These results concern first the different simple indices and then the global index of bargaining power itself; the interest being focused on their average and on the analysis of the correlation between them.
5.1 Results related to the dimensions of the BPI
The table 3 below summarises results related to Bargaining Power Index, EPI and DPI.
The average of Economic Power index (EPI) shows a small upward variation for all countries in the African and Mediterranean regions (respectively from 0.0002 to 0.001 and from 0.002 to 0.003 in this period). On the other hand, in other regions such as America, Europe and the Pacific, the trend is slightly downward over these three years, while for South East Asia, this remained stable over the period (see table 3). The average level of EPI appears to be very low for all regions, certainly due to the predominance of private sector contributions to the overall budget of the organisation.
Table 3 Average values of BPI dimensions by region and year
Regions (observations)
|
|
Africa (47)
|
America (35)
|
South East Asia (11)
|
Years
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
EPI
|
0.0002
|
0.0005
|
0.001
|
0.015
|
0.003
|
0.004
|
0.001
|
0.001
|
0.001
|
DPI simpleMaj.
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
DPI 2/3Maj.
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
Regions (observations)
|
|
Europe (53)
|
Mediterranean (21)
|
Pacific (27)
|
Years
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
EPI
|
0.006
|
0.005
|
0.005
|
0.002
|
0.003
|
0.003
|
0.004
|
0.004
|
0.003
|
DPI simpleMaj.
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
DPI 2/3Maj.
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
Source: Based on World Health Organisation data. Note: Values in the brackets are number of observations.
Furthermore, although its average has improved slightly, the Africa region as a whole, has the lowest level of EPI compared to the other regions. This is justified since most countries in this region are among the lowest contributors, whether assessed or voluntary. There is nevertheless a hint of willingness on the part of the latter to increase their contributions, given the trend observed; but this does not appear to be sufficient to reduce the gap that this region has with the others.
5.2 Decision-making Power Index in case of bloc formation
The hypothesis of a coalition between countries of the same region in the WHO can only be verified in the decision-making framework. For this to be true in the economic and financial dimension, it would be necessary to first define a quota for each country in the bloc, which would make the task even more complex, especially as fixed contributions are defined in advance by the organisation and voluntary contributions are random. Table 4 compares the different decision-making powers of the regions under the hypothesis of block formation (intra-zone coalitions).
The results show that, under the assumption that the countries of a region form a single bloc, i.e. that decisions are taken by consensus and unanimity within each bloc, there is an increase in the decision-making power of the regions, with the Africa region occupying second place after Europe.
Table 4 Overall statistics on decision-making powers according to the rules in force and regions’ size.
REGIONS
|
Weight
|
DPI
(Simple Majority)
|
DPI
(2/3 Majority)
|
Europe
|
53
|
0,318779
|
0,318784
|
Africa
|
47
|
0,269938
|
0,269938
|
America
|
35
|
0,18555
|
0,18555
|
Pacific
|
27
|
0,136668
|
0,136668
|
Mediterranean
|
21
|
0,102982
|
0,102982
|
South East Asia
|
11
|
0,051417
|
0,051417
|
Source: Based on World Health Organisation data.
This is due to the fact that by forming a coalition, countries from the same region aggregate their weight (number of votes) and thereby increase their influence in decision-making. Indeed, weight positively affects the decision-making power of the member (Dia and Kamwa 2020). However, once blocks are formed, switching from one voting rule to another does not change the power of the members as the results show. Such suggestions have also been made by Diss and Steffen (2017). Thus, in a context such as that of the WHO, countries in the African region would benefit from forming coalitions and remaining unanimous in their decision-making during assemblies to hope to increase their power. Then, this implies maximizing the probability of having health policy adopted that meets its preferences.
5.3 Results on the Bargaining Power Index
Several scenarios are highlighted here and various results are obtained according to the different weights assigned to the two simple indices, the different regions, and the time period as shown in table 5 below.
Table 5 Average change in bargaining power by region and dimension weight.
Weight of dimensions
|
Regions (observations)
|
|
|
Africa (47)
|
America (35)
|
South East Asia (11)
|
ri(a)
|
rj(b)
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
0.1
|
0.9
|
0.001
|
0.001
|
0.001
|
0.003
|
0.003
|
0.004
|
0.002
|
0.001
|
0.002
|
0.2
|
0.8
|
0.001
|
0.001
|
0.002
|
0.003
|
0.003
|
0.004
|
0.002
|
0.002
|
0.002
|
0.3
|
0.7
|
0.002
|
0.002
|
0.002
|
0.004
|
0.003
|
0.004
|
0.003
|
0.002
|
0.002
|
0.4
|
0.6
|
0.002
|
0.002
|
0.003
|
0.004
|
0.004
|
0.004
|
0.003
|
0.003
|
0.003
|
0.5
|
0.5
|
0.003
|
0.003
|
0.003
|
0.004
|
0.004
|
0.004
|
0.003
|
0.003
|
0.003
|
0.6
|
0.4
|
0.003
|
0.003
|
0.003
|
0.004
|
0.004
|
0.005
|
0.004
|
0.004
|
0.004
|
0.7
|
0.3
|
0.004
|
0.004
|
0.004
|
0.004
|
0.004
|
0.005
|
0.004
|
0.004
|
0.004
|
0.8
|
0.2
|
0.004
|
0.004
|
0.004
|
0.005
|
0.005
|
0.005
|
0.004
|
0.004
|
0.004
|
0.9
|
0.1
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
Weight of dimensions
|
Regions (observations)
|
|
|
Europe (53)
|
Mediterranean (21)
|
Pacific (27)
|
ri(a)
|
rj(b)
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
2017
|
2018
|
2019
|
0.1
|
0.9
|
0.005
|
0.005
|
0.005
|
0.003
|
0.003
|
0.003
|
0.004
|
0.004
|
0.003
|
0.2
|
0.8
|
0.005
|
0.005
|
0.005
|
0.003
|
0.003
|
0.004
|
0.005
|
0.004
|
0.004
|
0.3
|
0.7
|
0.005
|
0.005
|
0.005
|
0.003
|
0.004
|
0.004
|
0.005
|
0.005
|
0.004
|
0.4
|
0.6
|
0.005
|
0.005
|
0.005
|
0.004
|
0.004
|
0.004
|
0.005
|
0.005
|
0.004
|
0.5
|
0.5
|
0.005
|
0.005
|
0.005
|
0.004
|
0.004
|
0.004
|
0.005
|
0.005
|
0.004
|
0.6
|
0.4
|
0.005
|
0.005
|
0.005
|
0.004
|
0.004
|
0.004
|
0.005
|
0.005
|
0.004
|
0.7
|
0.3
|
0.005
|
0.005
|
0.005
|
0.004
|
0.004
|
0.005
|
0.005
|
0.005
|
0.005
|
0.8
|
0.2
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.9
|
0.1
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
0.005
|
Source: Based on World Health Organisation data. (a) is the DPI weights 𝑟𝑖 𝑎𝑛𝑑 (b) is the EPI weights 𝑟𝑗. Values in the brackets are number of observations
Firstly, it appears that the evolution of the BPI is almost zero overall. Indeed, when the two simple indices are given equal weights ), the BPI remains unchanged over the period studied for the majority of regions, with the exception of the Pacific region, where the average BPI declines slightly from 0.005 to 0.004 between 2018 and 2019.
However, for a region such as Africa, it appears that as the weight 𝑟𝑖 of the decision-making index increases, at the same time as the weight 𝑟𝑗 of the economic power index decreases, the average BPI increases from 0.001 to 0.005 for each of the three years. The same is true for other regions such as America, where the average BPI rises slightly from 0.003 to 0.005 for the first two years and from 0.004 to 0.005 in 2019. For South East Asia, this value increases from 0.002 to 0.005 in 2017 and 2019, while it goes from 0.001 to 0.005 in 2018. For the Mediterranean region, the average increases from 0.003 to 0.005 for all three years. The Pacific region instead sees its average BPI change from 0.004 to 0.005 in the first two years and from 0.003 to 0.005 in 2019.
These different results are due to the fact that the values taken by the Decision-making Index, independently of the weights that can be assigned to them in the BPI, are in majority more important than those taken by the Economic Power Index. This leads to a certain sensitivity on the part of the overall index (the BPI). On the other hand, contrary to other areas, the average BPI for the European region is stable regardless of the year and the weights assigned to each dimension.
Thus, a comparative analysis of the different regions during this period and according to the different scenarios, shows that the African region has the lowest average BPI overall. This position is due to several factors: firstly, the absence of a real leader within the region to pull the average upwards. Indeed, unlike this region, others have countries whose contributions tend to give a certain weight. These include: United States of America in America region; United Kingdom, Germany and Russia in the Europe region; and China and South Korea in the Pacific region. Kóczy (2016) has already shown, in the context of Brexit, the relative importance of the presence of 'large countries' in a union, in that their withdrawal tends to reduce the options of 'small countries' in favour of large ones. Moreover, such a disparity would also be due to the heterogeneity linked to the EPI, the DPI being constant for all. It is therefore important to identify exactly which dimension is most likely to increase the bargaining power of the countries in this region.
5.4 Correlation between BPI, EPI and DPI
The purpose of the test carried out here is to verify that a country that occupies a given rank in terms of its DPI (respectively its EPI) can occupy the same rank in terms of its BPI. This is the Kendall rank correlation test, the results of which appear identical regardless of the values taken by 𝑟𝑖 𝑎𝑛𝑑 𝑟𝑗 or the year considered. These results are summarized by table 6 below:
Table 6 Kendall's correlation test between the BPI and its dimensions
|
BPI
|
EPI
|
DPI
|
BPIa
|
0.973
|
|
-
|
EPI
|
0.9732***
|
0.973
|
-
|
DPIb
|
-
|
-
|
0.0000
|
Source: Based on World Health Organisation data. Note: *** p<0.01, ** p<0.05, * p<0.1; (a) this is the BPI regardless of the weights 𝑟𝑖 𝑎𝑛𝑑 𝑟𝑗 of the DPI and EPI; (b) this is the DPI regardless of the voting rule as DPI simple majority=DPI 2/3 majority and regardless of year considered.
Then, in view of the values taken by the rank correlation coefficients between the indices, there appears to be a monotonically increasing and significant link (τ=0.9732) at the 10% threshold, between the BPI and the EPI. That said, a country's ranking in terms of bargaining power is 97% associated with a better ranking in the economic power dimension. It should be noted here that a country's bargaining power retains the same information from the economic power dimension to the overall bargaining power index. As the decision-making dimension is constant, no statistics on it have been provided.