Views from the London School of Hygiene & Tropical Medicine

Global Health Lab: Can WHO Survive?

By Amy Potter of the International Centre for Eye Health

Can the World Health Organisation survive? With such a provocative title, it was hardly surprising the John Snow auditorium filled up quickly, with NGO representatives , media, and School staff and students.

I managed to squeeze in at the back just as co-chair and Lancet Editor Richard Horton set the scene with the findings of a ‘secret’ internal report into the state of WHO in 2006. Entitled ‘Competent People – Incompetent Organisation’, it cited fragmentation, management by structure rather than function), and a lack of leadership and vision, and concluded that deep reform was needed.

I was particularly interested to hear Gill Walt, Emeritus Professor at the School, as her book on Health Policy had opened my eyes to the role of international politics during my Masters in 2003. She led us through a brief history of WHO from 1948 to the present day, from an “outstanding agency” much admired for its pioneering immunisation and eradication programmes and technical expertise, through to a WHO under stress in the 1990s and beyond.

This latter-day WHO was better known for bureaucracy, outdated medical domination and lack of financial transparency, no longer the single biggest player in health but one of a proliferation of global organisations and actors, including the private sector. She concluded that although WHO still has a key leadership role in global health, it must adapt to survive in this new world.

Kathryn Tyson from the UK Department of Health spoke engagingly about her experiences of representing the UK at the WHO and working directly with the World Health Assembly. She stressed the importance of WHO in the global arena as an organisation with recognised technical expertise in both public health and in international operations. However, the challenges of funding, a constantly changing environment and multiple players mean that WHO needs improved  governance and administration, prioritisation and partnerships with member states and a variety of international actors.

Anders Nordstrom, Health Ambassador for Sweden and former acting director-general of WHO, mounted a robust defence of the organisation’s record, but was open about the need to adapt. He proposed that to move forward, WHO must develop clarity about its core roles and functions, and divest activities that do not fit with this. He felt strongly that WHO should be providing policy advice to countries at the highest level and on ‘big picture’ issues such as systems thinking and prioritisation, and that the quality of its work was central to survival.

A very lively discussion followed, chaired by Martin McKee. I was impressed by just how important these issues are to those of us who work in health. It was fascinating to hear from the contributors, who included Gaudenz Silberschmidt, former Health Ambassador for Switzerland and now adviser to the WHO director-general Margaret Chan.

The WHO’s vision for universal coverage is inspiring, but this debate made clear it is not enough to have passionate and competent people, but that the right organisational structures and processes are vital to delivering public health.

I’m not sure I’m any closer to knowing whether WHO has what it takes to survive to 2020, but I will certainly be taking a greater interest in the detail of reforms within WHO over the next few years, and looking forward to the next Global Health Lab debate in November!

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