1. WHO has been at the forefront of improving health around the world since its founding in 1948. But the challenges confronting public health have changed in profound ways and with exceptional speed. While WHO continues to play a leading role in global health, it needs to evolve to keep pace with these changes. This is the overall purpose of reform.
2. The reform agenda began with a focus on financing and the need for better alignment between objectives and resources. A Member State-led process has since evolved to address more fundamental questions about WHO’s priorities, its changing role in global health governance, and internal governance and managerial reforms needed for the Organization to be more effective and accountable. The continuing financial crisis means that the need for predictable and sustainable financing remains a central concern.
3. At the Sixty-fourth World Health Assembly,1 and at the Executive Board’s 129th session in May 2011, three objectives of reform were defined:
(1) Improved health outcomes, with WHO meeting the expectations of its Member States and partners in addressing agreed global health priorities, focused on the actions and areas where the Organization has a unique function or comparative advantage, and financed in a way that facilitates this focus.
(2) Greater coherence in global health, with WHO playing a leading role in enabling the many different actors to play an active and effective role in contributing to the health of all peoples.
(3) An Organization that pursues excellence; one that is effective, efficient, responsive, objective, transparent and accountable.
4. Since May 2011, three distinct and interconnected fields of work have emerged in line with these objectives: WHO’s programmes and priorities; the governance of WHO and WHO’s role in global health governance; and management reforms.
5. Consultations with Member States between the Board’s decision to establish the process in May,1 and leading up to the special session of the Board in November, focused initially on three specific issues: independent evaluation, the governance of WHO, and the World Health Forum. More recently, Member States have also received and commented on a separate paper on managerial reforms.
6. The present paper brings the three major lines of work – programmes and priorities, governance, and management reforms – together again. It incorporates feedback on the three concept papers presented to the Regional Committees, the draft managerial reforms paper, as well as other comments made by Member States through the web platform. In addition, it has benefited from the input of senior management and staff of the WHO Secretariat.
7. Programmatic, managerial and governance issues are closely interconnected. New health challenges and a more complex institutional landscape require different programmatic responses and place new demands on WHO’s governance. Similarly, management reforms cannot be planned in isolation from the programmes and new ways of working that they are designed to support.
8. Although there is an overall consensus on the need for reform, the different elements of it are at different stages of development. They also require different types of decisions by the Board. In the area of management, the paper highlights where specific decisions are needed, and distinguishes those areas from the ones in which work is already being carried out under the authority of the Director- General. In the area of governance, the paper sets out several options and seeks the Board’s guidance on which ones are the best candidates for more in-depth work.
9. This document is organized in three chapters:
(1) Chapter 1: sets out the programmatic work of WHO and proposed approaches to priority setting. It demonstrates how action in five core areas – health development, health systems, health security, health trends and determinants, and convening for health – can address current and emerging health challenges. Chapter 1 also outlines how work to date on programmes and priorities will form the basis of the next general programme of work. The Board is asked to reaffirm support for the five core areas and to provide guidance on the development of the next general programme of work.
(2) Chapter 2 addresses governance from two perspectives: the governance by Member States of the Organization itself, and the role that WHO plays in global health governance. The first part is organized around the formal governance structures of WHO and sets out, for each structure, challenges and a range of mutually supportive options by which those structures can be strengthened. The second part discusses WHO’s leadership role in global health, both in terms of engagement with other stakeholders and how WHO can promote greater coherence and coordination among the many actors involved in global health at global and country level. As in the first part of this chapter, the second part also sets out a series of options on which the Board is asked to provide guidance.
(3) Chapter 3 deals in more detail with management reforms in five areas: organizational effectiveness, financing and resource mobilization; human resources policy and management; results-based planning, management and accountability; and strategic communications. Each section sets out issues to be addressed and how proposed changes will improve performance by better alignment of work in the three levels of the Organization in order to respond to new ways of working, particularly for more efficient delivery at country level. Ongoing work by the Secretariat is distinguished from new proposals that require a decision by the Board. For the most significant reforms, next steps are identified, providing, where appropriate, more detail on timelines, resource implications and approaches to implementation.
