A reforma da Organização Mundial da Saúde: processo, tendências atuais e desafios (1998-2014)

Abstract

This study examined the current World Health Organisation (WHO) reform proposal with a view to identifying, describing and evaluating changes and continuities between the present process and other organisational changes (termed ‘reforms’) implemented between 1998 and 2014. The formation of the WHO was reviewed historically, along with the challenges it faced in gaining international legitimacy, including the internal and external conflicts that led to the present discussion over reform. The focus of the study is the 2010 reform proposal prepared by WHO Director-General (DG) Dr Margaret Chan, which addresses the future of WHO funding and the organisation’s “inability” to respond, quickly and agilely, to today’s global health challenges, which she sees as centred in a lack of sustainability of the present model of organisational management, funding and planning in light of populations’ health needs in the 21st century. They study examined the reforms drawn up by the various administrations over the period, focussing on budget proposals and institutional work plans. The analysis deployed a combination of different theoretical approaches relating to the impacts of globalisation on population-wide health; the greater interdependence among countries and the consequent broadening of power disputes in the world system; the relation between the term ‘global health’ and the dynamics among institutions operating in the international health sector arena; and the importance of health in contemporary international relations and ‘global governance’ of the field. The methodological strategy was case study-based, resting on qualitative data collection techniques (literature review, wide-ranging document survey and analysis, and direct social observation by the author. The starting assumption was that the budget issue is crucial to this process, and the analyses centred on the composition and historical evolution of the WHO budget, in order to problematise the current reform process’s potential for strengthening the organisation and enabling it to reposition as the leading player in the health arena internationally. In the endeavour to elucidate the origin of the WHO “funding crisis”, which is closely connected with its high degree of dependence on extra-budget funds, the study concentrated on budget proposals and work plans implemented during the study period, which spans the administrations of several different directors – from Gro Brundtland, in 1998, through to the present administration. It was concluded that, although the present WHO administrative reform process does introduce organizational and administrative changes, these appear to be insufficient to reposition the organisation at the forefront of global health. However, it is still too early to assert this with any certainty.