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WHO reform: construction work ahead!

WHO reform: construction work ahead!

The World Health Assembly is discussing these days the WHO Secretariat's report on WHO reforms, published only a week before the opening of the Assembly.

The title of the report is misleading, as it is about much more than the "future of financing for WHO". On the other hand, the reform of the World Health Organization outlined in the Secretariat's report is much less than would be needed for WHO to overcome its deep crisis, which is also a crisis of legitimacy. The lack of a clear vision cannot be hidden behind the marketing language used in the report ("unique function", "comparative advantage" of WHO) nor behind the concrete proposals such as the establishment of a World Health Forum ("enabling the many different actors to play an active and effective role", "increasing engagement and trust", "shaping decisions and agendas").

The future of WHO is at stake, and the discussions and decisions at this year's World Health Assembly will be leading the way.

As one of the participants at a recent civil society consultation in Delhi put it: "Do we allow the WHO to be consigned to being a 'technical' agency and stripped of its political role and look for alternate centres for stewardship of global health? Or do we find ways by which a nation-state driven process, such as the WHO, can be rescued."

Global public health governance is still an open construction site. On the institutional level, we wait for a really convincing plan how to recover the multilateral identity of WHO and how to strengthen its role as the global health authority. If we dig deeper, we will see that institutional reforms will not be enough to shift the balance of power over global health decision making back from the self declared "global stakeholders" to the inter-national, multilateral organizations of the UN system, to the states and governments who are responsible for the health of their citizens, and, finally, to people.

Thomas Schwarz
MMI Executive Secretary
May 2011

"The Future of financing for WHO
WHA A 64/4, executive summary (extract)

WHO continues to play a critical role as the world’s leading technical authority on health. Many constitutional functions, including the convening of experts, normative and standard-setting work, and technical cooperation with countries, have continued to meet health needs and form the backbone of WHO’s work. WHO has retained a rigid administrative and managerial structure. This is outdated, and impairs WHO’s ability to adapt to changing needs and respond to the shifting, complex web of international efforts to improve public health.

The first decade of the twenty-first century witnessed a series of commitments, opportunities, innovations, successes, setbacks, surprises, and new realities unprecedented in the history of public health. Equally unprecedented has been the vulnerability of health to new threats arising from the radically increased interdependence of nations and policy spheres. The forces driving these changes are powerful, virtually universal, and almost certain to continue to shape health for years to come. 

At the end of this decade, WHO finds itself overcommitted, overextended, and in need of specific reforms. Priority-setting is neither sufficiently selective nor strategically focused. Given the large number of agencies now active in health, duplication of effort and fragmented responses abound, creating an unprecedented need for greater coherence and more effective coordination. 

Financial support for WHO does not always give priority to areas where WHO is best positioned to bring the biggest improvements in health. Preparation of programme budgets is cumbersome and often poorly aligned with implementation capacity or with the new reality of financial austerity. Procedures for staff recruitment, retention, and career development follow a staffing model established decades ago, adding to the rigidity that impairs rapid adaptation to increasingly complex challenges. 

This paper proposes a series of reforms for consideration by the World Health Assembly.


The expected outcome of these reforms will be:

  • Greater coherence in global health, with WHO playing a leading role in enabling the many different actors to play an active and effective role in contributing to the health of all peoples.
  • Improved health outcomes, with WHO meeting the expectations of its Member States and partners in addressing agreed global health priorities, focused on the actions and areas where the Organization has a unique function or comparative advantage, and financed in a way that facilitates this focus.
  • An Organization which pursues excellence; one that is effective, efficient, responsive, objective, transparent and accountable."

Extracts of WHA report A 64/4 quoted from:

Statement of the MMI Network to the World Health Assembly
Committee A, 18 May 2011: ePlatform

64th World Health Assembly, full documentation:

Time to untie the knots: the WHO reform and the need of democratizing global health. "Delhi Statement", endorsed by the Medicus Mundi International Network (participating in the Delhi consultation, 2-4 May 2011)



Medicus Mundi International Network:
Global Health Governance, thematic guide


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