In the final report from Chatham House's Working Group on Health Governance, Charles Clift offers recommendations for serious reform of the WHO's core functionality, governance and financing.
What should the WHO do?
- The WHO’s core functions should explicitly provide for its work in promoting and maintaining global health security.
- The WHO should provide strategic technical assistance to countries in support of its mission as a provider of global public goods. It should not seek to undertake activities that could or should be done better by others – by the host government, with or without support from other agencies.
- The WHO should undertake a review of the skills mix and expertise of its staff to ensure that these fit with its core functions and leadership priorities.
Governance of the WHO: the global role
- The WHO should provide an internal separation between its technical departments and those dealing with governance and management by creating two posts of deputy director-general, with one to be responsible for each.
- The WHO should allow the director-general a single, seven-year term, without the possibility of re-election.
- The WHO should explore new avenues for collaboration with non-governmental actors that have a concrete and specific purpose.
Governance of the WHO: regions and countries
- The WHO should consider two alternative proposals for restructuring its regional offices:
- Unitary: The WHO should be like other UN organizations, where the need for regional (and country) offices is determined by what makes sense in terms of achieving organizational objectives. Elected regional directors should be phased out in order to allow structural changes to take place.
- Decentralized: The WHO should apply the Pan American Health Organization (PAHO) model to the other regional offices; and the assessed contribution should be provided to regional offices directly by regional member states, rather than redistributed by headquarters in Geneva. This would involve accepting a decentralized model in the WHO – or even the complete autonomy of regional offices, or their absorption by other regional organizations.
- A comprehensive and independent review – of the kind that has been suggested since 1997 – is overdue to examine how the staffing of country offices should be matched to the needs of host countries, in particular with a view to translating WHO recommendations into practice.
Financing of the WHO
- The WHO and its member states should examine how its effectiveness could be enhanced by reviewing – in conjunction with the other recommendations in this report – how the value added by its regional and country offices could be increased, and its administrative and management costs reduced.