from the state we have been in (pre-crisis) to a better/superior state (post re-building)?