WHO urged to outsource key functions following Ebola outbreak

13 Sep 16

A report by two senior health academics has called on the World Health Organisation to embrace wide-ranging reform, including outsourcing some its functions, in response to mistakes made in its handling of the Ebola crisis.

Writing in the British Medical Journal, professor Joel Negin of the University of Sydney and Dr Ranu Dhillon of Harvard Medical School, claim that only radical reform will ensure the WHO was able to tackle health crises in the future.

The WHO received criticism over its handling of the Ebola outbreak in west Africa, in particular for lacking both the capacity or culture needed to respond to a crisis of that scale, and failing to declare a public health emergency quickly enough.

The review highlighted that the global health landscape has changed significantly since the WHO was established in 1948. At that point, there were few global health actors, which made the organisation the “standard bearer and the institution that convened the greatest minds and talents working on issues of health.”

Now, however, the field of global health is far more complex with many more actors – and rival organisations have overtaken the WHO’s expertise in certain areas. For example, bodies such as the Global Fund for AIDS, Tuberculosis and Malaria, the GAVI Alliance, and the Bill and Melinda Gates Foundation and the World Bank, as well as a large number of NGOs, all play a role in global health policy and implementation.

The review called on the WHO to do more to leverage the expertise of these bodies, using its power to mobilise other organisations “for research, surveillance and technical assistance activities.”

This should include outsourcing a number of its functions to other global agencies that are more advanced in specific fields. “This would allow the WHO to focus on a small number of core activities where it has comparative advantage and to coordinate or orchestrate the broader array of global health actors to take on other activities.”

According to the authors, “positioning WHO as a regulator, orchestrator and clearing house of expertise resonates well with its global reach and mandate but acknowledges its limitations”.

A WHO spokesman noted that both the financial crisis and the Ebola crisis had given rise to public discussion of the WHO and its functions, which he said was welcome because it helps to create a better organisation and in both cases had triggered waves of reform. 

However in the case of Ebola, he said this was to make the WHO's emergency response "much more operational in the field" – not to scale it back. 

"The WHO has a unique ability to reach out across a wide range of partners, who all bring different strengths to the table. WHO is the world's best-placed convenor and has been mandated to build effective emergency response and management. 

"This is currently underway and will give WHO stronger operational capabilities in addition to our traditional technical and normative roles. The new programme will have more dedicated staff working on emergencies, while harnessing global expertise through hundreds of  partner agencies."

He highlighted that the new systems that are in place have already been used to respond to emergencies including the Zika virus, yellow fever and the humanitarian crisis in Nigeria, where they have implemented improvements in areas including early risk detection, strategic and joint operations planning and rapid release of funding. 

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