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BMJ No 7124 Volume 316 Editorial Saturday 3 January 1998 Who should be the next head of the WHO? A strong leader with a clear sense of purpose-and much else besides See WHO special feature After 10 years under the director generalship of Dr Hiroshi Nakajima, the World Health Organisation is to have a new leader. For the first time in the organisation's 50 year history there are more than four nominees for the post and also a strong chance that the new director general will come from outside the organisation. Both these firsts reflect more openness in the selection procedure and could presage a change in the WHO's fortunes. On p 11 five of the seven nominees answer questions about the WHO's future, and on the BMJ's website we invite you to cast your vote in advance of the decision by the WHO's executive board on 27 January (www.bmj.com). So what sort of organisation will the successful nominee take on, and what attributes should he or she have? The WHO was established to provide technical expertise and to set international standards for health. Two decades ago it embraced the wider role of international advocate for equity and social justice. This move into the complex and competitive realms of socioeconomic influences raised the organisation's profile as never before, with the commitment to Health for All and successful campaigns against the vested interests of the baby milk and pharmaceutical industries. But such an approach required strong leadership and a clear sense of purpose, things that the WHO has lacked in recent years. Financial constraints, shared by most other United Nations agencies, have not been helped by mismanagement or by the WHO's determination to spread its limited resources across an ever growing list of "priorities." The six autonomous regional offices, once considered the organisation's great strength, have lost the little accountability they had, dependent as this was entirely on the force of personality of the previous director general, Dr Halfden Mahler. The globalisation of diseases and the advent of modern management techniques have changed the rules, requiring global strategy setting and limited term projects rather than permanent departments. The WHO's undoubted successes - the eradication of smallpox in 1977 and the imminent eradication of polio - must be set against its failings in developing health infrastructure in individual countries. Other players in international health - Unicef, the World Bank, and non-governmental organisations - have too often been seen as threats rather than partners, so that countries are confused by an array of competing and sometimes inappropriate interventions. As programmes have been cut despite growing numbers of senior managers, staff morale has fallen. Gradually the scientists, clinicians, and administrators who gave their lives to furthering the good of mankind have found themselves mired in bureaucracy, political infighting, and petty corruption. The new director general faces a daunting challenge: to restore the WHO's finances, reform its constitution, modernise its management structure, recast its priorities, build creative alliances with other agencies, and rebuild staff morale. Faced with these challenges, what sort of person does the WHO need? Above all, it needs a leader - someone who can create a clear vision of where the organisation is headed, communicate that vision throughout the organisation and beyond, and motivate others so that they want to achieve that vision too. Beyond this fundamental attribute, the new director general should have certain specific skills and experience. She or he should be politically independent, command respect from the major donors, be able to relate to both developed and developing countries, be well versed in the problems of poverty and the links between development and health, and have a real interest in the empowerment of women. She or he should have proved abilities to cooperate in a complex global environment and to engender a culture of openness, accountability, and advancement on merit. She or he should be committed to reform. Not everyone will agree with this prescription. It is based on the premise that the WHO must change or die. The good news is that, for once, the field of applicants is strong; the bad news is that many of those who will choose the next director general may prefer the status quo to an uncertain future. Fiona Godlee Assistant editor, BMJ Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline