Education And Debate WHO in 2002

WHO's management: struggling to transform a “fossilised bureaucracy”

BMJ 2002; 325 doi: (Published 16 November 2002) Cite this as: BMJ 2002;325:1170
  1. Gavin Yamey, deputy physician editor, Best Treatments (
  1. BMJ Unified, London WC1H 9JR

    Gro Brundtland inherited the leadership of an organisation with major structural problems. WHO was top heavy, male dominated, and rife with cronyism, and staff morale was falling. Has the new management tackled these problems?

    On taking office as director general of the World Health Organization on 21 July 1998, Gro Brundtland was faced with two enormous tasks—to restore the organisation's place on the international stage and to internally reform a failing United Nations agency. There is little doubt that she achieved the former. In this article I consider whether her managerial reforms have been successful.

    Summary points

    In the 1990s, WHO was poorly managed, over- centralised, and rife with political appointments

    Brundtland established mechanisms to tackle cronyism and raised awareness of the need for greater staff diversity

    But WHO is even more centralised now and remains top heavy and dominated by men and representatives of developed countries

    Some WHO staff say that senior management stifles open debate and internal dissent

    Brundtland has been more successful at raising WHO's profile

    internationally than at transforming the organisation internally

    A failing bureaucracy

    Brundtland inherited the leadership of a dysfunctional organisation. In a 1995 editorial, Richard Smith, BMJeditor, argued that WHO was “overcentralised at headquarters and regions, top heavy, poorly managed, and bureaucratic and smells of corruption.”1 Brundtland's reform process, said Jon Liden, her communications adviser, had to “butt against a fossilized UN bureaucratic structure.”

    Under Brundtland's predecessor, Hiroshi Nakajima, the number of top ranking posts almost doubled.2 These appointments were widely held to be political, rather than based on merit. When Brundtland took office, for example, there were six assistant director generals. These posts, said Julio Frenk, Mexico's minister of health and a former executive director at WHO, were “geopolitical appointments—each of the permanent members of the UN security council had one.” Cronyism was widespread, …

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