British Medical Journal
http://www.bmj.com/content/current
13 August 2011 Volume 343, Issue 7819

 Irrelevant” WHO outpaced by younger rivals
Nigel Hawkes, freelance journalist

Extract
The World Health Organization’s critics accuse it of being bogged down in red tape and internal politics. However, attempts at reform are raising concerns over conflicts of interest. Nigel Hawkes reports

For as long as many can remember, the World Health Organization has been facing a crisis. From decade to decade, the nature of that crisis might change, but it never quite goes away.

Despite its past accomplishments, WHO fits increasingly uneasily into a world with a growing number of international players who seem fleeter of foot and deeper of pocket. Set up as an agency to provide advice to governments at a time when government health departments were the prime movers in health policy and delivery, it seems passé beside such upstarts as the Global Fund to Fight Aids, Tuberculosis and Malaria, the GAVI Alliance (formerly known as the Global Alliance for Vaccines and Immunization), and private philanthropies such as the Bill and Melinda Gates Foundation.

Setting the agenda of global health?
The existence of such organisations is a reproach to WHO, whose bureaucracy and politicisation have been increasingly bypassed by governments in the interests of getting something done. Jack C Chow, a former assistant director general of WHO, claimed last year that the organisation was becoming irrelevant. 1 It was outmoded, underfunded, and overly politicised, he said. “WHO is no longer setting the agenda of global health; it’s struggling to keep up.” His theme was echoed this year by Barry R Bloom, professor of public health at Harvard, who pointed out that of WHO’s budget of $3.9bn (£2.4bn; €2.7bn) in 2008-9, less than $1bn came from member states’ mandatory contributions. 2 The rest were earmarked funds provided by countries or foundations for specific projects, indicating a lack of confidence in WHO’s ability to set the right priorities if left to itself…