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The WHO Reform Process – Opportunities and Challenges

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Author: Dr. Tine Hanrieder, Head of the Research Group Global Humanitarian Medicine at the WZB Berlin Social Science Center, author of a 2015 book and many articles on WHO reform.

Main point: Reform efforts at the WHO have been going on for years. New reformers should avoid past mistakes and build on these efforts in order to strengthen the WHO.

This policy memo is part of a series explaining the WHO. Read more here.

  1. The WHO’s core funding is already too low, which undermines performance

Currently, less than a fifth of the WHO’s budget consists of regular member state contributions. The remaining 80 percent are voluntary contributions paid by member states and other international and philanthropic bodies. Many of these donations come with tight earmarking and inefficient micromanagement by donors.

The aggregate effect of these shortsighted funding strategies are a lack of program coherence and continuity, even in core areas of the WHO’s work. This became evident during the 2014 West African Ebola epidemic. Due to irregular funding, the WHO had laid off many of the epidemic response staff needed to understand and respond to such outbreaks. This contributed to its delayed reaction.

Without predictable funding, the WHO will not be able to perform its core tasks. Short-sighted conditionalities and earmarking should be replaced with pooled resources and multilateral oversight.

  1. The WHO needs a clearer conflicts of interest strategy

Transparent and independent oversight of the WHO is crucial for maintaining trust in the agency. This also requires a more coherent strategy for engaging with external advisors, especially the for-profit sector. A recent initial evaluation of the WHO’s new conflict of interest regulations concluded that these regulations are not yet implemented consistently. WHO members must push for more organizational leadership in the secretariat to reduce uncertainty about terms of engagement, in order to guarantee the independence of the agency.

  1. The International Health Regulations must be strengthened

The WHO’s emergency governance is based on a binding international treaty, the International Health Regulations (IHR), in force since 2007. Experience with past emergencies has shown, however, that member states have not built up sufficient outbreak preparedness capacities required under the IHR. Likewise, information sharing by and among member states is sometimes deficient.

A post-crisis review of the IHR needs to be transparent, inclusive, and multilaterally-owned, in order to allow the international community to jointly reform and strengthen the IHR.

  1. Reform by adding new organizations comes at a cost

Over the last decades, creating new institutions and programs has been a major reform strategy in global health. Examples include big disease-specific partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United Nations Joint Program on AIDS (UNAIDS) or, during Ebola 2014, the UN Mission for Ebola Emergency Response (UNMEER). Reformers should carefully balance the promise of innovation with the challenges involved in institution building in an already crowded policy field. Lack of on the ground experience and standard procedures can inhibit timely delivery during emergencies like Ebola 2014. Additionally, the proliferation of actors can create harmful competition, which undermines the performance of the health and humanitarian sectors.

Reformers can benefit from working through the WHO when they make use of its unique convening power in global health. As an inclusive multilateral institution, which also functions as a hub for global research institutions and laboratory networks, the WHO is uniquely positioned to facilitate coordination among both state and non-state stakeholders of global public health.


For more, read Tine Hanrieder’s blog post at Oxford University Press (January 17, 2016).


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The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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