Consultancies play an important role in developing policies and strategies for international agencies, such as the World Health Organization (WHO). Drawing on a recent study, Tine Hanrieder and Julian Eckl argue that consultants’ formidable ability to curate and draw together preferred evidence for influential case studies is enhanced by the low funding environment these agencies operate in.
Consultants have been described as “wizards“, superior analytical minds who can turn around businesses, but also as “pretenders” who sell management fads and quasi-academic insights to businesses and governments. In our recent research on the World Health Organization (WHO), one of our interviewees also described them as ‘priests’ – companies that are hired to transform the organisation on the basis of the ‘bible’ (organisational strategy). Yet, this neutral, detached image as a technical servant to a public organisation, is misleading. Rather, as we describe in our study of consulting firm engagement at WHO, consultants act as discretionary curators of reform inputs. They filter the knowledge and voices that go into reform proposals, and they are often closely entangled with the interests of certain stakeholders and funders.
Curating
What do curators do? In the arts, curators assemble objects, performances, or voices into a final exhibit. In business and politics, consulting firms do something similar. When they come to help change WHO, or other international bodies such as the World Trade Organization or the Munich Security Conference, they collect information, interview staff and other stakeholders, and reach for ‘case studies’ of so-called best practices as models for reform. The precise task and scope of work differs from contract to contract, but at least at WHO, many rounds of interviewing and consulting have been reported since the turn of the millennium.
In the arts, curators assemble objects, performances, or voices into a final exhibit. In business and politics, consulting firms do something similar.
Curating can create conflict when consultants are not perceived as neutral. For example, in a reform of the WHO-hosted public private partnership Roll Back Malaria, malaria endemic countries and their allies were side-lined in a Gates Foundation-sponsored consulting mission by McKinsey & Co. The consultants interviewed all kinds of stakeholders, but not malaria endemic countries or WHO staff, and the best practices they used to design a reform came from the business world, firms such as Uber and Alibaba instead of public institutions. Their reform proposal became the blueprint for a 2015 revamp of the partnership that, among other innovations, abolished the constituency-based representation of stakeholders, such as affected countries or NGOs.
No logo, no transparency
While such processes are controversial, they are also opaque. At WHO, an already underfunded organisation, a lot of consulting firm services to WHO are gifted by donors and as a consequence are less thoroughly scrutinised. And, since they count as ‘procurement’ instead of formal civil society collaboration, usual conflict of interest regulations do not apply. Funders may co-write the terms of reference, but this is also done informally. Technically, the WHO as the formal client buys the consultants’ input and owns the results, so that to outsiders, it is not clearly discernible what inputs the consultants generated, and through which methodology. Interviewees told us about sitting in organisational meetings and seeing those iconic PowerPoint slides that could only be from a consulting firm, but there was no logo. Reports generated in the consulting processes, when they are made available at all, also tend to remain vague regarding authorship. The reform task force for Roll Back Malaria had McKinsey consultants as key members, but their names were not listed as part of the team.
There is thus an accountability deficit in the way consultants operate. Consultants’ personal ties to parties in an organisational controversy might even be plain and criticised (like in the Roll Back Malaria reform), but there is no mechanism to address this. And unless a country holding the external auditor role at WHO decides to investigate consulting arrangements, very little data on these arrangements is publicly available. Where an auditor, provided by India, did look into consulting firm activities during Covid-19, they found irregularities in the way in which the consulting contract was awarded. Furthermore, while the consulting firm described its service as ‘pro bono’ work, it still cost the organisation millions of dollars.
Lots of money, little money
The Gates Foundation, one of the main sponsors of consulting firm services to WHO, has meanwhile decided to insource some management strategy capacity. The foundation runs, so to say, its own internal McKinsey. The reasoning is that even if you hire external strategy consultants, you need to be well resourced enough to know what kind of service you may need, and will get, from consultants. Fund-strapped organisations like WHO that need to survive on earmarked, project-specific funds, do not have that option. Consultants may come in to help them sell WHO’s value for money to donors, or signal accounting rigour to keep some income flowing. But, even if branded as donated knowledge, there is a lack of control and no way overlooking that these are expensive services bought to sustain a regime of deliberate austerity for global public health.
This post draws on the authors’ published article, The political economy of consulting firms in reform processes: the case of the World Health Organization, published in Review of International Political Economy.
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This is a valuable contribution to an important debate but I’d push back strongly on the claim that WHO does not have the option of “insourcing” consultants as it is “underfunded”. First, all bodies reliant on public money always claim to be underfunded. Second, international organisations (including but not limited to UN agencies) pay sky-high and usually tax-free salaries that are far above what similar roles in national bodies pay. Third, the entire United Nations system including WHO is notorious for its inefficiency and waste.
What the authors call a “regime of deliberate austerity for global public health” certainly does not translate into any form of austerity among the very privileged individuals working within that regime. Take the example of the World Food Programme. When there is “insufficient donor funding”, they cut refugee food rations in half, but they never cut their own salaries in half.
Cry me a river.
(Note: I am making this comment in a private capacity, as someone who used to work in international development and has had a lot of interaction with the UN and specifically with the WHO over many years.)