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Education And Debate WHO in 2002

Have the latest reforms reversed WHO's decline?

BMJ 2002; 325 doi: (Published 09 November 2002) Cite this as: BMJ 2002;325:1107
  1. Gavin Yamey, deputy physician editor, Best Treatments (
  1. BMJ Unified, London WC1H 9JR

    In the mid-1990s the BMJ published a series on the World Health Organization by Fiona Godlee, an assistant editor at the journal. Godlee argued that WHO was in crisis—lacking effective leadership, direction, and priorities. Seven years later, has the organisation successfully reinvented itself?

    In her book Betrayal of Trust, health writer Laurie Garrett described WHO's decade of decline: “The World Health Organization, once the conscience of global health, lost its way in the 1990s. Demoralized, rife with rumors of corruption, and lacking in leadership, WHO floundered.”1

    Fiona Godlee, in her series in the BMJ (box 1), came to a similar conclusion. She argued that Hiroshi Nakajima, then director general, had failed to communicate a coherent strategic direction for WHO. Its six regional offices were bureaucratic, rife with cronyism, and operating autonomously from headquarters and it had little impact at country level. Donors questioned WHO's effectiveness, seeing better “value for money” from channelling their funds into other agencies, especially the World Bank. Though WHO still carried out important work setting standards and giving technical support to countries, the bank took its place as the most influential global health agency. At the end of the series, Richard Smith wrote an editorial in which he challenged WHO to “change or die.”2

    Summary points

    In the 1990s WHO came under fire for poor leadership and lack of direction

    Gro Brundtland took office as director general in July 1998 and attempted sweeping reforms

    Brundtland prioritised WHO's activities and launched important global health campaigns

    She restored WHO'S credibility with donors and helped to place health on the international development agenda

    But her management changes have been unpopular, and critics argue that WHO is still too influenced by its donors

    Brundtland's reforms have not been felt where they matter most—at country level

    A new leader

    One woman was charged …

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