WHO under stress: implications for health policy.

A crisis is increasingly challenging the authority and prestige of the United Nations' specialized agencies. Although the World Health Organization is still held in great repute, it has not escaped criticism. Member countries have expressed concern about WHO's bureaucratic procedures, costs, proliferation of meetings, reports, lack of budget transparency. Doubts have been cast on the effectiveness of some programmes. This paper argues that such criticisms must be understood within the context of the huge changes that have occurred since WHO was established in the late 1940s. There has been a major shift in the financing of WHO, with extrabudgetary funding now providing more than half the total budget, which has implications for policy influence within the Organization. Policy is also being decided within an increasingly political milieu. These changes put significant pressure on the Organization in a number of ways, and it is essential to generate a public debate about WHO's future role if the Organization is to retain the esteem within which it is generally held. This paper makes an initial contribution to that debate.