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WHO needs more money to deliver better health care to poor people

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7510.180-c (Published 21 July 2005) Cite this as: BMJ 2005;331:180
  1. Owen Dyer
  1. London

    The World Health Organization is under-resourced, lacks direction, and is run by staff who are jaded and poorly managed, says a highly critical report from an independent health charity. To deliver the basic health needs lacking in the developing world WHO needs to re-examine its structure and policies and call for better funding, it says.

    The report is produced by the charity Medact and the People's Health Movement, the umbrella group that organised the first People's Health Assembly in Savar, Bangladesh, in December 2000.

    It says that resources devoted to WHO's international programmes are far smaller than most people believe. The global WHO budget for 2002 and 2003, for example, was equivalent to about 0.5% of the NHS budget over the same period. The annual budget of the entire United Nations, with all its agencies and peacekeeping operations, is $12bn (£7bn; £10bn)—less than the annual budget of New York city's Board of Education. WHO's funding arrangements leave the organisation susceptible to outside pressure, the report concludes.

    The report, which states that it set out to “explore this decline in WHO's fortunes from the perspective of a critical friend,” concludes that the organisation suffers from poor morale, declining influence, and lack of direction—and that these problems stem from the top. Senior levels are “dominated by white men from developed countries.” Its management is perceived as “top-heavy, hierarchical, overpaid and centralized” and “is beset by rumours of corruption and nepotism.”

    Interviews conducted for the report among more junior staff found that “a pattern of apathy, anger, cynicism and despair emerged” and that “the pervasively depressed but frantic mood inside WHO is a cause for huge concern.”

    Mike Rowson, managing editor of the report, said: “We are calling on donors to resource WHO much better and for a more rational allocation of those funds. We are also calling on WHO to open a public debate on its future direction, to cut down on ‘priorities,’ and re-inspire its staff.”

    The report depicts a world in which international cooperation on public health issues is only skin deep and in which many of the most influential voices are compromised by vested interests or undue pressure.

    The World Bank and World Trade Organization are singled out for particular criticism. The reforms demanded by the World Bank in poor countries have often hindered the development of public health services and overridden the priorities of the weaker WHO, the report argues. “Some of these institutions, the [World] Bank in particular, now operate in direct competition with WHO as the leading influence on health sector policy,” it says.

    The World Trade Organization has too often been guided by pressure from the pharmaceutical industry, says the report. One issue where this is most notable is in the negotiations over the TRIPS (trade related aspects of intellectual property rights) agreement, which limits the right of developing countries to issue compulsory licences permitting generic manufacturers to ignore patents.

    · The second People's Health Assembly was held this week in Cuenca, Ecuador, ending on 22 July.

    Global Health Watch is available at http://medact.org/hpd_global_health_watch.php

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