Education and debate

WHO in 2002

Why does the world still need WHO?

BMJ 2002; 325 doi: 10.1136/bmj.325.7375.1294 (Published 30 November 2002)
Cite this as: BMJ 2002;325:1294

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  1. Gavin Yamey, deputy physician editor, Best Treatments (gyamey@bmj.com)
  1. BMJ Unified, London WC1H 9JR

    The landscape of global health is changing. New donor money, disease control initiatives, and trade laws have all had an impact on international health cooperation. WHO is being forced to rethink what its functions should be

    WHO used to dominate international health. But in the 1990s, the World Bank took its place as the premier global health agency,1 and a wide array of health initiatives were launched, bringing new money and fresh ideas to tackle disease. Globalisation is presenting new challenges to an increasingly fragmented global health landscape.2 What are the implications for WHO of these changes?

    Summary points

    The World Bank, Gates Foundation, and Global Fund have become major financiers of global health activities

    WHO has little influence over the spending of these new health funds

    The poorest countries need WHO's support in applying for funds and rolling out new global health initiatives

    As international health cooperation fragments, WHO's role in setting global standards has become crucial

    WHO's integrity in setting standards remains open to undue influence

    New money for global health

    The World Bank has become the largest external financier of health activities in low income and middle income countries.1 In the 1990s its health loans far exceeded WHO's total budget (fig 1), and its health sector activities have continued to grow. Its new Multi-Country AIDS Programme alone provides $500m over three years to Africa—where the prevalence of HIV in adults is now 8.6%—to scale up existing HIV/AIDS interventions.3

    Fig 1

    The growing role of the World Bank in health1

    The Gates Foundation, the largest charitable donor of the 20th century,4 is often called the new “800 pound gorilla” in global health. By September 2002, it had granted $2.8bn in health funding.5 Its biggest donation was $750m over five years as a start up grant to the Global Alliance for …

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