THREE times in as many weeks the WHO has hit the headlines as it enters its
50th year. In January it elected itself a dynamic new leader and announced a
bold initiative to eradicate the blight of elephantiasis. But it also found
itself up to its knees in another jumbo-sized PR mess-up.
The first whiff of something unpleasant came during the American TV news
programme 60 Minutes. The deputy director-general Fernando Antezana
froze like a rabbit caught in the TV studio headlights while a CBS journalist
pointed out, before millions of viewers, the fictitious nature of Antezana鈥檚
curriculum vitae. Unfortunately, Antezana hadn鈥檛 faked a hobby interest in
photography. His deceit was more ambitious: non-existent health diplomas from
the universities of Stanford and Harvard and a debatable claim to be called
鈥渄辞肠迟辞谤鈥�.
How did controversial incumbent director-general Hiroshi Nakajima respond? He
issued a statement praising his prot茅g茅 and telling the world he
would continue as number two in the organisation until Gro Harlem Brundtland
takes over in July.
Advertisement
Any ambitions that the WHO leadership had of fending off allegations of
corruption and nepotism vanished at a stroke. And if Nakajima can behave with
such disregard for public opinion after such a public incident, what on Earth
has been going on behind closed doors in Geneva in the ten years of his reign as
WHO leader?
Not only are such management practices unethical, but they damage morale and
waste scarce resources on under-qualified, over-promoted lackeys. They also
provide donor nations with an additional excuse for withholding funds. And it鈥檚
not difficult to trace the effects of poor WHO management on people鈥檚 health: we
need look no further than the WHO鈥檚 failure to deal with the activities of one
of its own bodies, the Market News Service, in promoting dangerously substandard
pharmaceutical ingredients
(快猫短视频, 6 September 1997, p 5). The
cofounder of MNS was none other than Antezana.
It would be naive to suggest that the WHO carries the sole or even major
responsibility for the world鈥檚 health. The rich Western nations, many argue, can
and should look after their own healthcare. In the developing world, individual
governments have a duty to prevent illness and to treat the sick to the best of
their ability鈥攁 responsibility they frequently fail to meet. Not only
that, but the World Bank鈥檚 annual health budget of $2.5 billion is now
more than two and a half times larger than the WHO鈥檚. And then UNICEF, UNDP, the
World Bank and the Rockefeller Foundation as well as the WHO collectively fund
the ambitious Children鈥檚 Vaccine Initiative, which aims to protect all children
from infectious diseases.
Many health policy experts believe Gro Harlem Brundtland will have to grasp
the nettle and target the WHO鈥檚 limited funds more specifically at the poorest
countries. Brundtland has hinted that she intends to shake up the WHO鈥檚
management structures, but it鈥檚 less clear whether she will radically alter its
priorities. Even for such an experienced politician鈥擝rundtland is a former
prime minister of Norway and a qualified medical doctor鈥攖his is unlikely
to be an easy task. Critics argue that such a move risks angering richer nations
by denying them the benefits of an organisation they largely fund. But here
again, surely it would be naive to deny that the WHO has at heart been anything
but an altruistic exercise. Hopes are high that it will soon confine polio to
the grave alongside smallpox. And now, as a major step towards eliminating the
disfiguring disease elephantiasis鈥攕courge of millions of people鈥攖he
WHO has persuaded drug giant SmithKline Beecham to donate the treatment
Albendazole free of charge for the 20 or so years necessary.
A senior British government official points out that this, and its rapid
response to the ongoing Rift Valley Fever outbreak in Kenya, are examples of the
WHO coming up with the goods. But he regrets that such good deeds get more press
coverage than the 鈥渋diots in the leadership鈥�, adding that delicate and
conflicting diplomatic expediencies mean that 鈥渓abyrinthine鈥� politics are par
for the course at the WHO.
The onus should be on its leadership to sort itself out, not for the press to
ignore its shortcomings. And accepting the need for diplomacy is not the same as
putting up with waste and mismanagement. Flushing out the latter without
ruffling too many feathers will be a key challenge for Brundtland.