On March 23rd, Richard Horton, Editor, The Lancet, "tweeted" a series of 140 character messages in rapid fire about the World Health Organization (WHO) that caught my eye:
路 Just had a profoundly disturbing call from a Director of a WHO programme in Geneva. Cuts at WHO are huge - meeting a $300 million deficit.
路 Core functions are being slashed. Dedicated and quality staff are being fired. Others are being asked to retire early. WHO is "paralysed."
路 All are living in fear of losing their jobs. There is little or no consultation or planning. Staff are being transferred to disabled depts.
路 The result? Weaknesses are being compounded, lowering morale still further. There is a real and urgent crisis at WHO.
路 For all those who believe in multilateralism, what should or can we do? The situation seems desperate.
Tweets from the editor of a high impact factor global health journal aren't easily ignored (and I reproduced here with his permission), especially when they alert readers to an urgent crisis. What prompted Richard's worries about the WHO? A few things seem to be circulating in the global health world through back door conversations, but there is almost no public discussion about WHO's slow decay and what to do about it. So I decided to dig a little deeper (by speaking to WHO staff in Geneva) to find out what is happening inside WHO and use this information to trigger constructive public debate about the future role of this agency.
Margaret Chan, Director General of the WHO, won a lot of praise for her honest speech to the Executive Board of the WHO in January 2011 by pointing out WHO's need to strengthen its performance. Since then, WHO staff have received several internal memos "explaining" WHO's reform process. Unfortunately, I'm not able to link to these documents because they are not publicly available. But colleagues at WHO tell me that the focus of the reform process is all about creating efficiency by slashing expenditures, increasing resource mobilization, and reducing the $300 million deficit over the next three years. This financial condition is only a symptom of the real crisis that has been brewing over the last decade: What is WHO's role in a changing world?
Donors want WHO to be more efficient, focus on what it does best, demonstrate results, and improve transparency and accountability. While these are necessary pieces of a reform process, focusing on what it does best relative to other global health institutions is the key to WHO's future. In a recent JAMA commentary, Devi Sridhar and Larry Gostin lay out some specific and helpful recommendations to revive WHO's leadership role including its legal authority as a rule-making body. But WHO reformers have to think carefully about how WHO fits into the current global health and development landscape, and identify what it does best--set rules and guidelines, provide technical support, convene and coordinate partners--and to what end.
This is the time to define WHO's role in an increasingly complex global health and development landscape where other players seemingly wield more power than WHO because of the resources they can mobilize, and where countries' needs are changing as they develop. As a senior health ministry official from an emerging market country said to me recently when I asked about the future of the agency, "WHO, as it is? It's not that important to our needs. "
My take? Moving forward, setting key objectives with measurable results, tailored to different constituents (global, regional, country) should be WHO's first priority in reclaiming its role as a leader in global health. Form should follow function, and until that function is defined, re-forming WHO sounds like a lot of posturing and an enormous waste of resources.