WHO Seeks to Regain Its Strength

There’s an edginess apparent among the staff at the sprawling headquarters of the World Health Organization this spring as the agency that rid Earth of smallpox, helped alert the world to the international spread of AIDS and worked to eradicate polio in the Western Hemisphere finds itself under increasing attack for mismanagement.

Criticism from within and outside the United Nations agency has been building for years and is expected to reach a critical point in the next few months with behind-the-scenes maneuvering to nudge Dr. Hiroshi Nakajima, its controversial director general, into retirement next year.

This is an unaccustomed position for an agency that for decades has rested comfortably on its considerable laurels.

“For 40 years, the WHO had a reputation as the leading international health institution. . . . It has steadily diminished in recent years,” said Mark Moher, Canada’s ambassador to the U.N. in Geneva, in an assessment unusual only in its bluntness.

Budget reductions, a leadership vacuum and bureaucratic infighting have drained morale and undermined the agency’s effectiveness, critics say. Advocates of U.N. reform single out WHO perhaps more than any other agency of the world body as an example of the need for restructuring and the difficulty of achieving it.

The U.S.-backed reform effort aims at getting WHO to narrow its focus to what it does best, including setting international standards for foods and drugs, organizing child immunizations, promoting women’s health and developing strategies for fighting infectious and emerging diseases, especially in the Third World, said Dr. Kenneth Bernard, health attache in the U.S. mission here.

That may seem simple, sound management practice. But there’s the problem of what one Western diplomat calls WHO’s “bloated and dysfunctional” bureaucracy, as well as the inertia and international jockeying for power and position that inevitably accompany every major decision facing the U.N.

In the case of WHO, reform is complicated because, like most U.N. agencies in Geneva, it operates independently of the world body’s headquarters in New York.

Kofi Annan, the reform-minded U.N. secretary-general, has no direct authority over Nakajima, who is selected by and reports to the World Health Assembly, which comprises 191 member nations and meets annually.

According to diplomats and WHO officials, reformers will concentrate their efforts over the next few months in the following areas:

* New leadership: Nakajima, 68, is expected to announce by this summer if he will seek a third five-year term. Intense negotiations are underway to arrange what one source calls “a graceful departure” for the director general, widely criticized as a weak administrator and a poor communicator who has failed to develop or articulate a vision to carry the agency into the 21st century.

In a period of diminishing resources--budgets have failed to keep pace with inflation in many of the developing countries where WHO operates--Nakajima has avoided making tough choices and “tried to make everybody happy,” as one diplomat puts it. One result is a top-heavy administration in Geneva, where the number of high-level officials grew from 13 to 17 between 1992 and 1996.

Reformers are trying to avoid a confrontation with Nakajima and Japan by negotiating a settlement before next year’s election. A move to oust him in 1993 fizzled amid allegations that Japan threatened economic retaliation against nations that planned to vote against him.

* New priorities: Should WHO continue to spend money on health education in the U.S. and Europe when it duplicates efforts by private groups and governments? Or should it concentrate time and money on things such as research on malaria? The illness strikes about 500 million mainly poor people a year, but research on the subject receives little private funding.

A reform-driven group of middle managers within WHO has begun asking these kinds of questions in what could be the first step toward sponsoring fewer but better-funded programs.

* New faces: With Nakajima still in office, few have declared themselves potential candidates. But speculation centers on George A.O. Alleyne of Barbados, director of the Washington-based Pan American Health Organization, and Gro Harlem Brundtland, former prime minister of Norway.

Turner, the Times’ U.N. Bureau chief, was recently on assignment in Geneva.

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World Health Organization

Founded: 1948

Headquarters: Geneva, with regional offices in Washington; Alexandria, Egypt; Brazzaville, Congo; Copenhagen; New Delhi; and Manila.

Current annual budget: $421.3 million, plus $350 million in voluntary member donations.

U.S. share: 25%

Governing body: World Health Assembly of 191 member nations, which meets once a year.

Management: Director general appointed by World Health Assembly to a five-year term. Six regional directors elected by national governments within their region.

Number of employees: 4,000