Education And Debate

The World Health Organisation: WHO in crisis

BMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6966.1424 (Published 26 November 1994) Cite this as: BMJ 1994;309:1424
  1. Fiona Godlee, assistant editora
  1. aBritish Medical Journal, London WC1H 9JR
  1. Correspondence to: Department of Ambulatory Care and Prevention, Harvard Medical School, 126 Brookline Avenue, Boston, MA 02215, USA.

    Media attention has been focused on the leadership of the World Health Organisation, rather than on the real factors that limit WHO's effectiveness. These factors relate to the organisation's structure and also to its current priorities, methods, and management. This article examines the objectives and strategy of WHO in view of financial constraints and donor countries' demands; WHO's stated goal of integrated primary health care; staff morale; and the growing dislocation between the regions and headquarters.

    The World Health Organisation has an image problem. People know that it exists, and most people know that it eradicated smallpox, but few have a clear idea what it does. Of those I have spoken to, some think it is a sort of world medical association, others see it only as a source of standard technical medical reports, yet others as just another faceless United Nations body where overpaid bureaucrats carve out their careers. Some politicians and doctors in Britain see it as meddling in public health matters that need not concern it when it should be concentrating its efforts on the developing world. Doctors in the developing world respect the WHO for its technical advice and support but criticise the waste of money on salaries and bureaucracy. Its slogan “Health for All by the Year 2000” has entered the international vocabulary, but few people, apart from diehard enthusiasts in the organisation, believe the target can be realised or understand how WHO intends to achieve it.

    The media woke up to WHO last year when political and financial scandal seemed set to erupt over the re-election of its director general, Dr Hiroshi Nakajima. The outcome of an external audit fell short of media hopes; it found financial mismanagement and misuse of the organisation's funds but they cleared the director general of any involvement.1 …

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