WHO in 2002: Have the latest reforms reversed WHO's decline?

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Abstract
A new leader One woman was charged with saving the organisation. Gro Harlem Brundtland, a former prime minister of Norway, took office as director general on 21 July 1998 and promised radical reform for WHO. She restructured it, prioritised its activities, and launched new health campaigns. WHO made a comeback to the global political stage. Box 1: Fiona Godlee's BMJ series on WHO WHO in crisis. BMJ 1994;309:1424-8. (http://bmj.com/cgi/content/full/309/6966/1424) WHO in retreat: is it losing its influence? BMJ 1994;309:1491-5.(http://bmj.com/cgi/content/full/309/6967/1491) The regions—too much power, too little effect. BMJ 1994;309:1566-70. (http://bmj.com/cgi/content/full/309/6968/1566) WHO at country level—a little impact, no strategy. BMJ 1994;309:1636-9. (http://bmj.com/cgi/content/full/309/6969/1636) WHO fellowships—what do they achieve? BMJ 1995; 310:110-2. (http://bmj.com/cgi/content/full/310/6972/110/a) WHO's special programmes: undermining from above. BMJ 1995;310:178-82. (http://bmj.com/cgi/content/full/310/6973/178/a) WHO in Europe: does it have a role? BMJ 1995;310:389-93. (http://bmj.com/cgi/content/full/310/6976/389) Interview with the director general. BMJ 1995;310:583-88. (http://bmj.com/cgi/content/full/310/6979/583) RETURN TO TEXT But in a few important ways, WHO is still struggling. Its new structure has created a different set of problems for the organisation. There are serious questions about whether Brundtland's reforms have been felt at country level. And in a surprise move, on 23 August this year Brundtland announced that she would not stand for a second term. A new director general takes office next July, leaving the future of Brundtland's reforms uncertain. What impact have the reforms had on WHO's most important constituency—the poor? How has WHO engaged with other players in health? How is it responding to the multiplication of new global health initiatives? I will address these questions over the next few weeks, and begin here by discussing the reforms themselves. Box 2: How donors can call the shots WHO has two sources of funds. It receives “regular budget funds,” which are the membership dues paid by its 192 member states. Since 1980 the regular budget has been frozen, limited by several member states defaulting on their contributions. It also receives “extrabudgetary funds,” which are voluntary contributions from a handful of member states (called donor countries), other UN organisations, and private donors. These are largely used to fund disease-specific vertical programmes. Funding from extrabudgetary funds first exceeded the regular budget in 1990-1, and today it makes up two thirds of WHO's total budget. Although extrabudgetary funds can benefit the health of low income countries, they come with strings attached—donors can influence WHO programmes “by deciding on the allocation, volume, designation, and specification of their extrabudgetary funds.”4 RETURN TO TEXT