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Analysis And Comment International health

Open letter to the incoming director general of the World Health Organization: time to refocus

BMJ 2006; 333 doi: (Published 09 November 2006) Cite this as: BMJ 2006;333:1015
  1. Ruth Levine, director of programmes
  1. 1Center for Global Development, 1776 Massachusetts Ave NW, Washington, DC 20036, USA
  1. rlevine{at}
  • Accepted 27 October 2006

Ruth Levine argues that WHO needs to concentrate on confronting global health risks, improving the health of poor people, and marshalling technical expertise

As you take on what is arguably one of the most important leadership posts in the world, you have an opportunity for a moment of reflection: Is the World Health Organization, which was mandated at its founding in 1948 to be the “directing and coordinating authority on international health,” on the right track? The answer right now is a definitive “no.” Instead, it is on too many tracks simultaneously, suffering from years and perhaps decades of underfunded “mission creep.”

The central challenge of your new job—the task that will determine the success or failure of your tenure—is to refocus the organisation so it can identify cross country health priorities and provide credible technical expertise on public health problems and solutions that help national public health authorities to focus their resources effectively. To get there, you will have to institute recruitment, hiring, and firing policies based on merit (from the director general down); skilfully manage a transition to more adequate and secure funding for core activities; and foster a spirit of common purpose across the organisation.

You can see for yourself that WHO needs a major rethink. All around you narrowly focused yet intertwined global health initiatives have sprung up, and they aren't going to disappear: the Global Fund to Fight AIDS, Tuberculosis and Malaria; UNAIDS; the Global Alliance for Vaccines and Immunization; public-private partnerships dedicated to everything from inventing a malaria vaccine to promoting hand washing; private foundations, most notably the super-sized Bill & Melinda Gates Foundation; and many more. The complexity and fragmentation of funds and functions is reproduced in a proliferation of public and private actors within each region and country.

From the outside, we …

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