(Video WHO video for World Health Day, April 7, 2012)
By Tikki Pang and Laurie Garrett
The World Health Organization (WHO) is facing an unprecedented crisis that threatens its position as the premier international health agency. To ensure its leading role, it must rethink its internal governance and revamp its financing mechanisms.
The World Health Organization was born in the bifurcated Cold War world in 1948, and every aspect of its charter, mission and organizational structure was molded by diplomatic tensions between NATO and the USSR. However, with the collapse of the Soviet Union and the rise of the new emerging market superpowers, the WHO finds itself trying to straddle a global dynamic for which it was not designed.
Indeed, the WHO now finds itself marginalized in a crowded global health landscape characterized by poor coordination among multiple players. It is no longer the only major actor. At the same time, it faces an internal crisis, with major budget shortfalls and staff layoffs that have resulted in the organization embarking on the most radical reforms in its 64-year history. But the changes do not go far enough. A recent dialogue on WHO reform that we participated in, held by the Council on Foreign Relations in New York in February, identified several key challenges that should be addressed by the agency.
First and foremost, the WHO should refocus on its original aim of being primarily a 'knowledge broker' that gives advice and information about best practices but stops short of directly implementing programs. It should convene negotiations resulting in internationally binding legal agreements and monitor their implementation. Some of its most successful achievements - such as the Framework Convention on Tobacco Control, the International Health Regulations and the International Classification of Diseases - fall into this category.
The means by which such agreements are reached has changed, and the organization needs to adapt. In 1948, the WHO acted as a knowledge-and-standards broker between states, working almost exclusively with ministries of health and government leaders. In the twenty-first century, however, the WHO's credibility and relevance depend on its ability to exert a normative influence through the Internet, informing the global citizenry about all aspects of health - from relevant treaties to drug safety to disease outbreaks. Currently, the organization's website, is nearly impossible to navigate, akin to a well-stocked library with no catalog system. It needs an overhaul to be useful to the global citizenry.
The WHO not only needs to better communicate and coordinate with its global partners; it also needs to make improvements within, starting with its internal governance. The organization must enhance the relationship between its Geneva headquarters and its powerful regional offices. Guidance from Geneva is som