The World Health Organisation: WHO fellowships--what do they achieve?

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Abstract
Training health professionals is one of WHO's major strategies for improving health care in the developing world. The aim, to strengthen a country's own capacity rather than injecting expertise from outside, isin the best tradition of sustainable development. But how effective is this so called “capacity building in human resources”? Since it accounted for $43m of WHO's budget in 1992–3 and is considered by WHO to be a major contribution to health in individual countries, it deserves detailed examination. WHO funded over 4500 fellowships in 1992–3, to which it allocated about 5% of its core budget. The fellowships allow health professionals to visit teaching institutions, largely in the developed world, for periods of up to a year. They are administered by the regional offices but paid for almost entirely out of individual countries' budgets, the idea being that each country will know what expertise it needs and will be best placed to select the right people to train to fill the gaps. In theory the training fits fellows for a specific assignment when they return home, in line with the country's and WHO's strategic plan. Also in theory candidates are selected according to set WHO criteria by a specially formulated selection committee, which includes a representative from WHO. In practice, however, as several reports have made clear, the fellowship programmes in many areas are badly administered and often unevaluated. In a report to the executive board in January 1991 the director general highlighted major shortcomings in the fellowships programmes in some regions. Member states were requesting fellowships for training in highly specialised areas of medicine rather than primary health care, and many countries, especially in Africa, had no selection committees and no clear selection criteria. Three years later WHO's external auditor, Sir John Bourne, found little improvement. In a highly …

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