Member States Promise Big Reforms to the WHO. Can They Deliver?

[Updated] When the Ebola crisis spiraled out of control last spring and summer in West Africa, a number of people wondered why the World Health Organization was seemingly unable to stop it?

The WHO has an excellent reputation for setting global health standards and facilitating the coordination of action between countries. But the ebola outbreak exposed a key deficit of the WHO.  It turns out, the WHO’s capacity for emergency response was actually quite limited. Years of budget cuts undermined its ability to rapidly respond to a large outbreak of an infectious disease. As the CDC director Thomas Frieden put it, “The WHO we have, is not the WHO we need.”

So, on Sunday the WHO’s executive board, a group of 34 member states, took a hard look at these issues and proposed a sweeping set of reforms to bolster WHO’s capacity as an operational emergency response organization.

The New York Times has a good rundown of some of the key reforms.

Critical provisions of the resolution adopted Sunday include the creation of a global cadre of emergency public health workers, the establishment of a fund that could be tapped quickly, and stepped-up support for the development of vaccines, diagnostics and treatments for emerging infectious diseases. These steps were all recommended but not put in place after a review of the response to the 2009 influenza pandemic.

The board also asked the organization’s director general to ensure that the W.H.O.’s in-country staff members were selected for their expertise. Some critics have said the early response to Ebola was hobbled in part because some W.H.O. workers lacked important qualifications or had been chosen largely for political reasons.

The proposals would push the WHO in a brave new direction. But it’s not yet clear whether or not member states are willing to walk the talk and contribute the funding and political backing required to implement these reforms.

One positive indicator, so far, is a decision by the United Kingdom to contribute 10 million pounds toward the proposed contingency fund. Other member states need to follow suit. The level of new financial commitments will be single the clearest indicator of whether or not member states are prepared to back up this ambitious plan with the funding that is needed to execute against it.

Another indicator will be in future personnel decisions taken by the WHO and its regional organizations. In many ways, the WHO is structured more as a loose confederation of regional health organizations than a centrally directed body. The directors of these regional health organizations (there are six in total) are elected by the member states of their region. They do not report directly to headquarters in Geneva, but to their own region’s member states. This can inject a level of politics into the health organization, which has the potential to manifest itself in staffing choices. Indeed, one of the key criticisms of the WHO’s response to ebola had less to do with the “WHO” per se than its African regional subsidiary, and the performance of country-level WHO staff.

In her address to the Executive Board, WHO director Margaret Chan highlighted some operational challenges of a structure in which there’s a “WHO” in Geneva, a “WHO” in the region, and a “WHO” in the country. 

We need to apply the “one WHO” approach, whereby all three levels of the Organization use the same standard operating procedures, tools, and frameworks for risk assessment, monitoring, and accountability during emergencies.

The severity of the outbreak underscores the need to enhance crisis management and field experience during emergencies in WHO country offices.

Again, the early signs are encouraging that member states are stepping up to the this challenge. The WHO Executive Board, acting on the nomination of African member states, replaced the former African Regional director who has served in the post for 10 years. The new regional director, Dr Matshidiso Rebecca Moeti is a respected public health veteran with years of experience working for national health systems in African and also serving in top posts in various UN agencies.

It’s exceedingly difficult to devise an ambitious reform agenda for a large, member state directed international institution. It’s even harder to implement those big reforms. The WHO’s executive board deserve a great deal of credit for recognizing the potential value of a WHO capable of rapidly responding to large scale health emergencies. It’s now up to all member states to actually empower the WHO to do so.