Fiona Godlee

WHO at country level : a little impact, no strategy

The acid test of WHOs effect on the worlds health is its impact at country level. Unless it has an impact there, all of its declarations, its debates at the World Health Assembly, its conferences, its pamphlets, its political manouvering in Geneva and the regions, all of these come to nothing. Working as it does through national governments, WHO insists that it has no role in directly managing or delivering health care. Judging WHOs impact in individual countries is therefore difficult--its approaches are largely indirect, and initiatives may take years to bear fruit. But from the meagre resources that WHO makes available at country level it is clear why its country operations are criticised as the weakest link in an already weak chain of influence from its headquarters in Geneva to the people in its member states. Poorly funded, undertrained, and with no clear strategy to follow, its staff at country level stand little chance of making an impact.

The World Health Organisation. The regions--too much power, too little effect.

WHOs regional offices make it structurally one of the most decentralised of all United Nations agencies. But at what cost and to what effect? This article argues that too often the regions give only the illusion of decentralisation while wresting power from WHOs governing body and prolonging the time taken for resources to reach the point of need.