Global health governance: we need innovation not renovation

by Richard Smith and Kelley Lee
BMJ Global Health 2017;2:e000275

4 pp. 388 kB

Historically, global health governance has rested with the WHO. Criticisms of WHO have become frustratingly familiar – weak internal coordination, cumbersome bureaucracy, political appointments and ineffective leadership. The Ebola outbreak prompted some to describe it as facing a ‘do or die’ moment. Despite the Director-General admitting that ‘WHO was overwhelmed’ by the outbreak, WHO has not ‘done’, in the sense of fundamental reform to address criticisms, but nor has it ‘died’. Although the global health community widely accepts that WHO is no longer fit-for-purpose, the design and creation of an alternative remain fraught with difficult questions requiring imagination, an agreed vision and political consensus. In their absence, the tinkering continues and, with a few exceptions, most commentators cling to renovation (‘reform’), rather than innovation.

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