This week's lead editorial considers the future of WHO/AFRO (the African region of the World Health Organisation)-with the hope that the imminent election of a new leader for the agency will prioritise Africa's diverse health-care needs rather than the political expediency characteristic of the outgoing administration.
The editorial comments: 'WHO/AFRO's weaknesses are typical of a large organisation: ineffective and self-serving central management and demoralised and unsupported rank-and-file staff. At the heart of the regional office's ineffectiveness is its acting as a political rather than a technical agency. Recruitment of senior staff is rarely based on competence or qualification. In particular, appointments of country representatives, who should coordinate WHO efforts in their countries, are often paybacks for political or other favours. The regional office thus has strong, some might say incestuous, relations with African governments at the ministry level, to the extent that senior health ministry officials see WHO/AFRO as their future retirement home. As a result, the culture of leadership within the regional organisation tends to be autocratic, excessively bureaucratic, and highly centralised-a culture that dismally fails to motivate staff at the country level.'
'There is much that WHO can do at the Geneva headquarters, at regional, and at country level to improve this failing situation. First and foremost, the damagingly close political ties between WHO/AFRO and the member-state governments must be loosened and the agency must reorient its core function towards technical health expertise. Accordingly, transparent, binding procedures must be put in place to ensure that country representatives are appointed on the basis of competence and qualification. There are strong arguments for decentralisation of WHO/AFRO to at least four or five subregions. Such action could allow better assessment of the array of health problems within the 46 countries that make up the African region and more tailored support to struggling country offices.'
The editorial concludes: '…a new nominee gives opportunity for a joint re-examination of relations between Geneva and Brazzaville to ensure that WHO/AFRO can exploit the rich resources of Geneva while accepting its oversight and support. Unless WHO's African office is transformed from a political club to an effective health agency, its right to existence is questionable.'
Journal
The Lancet