An Open Letter to the New Head of the WHO

As Margaret Chan takes the helm of the World Health Organization as its new Director General, she will undoubtedly confront many competing priorities for her attention and action. Ruth Levine highlights the challenges ahead (as previously discussed here and here) and lays out key action items in an open letter published by the British Medical Journal. At the macro-level, Dr. Chan should concentrate her efforts on building the WHO's core capacities in technical expertise and cross-country analysis and priority-setting, but any major directional shifts will first depend on realigning the set of incentives facing the organization and its staff by implementing three internal policy changes:

• Ensure that staff decisions are based on merit and that political and financial considerations do not threaten your best staff. Extend that principle to the selection of the director general, working with the governing body to make subsequent elections more transparent.
• While committing to real and measurable institutional changes, demand an adequate core budget from member states and greatly reduce dependence on grants and trust funds. Ensure funding for priority functions is fully protected and avoid the temptation to take on non-priority work simply because funding can be found for it.
• Work toward an alignment across the organization, breaking up the current internal fiefdoms; dedicate staff, reporting to you, to ensure institutional coherence. In particular, look for ways to bring regional offices and headquarters closer together, so that all parts of the organization share a core mission and communicate common information, with a particularfocus on getting information from the field to Geneva.

While the WHO works to identify and leverage its comparative advantages within the growing constellation of global health actors and initiatives, we hope that Dr. Chan will first and foremost undertake the concrete institutional measures necessary for success.