Should the WHO put scarce resources into building up national health systems or building up the organization’s own capacity to respond to public health emergencies?
Despite its reputation as a leading global health institution, the World Health Organization seems to be suffering from an identity crisis of sorts. The issue that the WHO faces is not whether it should act as either a technical agency or as a capacity-building one, but rather how to it can combine both objectives in aid of becoming a successful global health entity. In order to accomplish all of this, it is vital that the WHO creates and fosters a sense of unity among its main and regional offices, funds meaningful capacity-building programs in its member states and continues to deploy the technical expertise for which it is so well regarded.
The World Health Organization has, by and large, regarded itself as a technical agency that lends medical expertise to member nations during their various health-related endeavors. It has not viewed itself as a capacity-building agent that focuses on strengthening its members’ health systems. This is a crucial error. The technical expertise that the WHO employs is essentially useless unless it can be implemented by local stakeholders using equipment and facilities fit for fulfilling the needs inherent in any health crisis.
A large part of the disconnect between the WHO and its ability to live up to its name as a leading global health institution is the disparity between its headquarters’ staff in Geneva and the members of its regional offices. As Patterson points out, the WHO’s 150 regional offices are spearheaded by leadership selected locally; there is no nomination process, no majority vote and no high-level committee proceedings that take place to install the management teams that oversee WHO activities in their respective regions. This in and of itself is not a problem, but it highlights the need for the WHO to adopt a strong central identity and mission that it can
There exists the argument that across-the-board capacity building is a fruitless endeavor, one that cripples the WHO by dedicating resources to projects that may or may not be needed. This argument, however, falls flat in the face of logic as dictated by global trends. Without adequate medical facilities, less-developed states will be left unable to contain and eradicate illnesses that can spread and have widespread effects on even the best-prepared societies.
The argument that funds shouldn’t be earmarked for projects that don’t have immediate impact is becomingly increasingly invalid. Globalization makes pandemics in even the most undeveloped parts of the world inevitably impactful and incredibly dangerous on the global stage; international travel is a reality and an outright necessity; human movement on the ground is also unavoidable, especially considering the number of people implicated in massive displacement crises as a result of civil war as well those fleeing to the global north in search of something other than the substandard living conditions they are accustomed to.
Greater investment in health infrastructure would encourage the WHO to be more accountable to its donors by forcing them to maintain the facilities they helped build—facilities that are instrumental in tackling health issues before they turn into full-blown pandemics. If adequate facilities had been in place ahead of the Ebola crisis, for example, it is possible that early detection would have prevented the spread of the disease and the ensuing global panic. By building up national health systems, the WHO is also building up its own capacity to respond to public health emergencies. Admittedly the investment in shoring up countless state health systems is mind-bogglingly massive, but it is key in positioning the organization to be truly effective in combatting global health crises. There is no good reason to regard these efforts as mutually exclusive. One might contend that such an ambitious mandate is unsustainable or unappealing to donors, but championing the long-term benefits of such a reimagined institution may be enough to convince them of its overall value.
The WHO has a number of significant issues it must overcome in order to be truly effective in its mission. In addition to coming to grips with its identity, the organization must make meaningful investments in capacity building efforts and work to maximize the effectiveness of its trademark technical expertise. On a global stage with dynamics as complex as those faced by all international organizations, the WHO must reprioritize and reimagine its mission by being proactive and not reactive.