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Can the World Health Organization (WHO) still be reformed or must it be reborn? Can it address concretely and effectively the challenges it is facing? Should WHO be dismantled? This are important questions, not only for the next director-general but perhaps even more for the member states who are the real “owners” of WHO.
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Like most United Nations agencies, WHO has a checkered history. Like most United Nations agencies, WHO has a checkered history. Its successes are monumental, and so are its failures. Despite such credentials, WHO’s claim to global leadership in health matters is challenged by new entrants, such as the World Bank, the Global Fund, bilateral development agencies, private foundations, and other global health partnership programs.
WHO’s financial base, is dwarfed by some of the private foundations. The organization’s image, was, unfortunately, tainted by many of its leaders. Under globalization, international trade is a major determinant of good health, particularly for low-income countries, but WHO is hampered in negotiating with powerful actors such as the World Trade Organization and the pharmaceutical industries.
WHO sometimes is accused of delay and excessive bureaucracy. When the Thai government needed the government use of patent to allow access to essential medicines, it asked WHO for technical support. After a lapse of several months, the WHO headquarters responded by asking its regional office to provide the support—which the latter was unable to do. It took a few more months for the Geneva, Switzerland, office, after some further prodding, to dispatch a team of experts to Thailand.
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WHO’s bureaucratic structure is stultifying. Bureaucrats in WHO enjoy such lucrative benefit packages that they rarely speak out or take risks. Some of the more committed and capable staff simply leave the organization.
WHO is also accused of inertia — it initiates but does not always carry through. The landmark work on the social determinants of health is a case in point. Carefully conducted community-based studies continue to document an immense potential role for other development sectors in improving health.
A study carried out in Matlab, Bangladesh, for example, found a clear impact of a women-focused development program, implemented by a nongovernmental organization BRAC, in improving child mortality. The children of mothers who participated in the microfinance and women’s development programs had consistently higher survival experience than others, resulting in the disappearance of socioeconomic inequities in child survival. The hopes created by the Commission on Social Determinants of Health will fade away without a concerted effort to rally other actors for coordinated action.
WHO is a producer and user of global knowledge on health. Its support of research has contributed to its many successes. There have also been some significant problems. In the case of the 2009 H1N1 pandemic, WHO was accused of overplaying the danger to member states by faking a pandemic for the vaccine lobby, which bought a billion doses of vaccines that lay unused, thus wasting billions of dollars.
WHO has been losing the confidence of its stakeholders. The Ebola crisis is an example. The epidemic killed more than 11 000 people and caused an economic loss of more than $2.8 billion for the West African countries. To many, WHO was more reactive than proactive in foreseeing the epidemic and tackling it. The crisis thus exposed the organization’s weaknesses as a global leader in health emergencies. “At times of crisis, the world doesn’t need file pushers. It needs boots on the ground, whether in fatigues or white coats,” wrote a critic.
There are questions about WHO’s management and financial transparency. The organization’s dependence on earmarked funding (about 80% of it $4 billion biennial budget) puts it at the mercy of donors; WHO may toe the line of donors’ interests rather than following its own agenda.
Should WHO be Dismantled?
WHO is physically present in 147 countries with six regional offices. This global infrastructure accounts for 70% of the organization’s budget. The world needs a strong global health agency, but WHO, in its current state, seems unable to cope with the dynamics of the rapidly changing global health landscape.
Suwit Wibulpolprasert, MD and Mushtaque Chowdhury, PhD for American Journal of Public Health. 2016 November.
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