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World Health Organisation should outsource key duties, experts say

British Medical Journal report advises fundamental overhaul of the WHO to avoid loss of funding, warning it is at risk of repeating mistakes of the Ebola crisis

Global public health experts have called for fundamental and extensive reform of the World Health Organisation (WHO) including major outsourcing of key activities, warning that the organisation is already at risk of repeating the mistakes it made in handling the Ebola crisis.

Writing in the British Medical Journal (BMJ), Professor Joel Negin of the University of Sydney and Dr Ranu Dhillon of Harvard Medical School say that only radical reform of the organisation will ensure it can get sufficient funding in the coming years and tackle public health crises.

Negin describes the current WHO response to an outbreak of drug-resistant tuberculosis in Papua New Guinea as having a similar pattern to the Ebola catastrophe.

They are being slow in their response, not taking it as seriously as some others suggest they should. Some on the ground are saying this is like Ebola with wings, and we have a potentially cavalier attitude from the WHO, he says.

The WHO faced severe public criticism for its handling of the Ebola crisis in West Africa in particular over the failure to declare a public health emergency quickly enough. About 11,000 people died in the outbreak, which started in 2013. Dhillon and Negin say that there have been similar failings in public health responses in Sri Lanka in 2009, Haiti in 2010 and South Sudan in 2013.

At the heart of the vision for reform outlined in the article is a radical change to the way the WHO operates, with vital activities outsourced to other key players in the global health field, such as the Bill and Melinda Gates Foundation, the Global Fund for Aids, TB and Malaria, and frontline humanitarian response groups including Mdecins Sans Frontires (MSF).

The report says: WHO should aim to outsource a number of its functions to other global agencies that are already leading the way. This would allow the WHO to focus on a small number of core activities where it has comparative advantage and to coordinate or orchestrate the broader array of global health actors to take on other activities.

Negin points to recent calls, following the Ebola epidemic, for the WHO to establish a humanitarian rapid response team. Why does this role fall to WHO when organisations such as MSF and the International Rescue Committee already have committed experts willing to travel to crisis zones and systems in place to quickly mobilise a response? These organisations have the credibility, track record and networks to fulfil this role and could further be reinforced instead of trying to create parallel mechanisms within WHO.

Responding to the BMJ article, a spokesman for the WHO said that the organisation is already undergoing two waves of reform following public discussion on its functions.

The first [of these] was triggered by the financial situation after the global financial crisis. On top of this, the Ebola outbreak has shown that WHO needed to reform its work on emergency response to become, in addition to its normative and technical mandates, much more operational in the field.

WHO is the worlds best-placed convenor and has been mandated by its 194 member states to build an effective emergencies response and management function. This is currently under way.

Much of the WHOs work in the humanitarian sector is severely underfunded but Negin believes that without substantial reform and a willingness to use the expertise already existing across the sector, funders will not be prepared to give the large sums that the WHO needs, putting its operations at risk.

A lot of donors are more impressed by the actions of other global health actors so they cut their funding for the WHO I just want [the organisation] to be more focused on a few things it does well, [such as] orchestrating the global health community expertise. WHO is being bypassed and only with reform can it play the role it should play.

Read more: https://www.theguardian.com/global-development/2016/sep/12/world-health-organisation-should-outsource-key-duties-experts-say-british-medical-journal