WHO signals intent to trim sails.

a time of substantial change for the World Health Organization (WHO), which plans on initiating reforms to improve its leadership, increase cooperation between member states and become more efficient and transparent. Though the proposals for reform have only been described in broad strokes thus far, one thing is certain: It all begins with money. “This WHO debate about reform has been going on for a while, and much of the concern is about the way it is financed,” says Dr. Andrew Cassels, director of strategy in the office of the director-general of the WHO. “Our budget is made up of 25% membership fees, which everybody pays, and 75% comes from voluntary donations. That 75% is pretty heavily tied to certain areas, so some objectives get good funding and others less so. Can we do something about increasing the flexibility of our financing? That’s where we are starting.” The financing reforms will be implemented in conjunction with a narrowing of WHO’s focus to five core areas: health development, health security, strengthening health systems and institutions, generating evidence on health trends and determinants, and convening for better health (www .who.int/mediacentre/news/notes/2011 /eb_20111104/en/index.html). WHO’s executive board also indicated during a special session in November 2011 that it supported proposals forwarded by member states and the director-general which are aimed at strengthening governance, improving financing, facilitating communication across the organization, and increasing transparency and accountability. The integral financing issue is scheduled to be addressed at a January 2012 meeting of WHO’s executive board. Part of the strategy will likely include dealing with donor nations in the aggregate rather than individually, which will enable each country to learn what others are doing, Cassels says. It would also enable countries to cooperate to achieve international health goals and help to reduce gaps in funding in certain areas. From there, work can begin on a framework for more detailed priorities. “The whole thing comes together at the World Health Assembly in May,” Cassels says. “We will be clear on the proposed reforms. We will know then which ones will fly and which ones will drop.” Many experts on global health have claimed WHO is overcommitted and News CMAJ