WHO in 2002: WHO's management: struggling to transform a "fossilised bureaucracy"

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Abstract
A failing bureaucracy Brundtland inherited the leadership of a dysfunctional organisation. In a 1995 editorial, Richard Smith, BMJeditor, argued that WHO was “overcentralised at headquarters and regions, top heavy, poorly managed, and bureaucratic and smells of corruption.”1 Brundtland's reform process, said Jon Liden, her communications adviser, had to “butt against a fossilized UN bureaucratic structure.” Under Brundtland's predecessor, Hiroshi Nakajima, the number of top ranking posts almost doubled.2 These appointments were widely held to be political, rather than based on merit. When Brundtland took office, for example, there were six assistant director generals. These posts, said Julio Frenk, Mexico's minister of health and a former executive director at WHO, were “geopolitical appointments—each of the permanent members of the UN security council had one.” Cronyism was widespread, and debased WHO's technical competence. Regional directors would often assign country representative posts as a reward to doctors who had served their national governments.3 With its regular budget frozen, WHO relied heavily on additional voluntary contributions from donors. WHO departments would fight with each other for these funds, and over territory, and there was poor communication between them. The result, said one programme director in 1994, was that “the right hand never knows what the left hand is doing.”2 The autonomous functioning of the regional offices added to WHO's difficulty in acting strategically across the organisation.