The World Health Organisation: WHO's special programmes: undermining from above

Despite the World Health Organisation's spoken commitment to developing integrated primary health care, its most visible and successful activities are not integrated within countries; they are its disease specific intervention programmes, such as the Global Programme on AIDS and the programmes for the control of diarrhoeal and acute respiratory diseases. The 10 or so special programmes, all but one of which (the onchocerciasis control programme) are based in Geneva, have found increasing favour among donors, but critics say that they undermine WHO's attempts to integrate its activities at country level and discourage countries from developing their own capacity.

WHO's special programmes were set up in response to the perceived need among donors for something more comprehensive than WHO's regional and country based activities could offer. The idea is that they boost the organisation's routine activities, using international and regional expertise and a project based approach to attack specific diseases or health issues. The special programmes receive no funds from WHO's regular budget. They are funded from so called extrabudgetary contributions. Because of this they are not under the control of the director general, the executive board, or the World Health Assembly. Each special programme has its own director and a management executive committee made up of donors' representatives.

From the donors' point of view the special programmes have clear advantages over WHO's non-project based activities. They have well defined aims and strategies; they have outcome measures, even if most relate to process rather than health indicators; they are more financially accountable than the rest of WHO; and they are not under the direct control of the secretariat. This last point has become increasingly important in the past five years, according to diplomats in Geneva. As donors in Europe, Scandinavia, and America have become increasingly discontented with the organisation's lack of …