Working Group Paper
The World Health Organization (WHO) was founded in 1948 with an ambitious objective – ‘the attainment by all peoples of the highest possible level of health.’ Since 1948, many things have changed in the world of global health, in particular the creation of a large number of new initiatives and institutions that challenge its role as a directing and coordinating authority. There are many questions about how the organization should locate itself in relation to this new institutional environment. Global health experts at a workshop of the Chatham House Centre on Global Health Security in 2012 identified a need for feedback from member states in the South East Asia Region (SEAR) on each of these topics, based upon their experiences and expectations of WHO governance.
A qualitative research study, approved by the Institutional Review Board of the Public Health Foundation of India, was designed to:
- describe experiences of collaboration with WHO regional offices and countries in the region for priority-setting, action and evaluation of national health goals, regional health targets and global health goals (Millennium Development Goals and others); and
- identify country expectations and suggestions of best practices with respect to regional governance of the WHO.
Semi-structured in-depth interviews were undertaken with purposively selected national health decision-makers from ministries of health, technical agencies and research institutions in six countries of the region, namely Bangladesh, Bhutan, India, Myanmar (Burma), Sri Lanka and Thailand. Forty-nine interviews were analysed following Ritchie and Spencer’s framework approach of thematic analysis.
Participants had between one and 46 years of experience in the health sector and a median of 13 years of interaction with the WHO. Experiences, expectations and ideas for improvement with regard to the organization varied somewhat according to some shared characteristics of countries – which in our study we divided into ‘inward-looking,’ ‘outward-looking,’ and ‘forwardlooking’ positions. We observed convergence in admiration and appreciation for individuals working in the organization (especially some of the WHO country representatives), experiences of weaknesses in the South-East Asia Regional Office (SEARO), expectations of the institution’s dynamism and resilience (if not complete rebirth) more broadly to be commensurate with changing global and country health landscapes, strong concerns about the toll bureaucratization and politicization of the organization were taking on its technical legitimacy, and a hope that its coordination role would be more focused on the one hand, and engage a wider range of players on the other.
There was a plurality of views on how the process for electing the Regional Director could be improved upon (or indeed, whether it should be), and about the particular areas of focus on which the WHO should concentrate (non-communicable diseases, Universal Health Coverage, etc.). Within countries, varying degrees of importance were attached to countries reforming some of their own practices, communication and prioritization processes to help the organization fulfil its responsibilities. In many countries, participants noted that ‘reform cannot be only the WHO reform. There has to be the other side of it also.’
There is indeed a long path ahead, and whether motivated by a hope in WHO reform or health reform more generally, countries in the region appear to be ready for change. The recent succession of SEARO’s regional directorship represents a ripe opportunity to act upon this readiness.