An Organizational Analysis of the World Health Organization

Narrowing the Gap Between Promise and Performance

Published in: Social Science Medicine, v. 40, No. 6, 1995, p. 731-742

Posted on RAND.org on December 31, 1994

by John Peabody

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The author of this article examines the future of the World Health Organization (WHO) and applies organizational theory to try to understand how the organization can be made more effective. WHO stands as a testimony to the dream of global cooperation and international social justice. However, after 45 years, it is also clear that the organization has grown into a complex bureaucracy with significant inefficiencies, conflicting incentives, and a limited medical paradigm that inhibits its potential. Although expectations for the organization are growing, and despite increasing demands for collaboration, WHO's regular budget has been frozen at zero growth for over 10 years. The author makes the following suggestions for improving the effectiveness of WHO: (1) give authority to WHO representatives and staff at the country level; (2) give professional staff specific and measurable outcome objectives and thereafter assign budget constraints and policy boundaries; (3) close regional offices over time; (4) offer structural reform as a way to increase WHO funding; (5) establish linkages among donor countries, the voting majority, and the organization; and (6) hold elections in an open forum. As the regional offices are phased out, the six area director generals should also be elected in an open election, with each of the area director generals representing one area of the world. Such a public and priority-driven approach would align donors and voters in a constructive way, thereby increasing VTHO credibility and funding. This article is a provocative position statement of what needs to happen ensure that WHO survives.

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