Misdiagnosis: What Jack Chow got wrong about the WHO

Dr Jack Chow, a former WHO official with a colorful background including management consulting and investment banking, takes a bird’s eye view of the World Health Organization in Foreign Policy magazine. WHO cannot become complacent (see here) and needs to pursue serious reforms but my agreement with Dr Chow ends there.

First, the “product” of WHO is not expertise but the ability to operate as a neutral forum for cooperation between all countries. WHO is an intergovernmental agency. Period. This feature makes it unique among other health related organizations and provides unmatched credibility and mandate. In fact, it is this aspect which enables WHO to host the diverse and talented technical panels which produce the guidelines and standards that represent the agency’s expertise.

Second, strengthening country offices is an important goal but the most pressing, and admittedly difficult, reform WHO needs is in its financing structure. WHO budget comes from two sources: general UN contributions by member countries and donated funds (usually earmarked). The balance between the two sources has changed with the latter growing in proportion with time. Now, regular contributions compose only 20% of the total meaning that the vast majority of WHO budget, and consequently operations, is under donor control. Laurie Garret notes:

Yet, as Harvard University’s Christopher Murray points out, the WHO itself is dependent on donors, who give it much more for disease-specific programs than they do for its core budget. If the WHO stopped chasing such funds, Murray argues, it could go back to concentrating on its true mission of providing objective expert advice and strategic guidance.

Overall, the article belays impatience with an admirable spirit to just “get things done” but without much concern for process, sovereignty, and accountability. Dr Chow advocates for WHO to become the go-between for donors and to bypass governments to directly work with NGOs, bilateral programs, and the private-sector groups “on the ground”. Barring the question of whether this is even desirable (it undercuts state responsibility for health and represents mission creep), if WHO is underfunded, understaffed and already can’t keep up with government needs as the article notes – how will it handle those of additional players? I expected more.

For a work that carefully dissects WHO place today in the context of it’s long history see the five-part series from the unfortunately now defunct blog Effect Measure.


1 Response to “Misdiagnosis: What Jack Chow got wrong about the WHO”

  1. 1 Eric Butter March 6, 2011 at 2:59 pm

    I would argue that the UN’s big issue is mission creep; its core business is supposed to be international cooperation and mediation, so why is it sourcing donor funding and earmarks at all? It is not an NGO. Member countries already pay “dues” assessed based on their national budgets. The UN should not be leading and financing public health and agriculture implementation programs. It should be in the business of building consensus and coordinating development efforts .

    UN agencies are “less relevant” today because they are not focusing on their core mission of coordinating between governments. If they focused on that mission, they could create a manageable, transparent budget — they would have the resources and focus to also better direct NGOs and philanthropies where they are most needed (all the while coordinating and prioritizing with the governments). If they focused on that mission they would not need the massive, inefficient bureaucracy they have right now.

    At the end of the day, as you wrote, the problem always comes down to money (sex and drugs too, but those are harder to track!) 🙂 The muddled financing structure appears to me to be an underlying CAUSE for the mission creep; there are power-hungry people at the top who want to be more relevant by handling more money and more responsibility. In the process, the mission creep is undermining sovereign governments’ responsibilities and undermining self-reliant decentralized growth.

    The WHO and the UN in general are sorely needed — to fulfill their central mission. If the UN was slimmed down and these non-central “development” projects were instead directed <> to NGOs and governments, we would at least be able to follow the money trail a little bit better.

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