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Commentary
Outsourcing: how to reform WHO for the 21st century
  1. Joel Negin1,
  2. Ranu S Dhillon2
  1. 1Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
  1. Correspondence to Dr Joel Negin; joel.negin{at}sydney.edu.au

https://doi.org/10.1136/bmjgh-2016-000047

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    Summary box

    What is already known about this topic?

    • Reform of WHO is needed as highlighted by a number of international reviews following on from the substandard Ebola response.

    • Global health has become a multistakeholder community with a number of organisations of considerable, world-leading expertise who have much to offer.

    What are the new findings?

    • A new reform model is proposed: outsourcing of key activities, thus leveraging the expertise of global health organisations beyond WHO.

    Recommendations for policy

    • Outsourcing should be considered as part of the current debate on WHO reform in order to solidify WHO leadership and centrality while acknowledging that WHO cannot do it all itself.

    The need for WHO reform

    The Ebola epidemic has drawn unprecedented attention to the WHO and its deficiencies.1–3 However, WHO's shortcomings are not limited to its mishandling of Ebola alone and extend more widely. Checchi et al4 highlight fundamental challenges in terms of structure, governance and prioritisation of political considerations. In addition, Laurie Garrett of the Council on Foreign Relations states that “WHO has struggled to remain credible, as its financial resources have shrunk, tensions have grown between its Geneva headquarters and its regional offices”.3 The size and scope of the WHO lead to considerable management challenges with a senior member of the Organization lamenting “I think it may be one of the most complex organizations that exists”.5 Others have noted that the organisation lacks the confidence of donors amidst continuing underperformance.6 In a number of recent reports and esteemed panels, including the Harvard-LSHTM Independent Panel on the Global Response to Ebola, the need for fundamental and extensive reform of the WHO has been made clear.1 ,5 ,7

    The institutional failures of the WHO have serious consequences for global health as evidenced not only by shortcomings in the Ebola response but also in Sri Lanka in 2009, Haiti in 2010, South Sudan in 20134 and …

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