Calling it a “historic moment,” World Health Organization Director General Tedros Adhanom Gheyebresus (Dr Tedros) today announced wide-ranging reforms in the organization’s structure – claiming they would prove to be the most significant ones in WHO’s 71-year history.

The director general, unveiling the changes today via a WHO media release and in a meeting with WHO staff at the Geneva headquarters, also broadcast to WHO staff worldwide, said the structural changes would help the organization reach the ambitious goal of improving the health of 3 billion people by 2023.

He said that the changes are core to the plans for reaching the so-called ‘Triple Billion’ targets that aim “to make a measurable impact on the health of the world’s people, and to support countries in reaching the Sustainable Development Goals.”

The reforms would also ensure that the organization – which straddles six regional offices, nearly 100 country offices and some specialized bureaus, functions more as “One WHO,” the director-general affirmed.

“For the first time, the heads of the 7 major [regional] offices have worked together to identify the changes we need to make at all three levels of WHO – headquarters, regional offices and country offices – to transform this great organization and make us more effective and efficient,” said Dr Tedros.

The appointment of Dr Zsuzsanna Jakab, currently director of WHO’s European Region, as WHO deputy director in Geneva, underlines the intention of reinforcing those links, he said.  And in the presentation before staff, regional directors from all six WHO regions also addressed an element of the reform message.

The reforms are designed to make country health needs the key priority; move programme areas out of silos and promote integrated approaches to health challenges, the regional directors said, each speaking in turn. They also should ensure that WHO seizes opportunities created by digital health; and builds the skills of millions of health workers worldwide through a new WHO Academy.

The WHO Academy would be created in collaboration with leading academic institutions around the world, such as the Massachusetts Institute of Technology, and other leading institutions from Switzerland to Singapore.

The organizational structure would create a new division for antimicrobial resistance, reflecting the worldwide mounting concern over the issue, and a new supra-division for health emergencies, led by an executive director, Dr Michael Ryan, currently a senior WHO advisor on the WHO’s Global Polio Eradication Initiative, based in Islamabad, Pakistan.

An all-new function of WHO chief scientist is being created and filled by Dr Soumya Swaminathan to oversee one of WHO’s core functions — setting health-based norms and standards in dozens of areas ranging from medicines to food safety to  air quality.  Swaminathan, currently a WHO deputy director general, is a former head of the Indian Medical Research Council.

Other WHO technical programmes (outside of Emergencies) will be streamlined into a “Four Pillars” organization including the following divisions:

• Universal Health Coverage/life course, led by Dr Peter Salama, currently heading WHO’s Health Emergencies Programme;
• Universal Health Coverage / Communicable and Noncommunicable diseases, led by Ren Minghui, currently assistant director general for Communicable Diseases;
• Healthier populations led by Naoko Yamamoto, currently a WHO assistant director general for Universal Health Coverage and Health Systems.
• Antimicrobial resistance (AMR) – led by Hanan Balkhy, a longtime WHO advisor on AMR, and currently executive director of infection prevention and control in the Ministry of National Guard, Health Affairs, Saudi Arabia.

The director general said that the new structure announced for Headquarters would be mirrored across all levels of the organizations — including WHO’s regional and country offices.

The reforms have been nearly two years in the making – beginning soon after Dr Tedros took office in May 2017.

However, despite the hoopla over a much-awaited event, some observers questioned if this “Tranformation,” as it has been dubbed, could also pan out to just another in series of organizational reshuffles introduced by every director general that has led WHO over the past 71 years.

Left unanswered were questions about how the new functions – such as the chief scientists’ division also including an ambitious new Digital Health Hub, would be financed. It was also unclear how staff might be re-assigned amongst the new divisions and departments—and whether there might be a new distribution of resources between headquarters and regional and country offices – the latter suffering from a chronic lack of human and financial resources.

New WHO mobility policies that would make relocation mandatory for virtually every WHO staff member have also created internal controversy. While the policies can introduce new career opportunities for WHO staff who have worked for years in a particular country office, staff in WHO’s Geneva headquarters have complained that frequent, mandatory moves would disturb the continuity of many core functions as well as uprooting families.

Over the past 25 years, WHO’s funding base has been eroded and institutional confidence shaken by the shift of donor funding to countless public and private partnerships filling functions, such as data research, over which WHO once had a monopoly. Along with that, the proportion of the WHO budget coming from regular assessments to countries, and flowing into WHO’s general finance coffers have been depleted in favour of more “earmarked” monies for specific programmes and projects.

This, the director general has said, makes it difficult to rationalize funds to urgent corporate needs, as well as swelling the bureaucracy around the management of several thousand individual grants.

All of these forces have merged to require an “overhaul of all of our major processes” the director general affirmed to staff.

“We were advised not to redesign more than two or three major processes at once. But we are ambitious and impatient,” he said. “We identified 11 processes for radical redesign – planning, resource mobilization, external and internal communications, recruitment, supply chain, performance management, norms and standards, research, data and technical cooperation.”

See the WHO press release here.

A detailed diagram of the new WHO structure is available here.

Image Credits: WHO.