In a BMJ analysis examining the future of the WHO, David Legge, scholar emeritus at Australia’s La Trobe University, notes “[a] substantial shortfall in the funds available for basic administrative functions led WHO’s director general, Margaret Chan, to initiate another reform of the WHO in 2010,” and “outlines the problems and what the reforms are trying to achieve.” He writes, “Success of the current reform program depends on resolving the contradiction between member state priorities and donor control and requires the freeze on assessed contributions to be lifted,” adding, “To achieve this, member states must be persuaded to prioritize global health over parochial interests.”

“A strong and effective WHO is a necessary condition for the global health crisis to be addressed,” but “WHO’s capacity to provide the necessary leadership and drive is compromised by serious budgetary and organizational disabilities, including donor dependence, contradictions in human resource management, excessive decentralization, and lack of accountability on the part of member states for their custody of this critical global institution,” Legge states and expands on each of these points. “If member states are not willing to address the root problem of donor dependence and lack of flexible finance, WHO will slide further into irrelevance, with disastrous consequences for the global health crisis,” he writes, adding, “Paradoxically, the unnamed disability — the lack of accountability of member state representatives and the limited engagement of civil society in holding WHO to account — may provide the most promising strategy for driving successful reform” (10/25).