Education And Debate

The World Health Organisation: The regions — too much power, too little effect

BMJ 1994; 309 doi: (Published 10 December 1994) Cite this as: BMJ 1994;309:1566
  1. Fiona Godlee, assistant editora
  1. a British Medical Journal, London WC1H 9JR
  1. Correspondence to: Department of Ambulatory Care and Prevention, Harvard Medical School, 126 Brookline Avenue, Boston, MA 02215, USA.

    The regions—too much power, too little effect

    WHO's regional offices make it structurally one of the most decentralised of all United Nations agencies. But at what cost and to what effect? This article argues that too often the regions give only the illusion of decentralisation while wresting power from WHO's governing body and prolonging the time taken for resources to reach the point of need.

    The World Health Organisation's division of the world into six regions is an accident of history rather than the result of design. When the organisation was founded in 1948 two regional public health bodies already existed: the International Sanitary Bureau in Washington and the Conseil Sanitaire Maritime et Quarantinaire in Alexandria. Both were incorporated into WHO's constitution and to some extent dictated the design of the four other regional offices. The bureau in Washington was particularly responsible for the degree of autonomy enjoyed by the current regional directors. Now called the Pan American Health Organisation, it agreed to serve as WHO's regional office for the Americas only on condition that it maintained its autonomy. It remains the most independent of the six regional offices and functions almost completely without reference to Geneva.

    The regional structure allows WHO to claim to be one of the most decentralised of the United Nations agencies, an important weapon when the United Nations stands accused of being out of touch with life beyond Geneva and New York. Staff say that the division into regions allows WHO's actions to be more flexible and relevant to the needs of individual countries. But the regions have come under increasing criticism both from within and outside WHO, the main charges being that they are inefficient and bureaucratic, that they duplicate expertise available at the headquarters in Geneva, and that they are too bound up in regional politics. What, critics ask, does …

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