World Health Organisation: Time for reflection, reform and realistic expectations

The World Health Organisation (WHO) has come under criticism for its handling of Ebola crisis.  Donors, international activists, national programs, CDC, and other key stakeholders were surprised about the slow response to an epidemic.  If it was not for the US government’s bolds steps to send soldiers and technical assistance with an urgency as well as other donors such as UK, the deaths would have been much higher.  A number of US and European NGOs also played critical role and a number of our brave American doctors and nurses took enormous risks to help.  This crisis demonstrated one thing – that WHO is not an emergency response mechanism and we should not try to make it one.

Ebola resulted in huge human costs of over 10,000 deaths, over USD4 billion in response from 70 countries, and complete breakdown of health systems to deal with one epidemic in three countries.  Ebola continues and can re-emerge as an epidemic and we need to do everything now to stop this.  If Ebola spreads to any large population countries, the deaths will be much higher and costs will be astronomical.

{mosads}The Executive Board of WHO deliberated on this issue in January and have adopted resolution to reform the organisation so that it can respond to future epidemics.  EB resolution will be discussed during World Health Assembly in May.  The Director General Margaret Chan also acknowledged WHO’s shortcomings in ‘administrative, managerial, and technical infrastructure’.  It is also known than WHO regional offices work as independent entities, thus making coordination and collaboration even more challenging.

What one thing need to change?  That is the critical question.  WHO is a technical agency and it has been recruiting medical doctors and technical people in management and other positions from the beginning. Therefore, the structure continues to function to provide technical support only.  Even though there have been several discussions to strengthen management with management expertise, it has not done anything to address this gap. All director level positions must have medical degree and not management expertise.   WHO assumes that only medical doctors can manage technical people and only medical doctors can address medical problems in developing countries.  These are old concepts which have been discarded by many organisations.

WHO has political power because of its longstanding relations with Ministers of Health and other political leadership in countries.  It also has huge convening power.  It has experienced technical people and it has good systems for approving policies and pre-qualifying drugs and diagnostics.  It has good research expertise. It has country presence and works closely with all Ministry of Health. All these are strengths.  If we can think of one area of change, it would be to introduce professional managers in the mid to upper management of  WHO.  The recruitment process has to be changed.  The job descriptions have to change.  WHO needs to adopt some of the lessons from the private sector hospitals and introduce critical mass of private sector experienced management professionals.  WHO needs to infuse some private sector thinking and approaches to its work.  It has to manage its resources more efficiently and put in place a much more responsive management system.  Its management resource can be used by developing countries to improve its own management of health systems.

A second area that needs to change is its regional office relations.  The six regional offices work independently of headquarters.  The time for serious discussion of an integrated management arrangement has come.  Such discussions should not take years, a clear timetable of one year to initiate quick changes is needed.  The regional offices must be accountable and should also infuse management expertise to reflect the reform needed.  The entire system must focus on management for results and value for money. 

WHO faces serious financial resource constraints from donors who have moved to multi-lateral financing mechanisms.  Without adequate financial resource, WHO cannot deliver on its mandate. At the same time, WHO has to become much more proficient, transparent, and efficient in financial resource use. It must show how resources are used and where.  World Bank, IMF, regional banks, and Millenium Challenge Fund should work closely with WHO and share some resources. A very small percentage, 2% to 3% of US and other donors support to Global Fund, GAVI, etc. should also be allocated to technical support through WHO. If donors want WHO to reform, it also has a responsibility to re-look at how they allocate resources. Sustainable health systems does require a fully funded WHO.

WHO should continue to play its pivotal role to support developing countries but it needs to reform quickly to respond to a changed world.   

Rahman is an international health specialist with over 25 years of experience. He is based in Geneva, Switzerland.