Outsourcing: how to reform WHO for the 21st century

Correspondence to Dr Joel Negin; [email protected] THE NEED FOR WHO REFORM The Ebola epidemic has drawn unprecedented attention to the WHO and its deficiencies. However, WHO’s shortcomings are not limited to its mishandling of Ebola alone and extend more widely. Checchi et al highlight fundamental challenges in terms of structure, governance and prioritisation of political considerations. In addition, Laurie Garrett of the Council on Foreign Relations states that “WHO has struggled to remain credible, as its financial resources have shrunk, tensions have grown between its Geneva headquarters and its regional offices”. The size and scope of the WHO lead to considerable management challenges with a senior member of the Organization lamenting “I think it may be one of the most complex organizations that exists”. Others have noted that the organisation lacks the confidence of donors amidst continuing underperformance. In a number of recent reports and esteemed panels, including the Harvard-LSHTM Independent Panel on the Global Response to Ebola, the need for fundamental and extensive reform of the WHO has been made clear. 5 7 The institutional failures of the WHO have serious consequences for global health as evidenced not only by shortcomings in the Ebola response but also in Sri Lanka in 2009, Haiti in 2010, South Sudan in 2013 and with regard to the MDR-TB response in Papua New Guinea at present. There is a need for clear global leadership, particularly when it comes to establishing global technical standards, addressing challenges that cross or transcend borders, and responding to health crises, such as the Ebola epidemic, that require the mobilisation of unique skill sets, capacities and resources. The time is ripe for reconsidering how the global health architecture should be reshaped to allow for greater assurance of global health and to prevent future health crises and pandemics. Most current proposals have focused on the ways the WHO could be made more effective and particularly emphasised the need for greater funding from member states. However, such a status quo solution may not match the magnitude of the problem and seems unlikely to actually resonate with funders who question WHO’s efficacy. Alternative options must be raised.