Abstract

PIP: This article discusses some needed changes to the functioning and management of the World Health Organization (WHO). WHO is unable to meet new challenges and needs reform. The Executive Board of WHO initiated an internal review in 1992 that led to a management-related focus, while informal groups within the agency tackled funding constraints. Some governments and nongovernmental groups have proposed reorganization of international health assistance. The authors urge that the public health sector and researchers join the reform effort. WHO was established in 1948 and was the sole global health agency. The demand for greater international health cooperation has increased over time. WHO is an association of sovereign states. WHO demonstrated success in eliminating smallpox, promotion of health policy, collection and dissemination of epidemiologic information, and establishment of standards in health care and medical ethics. WHO staff comprises about 5000 persons. The annual budget is too small at about US$900 million. In 1995 only 56% of receipts were collected. WHO's constitution mandates complete health for all, but there has been a widening gap between rich and poor and those with access to health services and those without. Absolute and relative poverty are the main determinants of premature mortality and ill health. The major challenge for health policy is this disparity; the focus of international collaboration should be on this issue. The machine metaphor of organizational structure no longer works in today's world. The authors propose that WHO limit functions in health development and create a full mandate for dealing with determinants of health. WHO should be participatory, open to constituents, autonomous, and flexible. Member states must be more powerful in policy formulation. Program implementation should occur in independent programs in a decentralized system.