Document Type


Publication Date



Director-General Margaret Chan recently called the WHO overextended and unable to respond with speed and agility to today’s global health challenges. Given the importance of global health cooperation, few would dispute that a stronger, more effective WHO would benefit all. In this commentary, we offer 5 proposals for re-establishing WHO’s leadership.

(1) Give Real Voice to Multiple Stakeholders
The WHO would be more effective by giving real voice and representation to key stakeholders, including philanthropies, businesses, public/private partnerships, and civil society. Meaningful stakeholder engagement would instill confidence, and spark investment, in the agency.

(2) Improve Transparency, Performance and Accountability
Stakeholders demand clarity on how their resources will achieve improved health outcomes, as they shift towards results-based financing and performance-based measures. To improve its standing, WHO must rigorously evaluate programs, and demonstrate that they effectively translate into better health outcomes.

(3) Exercise Closer Oversight of Regions
WHO headquarters should exercise more oversight and control over regional personnel and decision-making. Minimally, the agency should fully disclose the funds held within each regional office and how regions meet health objectives, with monitoring and benchmarks of success.

(4) Exert Legal Authority as a Rule-Making Body
The WHO Constitution grants the agency extraordinary rule-making powers, but in more than 60 years the agency has promulgated only 2 major treaties. The agency could exert normative power through innovative treaties (e.g., a Framework Convention on Global Health) or through “soft” power (e.g., codes of practice) with strong incentives for compliance.

(5) Ensure Predicable, Sustainable Financing
Extra-budgetary funding, which now represents almost 80% of the agency's budget, has transformed the WHO into a donor-driven organization, restricting its ability to direct and coordinate the global health agenda. The ideal solution would be for the WHA to set higher member state contributions. Failing decisive WHA action, the WHO should consider charging overheads of 20-30% for voluntary contributions to supplement its core budget.

There is no substitute for WHO, with its progressive constitution and global legitimacy. Consequently, while remaining true to its normative and bold vision of health-for-all, the WHO must adapt to a new political climate, demonstrate global leadership, and deliver results.

Publication Citation

JAMA, March 29, 2011,