• J W Peabody.
• General Internal Medicine Division, Veteran's Administration, West Los Angeles, CA, USA.
• Soc Sci Med. 1995 Mar 1;40(6):731-42.

AbstractThe World Health Organization's (WHO's) nearly half century amelioration of suffering stands as a singular achievement in international cooperation. But after 45 years, the Organization has grown into a complex bureaucracy with an outdated organizational structure. A multidisciplinary framework, which emphasizes organizational theory, yields some insights into these problems. Using this approach, this paper examines the structure, culture, mission, and rules of WHO, and adds a perspective, not otherwise found in the literature, to the growing debate on the future of the Organization. Previous studies of international organizations have explained their behavior as the consequence of the dominant external interests of powerful members. This perspective suggests that organizations like WHO have fewer options and less control of their policies and output. By contrast, there has been very little analysis explaining how international organizations function internally. This paper refutes an exclusively external perspective and shows that the internal organization is also important to understanding WHO. Several conclusions are drawn from this perspective. WHO's organizational myths, as a politically neutral technical agency staffed with uniquely qualified staff, need to be validated and enhanced to attract funding. A new organizational structure, based on an 'open systems' model, is proposed. This strategy would strengthen the WHO Representative Country Offices, redefine staff objectives, close the Regional Offices, and establish open, public elections of the Director General. Traditional WHO culture should only be used for health problems that are well matched to WHO's critical tasks. For more complex social and economic issues, newer, often non-medical, approaches are needed. The internal and external rules, which shape the incentives of WHO staff and leaders, need to be realigned to close the gap between WHO's myths and its day to day work. In the short run it is possible for WHO to do more with its limited budget if it changes its organizational structure; in the long run a reorganized WHO will be able to garner more funding and attract wider international participation.

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