Have the latest reforms reversed WHO's decline?

In the mid-1990s the BMJ published a series on the World Health Organization by Fiona Godlee, an assistant editor at the journal. Godlee argued that WHO was in crisis—lacking effective leadership, direction, and priorities. Seven years later, has the organisation successfully reinvented itself?

In her book Betrayal of Trust, health writer Laurie Garrett described WHO's decade of decline: “The World Health Organization, once the conscience of global health, lost its way in the 1990s. Demoralized, rife with rumors of corruption, and lacking in leadership, WHO floundered.”1

Fiona Godlee, in her series in the BMJ (box 1), came to a similar conclusion. She argued that Hiroshi Nakajima, then director general, had failed to communicate a coherent strategic direction for WHO. Its six regional offices were bureaucratic, rife with cronyism, and operating autonomously from headquarters and it had little impact at country level. Donors questioned WHO's effectiveness, seeing better “value for money” from channelling their funds into other agencies, especially the World Bank. Though WHO still carried out important work setting standards and giving technical support to countries, the bank took its place as the most influential global health agency. At the end of the series, Richard Smith wrote an editorial in which he challenged WHO to “change or die.”2