World Health Organization : The mandate of a specialized agency of the United Nations

PART I : The institution

Chapter 2

STRUCTURE : WORLD HEALTH ASSEMBLY, EXECUTIVE BOARD AND SECRETARIAT

The structure is the way in which the parts of a system are organised and connected[1]. It could be seen as the skeleton of a body, where different parts represent diverse organs linked to each other. It is extremely important to gain an inview of how an organisation is structured, because it allows to better understand how it works on a day to day perspective. Behavioural theorists argue that "structure influences an organization's outcomes and, therefore, structure defines the organization's agenda"[2]. For this reason, the second chapter will be an overview of the parts of the World Health Organization structure, in order to start to enter in the Organization's work perspective. It will give the basic instruments necessary to be able to understand the interactions and interconnections, which will be then analysed in the second and third part of this dissertation. Therefore, this chapter does not want to be a specific analysis of the mechanisms concerning each single organ, but a broad description about how each of them is composed and works.

The structure of the WHO does not differ much from the one of the other specialised agency. In fact, although the structure of an organisation is shaped on its basic functions and activities, and it is consequently different in each organisation, it is frequent to find certain similarities in it, which could be called 'general principles of structure'[3]. Therefore, like many other specialised agencies, the WHO structure has two characteristics: the first one is that the work of the Organization is carry out by two governing bodies, and a permanent staff; the second one is that its work is organised at three different levels.

The following two chapters have as an object these two structural characteristics. The first one deals with the analysis of the plenary organ, the executive organ and the permanent staff, respectively the World Health Assembly, the Executive Board and the Secretariat. The second one is a description of the WHO's three layers: the headquarters of Geneva, the Regional Organizations and the Country Offices.

2.1. World Health Assembly

The World Health Assembly (WHA) is the first organ provided by the Constitution to conduce the work of the Organization. The WHA is the organ in which all the member states are directly represented. For this reason, it is called plenary organ. However, its activity is to be ascribed to a superior entity, which is the international organisation itself which the organ is part of[4].

The WHA is the supreme governing body of the Organization, which means that it acts as the supreme decision-taking and policy-making body. It is also frequently called legislative body, considering its activity in the adoption of regulations and recommendations.

Chapter V of WHO Constitution and the Rules of Procedure of the World Health Assembly provide all the needed information concerning place and time, composition, functions and method of work of the WHA.

2.1.1. Place and time of the WHA

According to article 13 of WHO Constitution, the World Health Assembly shall meet regularly once a year[5]. The Constitution also provides the possibility for special sessions to be convened in case the Executive Board or the majority of the states desire it. The date of each annual and special session is determined by the EB, after consultation with the Secretary-General of the United Nations[6].

It is interesting to know that, in 1950, the Danish, Norwegian and Swedish delegations submitted a proposal to the WHA. They wanted the sessions to be biennial, instead of annual. They argued that in this way WHO would save money and time, and they also considered that one year was too short to create a totally new agenda to present to the next WHA. Another argument was to try to maintain an uniformity with the rest of United Nations system. However, this proposal was refused for different kind of reasons, and since then no more changes in this rule were projected[7]. Nonetheless, the duration of the session started to be reduced. In 1996, it was established that the WHA should last a maximum of six days[8].

According to article 14, the place is determined by the WHA itself. It designates the country or the region where the next session would be held. After that, the Executive Board fixes the exact place for the meeting[9]. The third General Assembly of the United Nations, in 1947, recommended that the annual conferences of the specialised agencies shall take place as much as possible at the Organisation's headquarters. The Executive Board had to decide whether it was more convenient to hold WHA sessions always at WHO headquarters or to change the place each time. In the end, all the WHA meetings were held in Geneva, except two[10]. The second WHA convened in Rome, in 1949 and the eight one in Mexico City, in 1955. The condition was that the Mexican and Italian governments had to cover all the additional expenses due to the place variation[11].

Therefore, since its first meeting, the WHA has been meeting annually in Geneva in May.

2.1.2. Composition of the WHA

The World Health Assembly is composed by delegates from all member states. According to article 11, each member state can be represented by three delegates. One of them is designated as chief of the delegation. Delegations can be accompanied by alternates and advisers. Delegates should be chosen from among persons who are characterised by technical competence in the health field and who represent the national health administration[12]. The delegates represent their countries and express the views of their governments. Representatives of the Executive Board, of the United Nations, of other specialised agencies and of intergovernmental organisations which established a special relationship with the WHO can also take part to the WHA, as well as observers of non member states or of Nongovernmental Organizations (NGOs). However, they do not have the right to vote[13].

2.1.3. Functions of the WHA

Article 18 describes the World Health Assembly functions through thirteen paragraphs from a) to m)[14]. To have a clearer view about the activity of WHA, we can summarise it in four main functions.

The principal function of the WHA is to determine the policies of the Organization. It takes the most important decisions concerning strategies, programmes and activities of the Organization. For example, this means that it determines the overall policy direction of WHO's general programme of work, which will be analysed in the second part of this work[15].

Secondly, the WHA has a special role in the election of the Director-General. The WHA is in charge of the appointment of the head of the Secretariat.

Thirdly, on one side, WHA reviews and approves reports and activities of the Executive Board or of the Director-General; on the other side, it can also instruct the Executive Board in regard to matters upon which action, study, investigation or report may be considerable. Finally, WHA supervises the financial policies of the Organization and reviews and approves the budget.

Furthermore, according to articles 19, 21, 23, WHA has also the authority to adopt conventions or agreements and regulations, and to make recommendations[16]. For example, it can adopt regulations in such fields as sanitary and quarantine requirements; nomenclature for diseases, causes of death, and public health practices; and standards with respect to safety, purity and potency of biological pharmaceuticals, and similar products[17]. This function corresponds to the 'legislative' activity of the World Health Organization. As chapter 4 will show, this kind of documents are not legally binding, and therefore they could not be properly considered legislative, yet 'quasi-legislative'[18].

2.1.4. Method of work: Rules of procedure of the WHA

According to article 17, the World Health Assembly shall adopt its own rules of procedure[19]. Therefore, as it states the Preamble of the Rules of Procedure of the World Health Assembly, the Rules of Procedure are adopted under the authority of, and are subject to, the Constitution of the Organization. If there is any conflict between any provision of the Rules and the Constitution, the Constitution shall prevail[20]. They were adopted by the eight World Health Assembly and repetitively amended during the past years.

Once the legal source has been stated, I can analyse the method of work adopted during WHA sessions. The Rules deal with different aspects: agenda, committees, conduct of business, voting, budget and finance, etc.

I present a broad description of how a session is usually conducted[21]. The Executive Board prepares the provisional agenda for each session after considering proposals submitted by the Director-General of the Organization. The Executive Board shall include in the agenda: the annual report of the Director-General on the work of the Organization, all items that WHA has ordered to be included, any items pertaining to the budget for the next financial period, any item proposed by member states, associate members, United Nations and by any other organisation of the United Nations system.

At each meeting, the WHA, after considering the report of the Committee on Nominations, elects a President, five Vice-Presidents and a Chairman for Committee A and Committee B, which are the two main committees to help WHA with its work.

The General Committee consists of the President, Vice-Presidents, the Chairman of the two main Committees and seventeen delegates. No delegation may have more than one representative on the General Committee. Meetings are usually held in private.

Committee A deals predominantly with programme and budget matters. Committee B deals predominantly with administrative, financial and legal matters. Each delegation is entitled to be represented on each committee by one of its members. The meetings of these committees and their sub-committees are usually held in public.

The reports of all committees, including draft resolutions must be distributed at least twenty-four hours before the plenary meeting at which they will be considered.

A majority of the member states represented at the session constitutes a quorum for the conduct of business at plenary meeting. It is valid the principle 'one state, one vote'. Decisions on important issues, as the adoption of conventions or agreements, amendments to the Constitution, are taken with a two-third majority of the member states present and voting. However, most decisions are made by consensus.

English, French, Chinese, Arab and Spanish are the official languages. The documents are usually in English and French. In case one of the member state requires it, they can be also translated into one of the others.

2.2. Executive Board

The Executive Board (EB) is the second organ established by the Constitution to carry out the work of the World Health Organization. If the WHA is the legislative body, the EB is usually considered as the executive body of the Organization. This means that it oversees the implementation of decisions taken by the WHA. Generally speaking the EB is in charge of taking less strategic and more operational decisions.

However, the structure of international organisations, as their functions, is easy to change in its parts. Cox and Jacobson, two of the most important authors on the international organisation's topic, affirm that "regardless of the rigidity of their charters […], once established, in many instances they evolve in ways that could not have been foreseen by their founders"[22]. Thanks to discussions and interviews with persons of the Secretariat during the 111th EB in Geneva, from 20 January 2003 to 28 January 2003, I was able to realise how the given definition is rather broad and not totally complete. In the next paragraphs, I will highlight the changes which occurred in the composition of the EB, and I will give a clearer description of the EB functions.

The starting information concerning place and time, composition, functions and method of work of the EB are provided by Chapter VI of WHO Constitution and by the Rules of Procedure of the Executive Board.

2.2.1. Place and time of the EB

According to article 26 of the Constitution, the EB "shall meet at least twice a year and shall determine the place of each meeting"[23]. The Constitution also provides the possibility to convene special sessions. The main EB meeting, at which the agenda for the forthcoming WHA is agreed upon and resolutions for forwarding to the WHA are adopted, is held in January. The second shorter meeting is usually in May, immediately after the WHA, for more administrative matters[24].

The place of the meeting has always been Geneva, except certain particular situations, as the 16th EB that was held in Mexico City[25].

2.2.2. Composition of the EB

Articles 24 and 25 of the Constitution describe the composition of the Executive Board[26]. Although the Constitution affirms that the EB is composed by 31 members, since 1994 they are 32[27]. They are from Brazil, China, Colombia, Cuba, Democratic People’s Republic of Korea, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Grenada, Guinea, Iran, Italy, Japan, Jordan, Kazakhstan, Kuwait, Lithuania, Maldives, Myanmar, Philippines, Republic of Korea, Russian Federation, Saudi Arabia, Spain, Sweden, United Kingdom, Unites States, Venezuela[28]. These 32 members seat around the table in the Executive Board room at the Geneva headquarters[29].

These persons are designated by as many member states that have been selected to serve by the WHA. Not less than three members shall be selected for each Regional Organization. One of the criteria the WHA should take into account in designating member states is an equitable geographic distribution. Member states are elected for a three-year terms and may be reelected. Furthermore, each year one-third of EB members is retired. In this way, recycle and continuity are guaranteed at the same time.

Article 24 refers to EB members as 'persons', implying that individuals serving as EB members serve in a personal capacity, as technically qualified in the field of health, rather than as representatives of particular governments. This believe, difficult to be held in practice, resisted till 1998. Till that time, the EB was supposed to act on behalf of the whole membership of the Organization and not on behalf only of those countries elected to designate its members. The EB was defined as "the collective expression of the total membership of WHO and the conscience of its member states"[30]. As a consequence, members of the EB were not to represent their countries and rather to express their own opinion[31]. This system, which was unique in the UN system[32], probably wanted to reflect "the once held belief that health was an apolitical issue"[33] and political forces should not influence it[34]. However, it is interesting to wonder whether this 'independence' was effectively respected[35]. In all probability, this happened in case the EB dealt with technical issues; however, coming to discussions concerning international politics, the Director-General elections or the budget, this was not so sure[36]. During the sessions of the EB, it was noticeable a kind of embarrassment from the EB members when they had to refer to the countries they were from, without having bias towards them. Picturesque expressions to talk about their own countries could be heard, such as "un pays que je connais bien" or "le pays que je connais le mieux"[37]. Therefore, for many authors the independence of the EB members was considered as a fiction[38]. Vignes calls the independence of the EB members a myth, and he deems necessary a reform of their status.

The reform came in 1998, when a group of member states decided to accept the reality and to abandon the myth. The EB members shall not serve in their personal capacity, but act as representatives of the member states entitled to designate them. A change of the EB member status would have implied a constitutional change, because article 24 of the Constitution refers to them as 'persons' and not as 'delegates', as in the WHA case. The reforming group deemed too a complicate and long procedure to intervene on the constitutional text. For this reason, it found a discrepancy in the text of the English and French Constitution. The first one refers to EB members as 'persons', whereas the second one as 'délégués'. This ambiguity was enough to invoke article 75, which refers to questions or disputes concerning the interpretation or application of the Constitution. According to this article, the first step in order to settle the risen problem is to refer to the WHA. In 1998, the WHA was called to decide on this issue. The WHA, "noting the ambiguity which results from the difference in the authentic languages of the Constitution concerning the status in which persons serve as members of the Executive Board"[39], adopted a resolution which states that "member states entitled to designate a representative to the Executive Board should designate them as government representatives, technically qualified in the field of health"[40]. Consequently, the EB has become an independent intergovernmental organ. Since then, the EB members have been considered representatives of their countries, giving to the EB rather a political character than a technical one.

The problem of the EB members independence touches one of the most debated issues, not only inside the WHO, but also relatively to the system of the specialised agency of the UN system as a whole. The issue concerns the 'non-political' character of the specialised agencies and in particular the level to which health can be politicised, and whether WHO should be influenced by political forces or autonomously act[41]. The next part of this contribution will be referring to this debate[42].

2.2.3. Functions of the EB

Article 28 describes the Executive Board's functions through a list of nine paragraphs, from a) to i)[43]. Its main functions are to cooperate with the WHA in carrying out the work of the Organization, both through a preparatory and an executive function. On one side, it prepares the agenda of WHA meetings, it advises the WHA either on questions referred to it by that body, or on its own initiative, it submits to the WHA for consideration and approval a general programme of work covering a specific period, the financial report and the proposed budget; on the other side, it acts as the executive organ of the WHA, which means that it gives effect to the decisions and policies of the WHA and it performs any other functions entrusted to it by that body. The technical work is then carried out by the other organ of the WHO, the Secretariat, which is in charge of practically implement the policies adopted by the governing bodies. Therefore, WHA and EB work is strictly connected.

Besides the preparatory and executive roles, the EB can also have an autonomous initiative dealing with events requiring immediate action, as an epidemic or a calamity. In this situation, the EB can take, or can authorize the Director-General to take emergency measures within the functions and financial resources of the Organization[44].

2.2.4. Method of work: Rules of procedure of the EB

According to article 27, the Executive Board shall adopt its own rules of procedure[45]. The EB adopted its own Rules of procedure at its 17th session, and they have been amended many times in the past years[46]. They deal with several aspects, as membership, sessions, agenda, committees, conduct of business, voting, etc.

The Director-General has to send notices convening the EB six weeks before the beginning of the regular sessions. He also has to draw up the provisional agenda of the EB. It should include: all items the inclusion of which has been ordered by the WHA, by the EB at a previous session, or by the Director-General; any item proposed by a member state, by an associate member or by an EB member, by the United Nations, as well as by any specialised agency with which WHO has entered into effective relations.

In May, each year, the EB elects a Chairman and three Vice-Chairmen from among its members. The Chairman is not eligible until two years have elapsed since he ceased to hold office.

As the WHA, the EB may establish committees to study and report on any item on its agenda.

Two-thirds of the 32 members shall constitute a quorum. Each member of the EB shall have one vote. Furthermore, it is valid the principle "members present and voting", which means members casting a valid affirmative or negative vote. Members abstaining from voting shall be considered as not voting. The decisions of the EB are made by a majority of the members present and voting.

The official languages of the EB are Arabic, Chinese, English, French, Russian and Spanish. All resolutions, recommendations and other formal decisions of the EB shall be made available in the working languages.

2.3. Secretariat

The Secretariat is the third organ provided by the Constitution to carry out the work of the Organization. The Secretariat is the WHO staff as a whole, throughout the world.

The term 'Secretariat' as one that includes the whole staff, although allowed by tradition, is far from conveying the nature of the work of the technical staff of the WHO, and especially that one of the field staff, who often works in conditions of difficulty if not of hardship[47]. In fact, the origin of this organ has to be traced back to the Interim Commission. The Director-General was given by this Commission a personnel with various tasks according to its original different functions and activities. At least for the beginning, it was necessary to keep the services that the Commission previously established in order to put on epidemiological information, external and field activities, publications, etc[48].

Considering Chapter VII of WHO Constitution and the Staff Regulations, I will provide in this paragraph all the needed information concerning the main characteristics of the WHO staff, its main functions and method of work.

2.3.1. Main characteristics of the Secretariat

The Secretariat is composed of the Director-General, six Regional Directors, as well as appropriate technical and administrative staff[49], based in headquarters, Regional Offices and in specific countries. The next chapter will describe these figures and the three layers of work. In this part, I limit to highlight the main characteristics of WHO staff kind of work.

The main characteristic of the staff of the WHO is their status of international civil servants. The first international secretariats were created in the nineteenth century in relation to international conferences and institutions. The concept of an international civil service was based on two principles. On one side, the "allegiance owed by staff members exclusively to the international organization that employs them"[50]; on the other side, "the complementary duty of the member states to respect the exclusively international character and responsibilities of the staff"[51]. The meaning of this status is clearly described in a pamphlet from Mr A.T. Slater, the Director of the Division of Personnel in 1998[52], which states privileges and obligations of an international civil servant.

Concerning the privileges, they are: to be immune from prosecution under national laws to the extent that this is necessary to carry out his functions; to be able to cross national borders with relative ease and take up residence in countries where this would normally not be possible; to be exempt from national taxation; to have relatively good salaries and good conditions of work.

Moving to the obligations, the international civil servant must be characterised by integrity, international outlook, independence, impartiality and loyalty. Integrity for an international civil servant means to regulate his conduct with the interest of WHO in view only. He must subordinate his private interests and not place himself in a position where either his interests would conflict with those of the Organization or where he would personally profit through your action or inaction, or from the information he has gained. The best description we gained of this duty is the one Ms Yukiko Maruyama gave us in one of the interviews: "the Secretariat should act as servant to the member states. Civil servants should not work in terms of personal profit, but for the needs of the member states. It is a kind of volunteering. We do not work for ourselves, but for the member states. They need us, and we serve them"[53]. Nevertheless, an ongoing debate concerns the effective integrity of the staff of the WHO[54].

To continue with the Secretariat obligations, international outlook means to try to be as much as possible open to different points of view and approaches, without giving up with own personal or political views. Whatever personal views are, he can willingly conform to his international obligations and support the decisions of WHO.

Independence refers to the fact that the international civil servant, in the exercise of his functions, has to remain independent from any authority outside the Organization. If the EB member independence from governments can only be derived from an interpretation of the article 24 of the Constitution, on the contrary, the same principle is explicitly affirmed for the Secretariat by the Constitution. The independence and autonomy shall be respected by both the staff itself and the governments of the member states. According to article 37, "in the performance of their duties, the Director-General and the staff shall not seek or receive instructions from any government or from any authority external to the Organization. They shall refrain from any action which might reflect on their position as international officers". At the same time, from the other side, "each member of the Organization on its part undertakes to respect the exclusively international character of the Director-General and the staff and not to seek to influence them"[55].

After integrity, international outlook and independence, impartiality must be added. It means objectivity, lack of bias, tolerance and restraint when political, religious or other disputes or differences arise.

Last but not least, loyalty to the aims, principles and purposes of the Organization. It also means to respect the decisions taken by the governing bodies or by the Director-General and not seek support from governments or outside parties towards influencing or obtaining a change in those decisions and not to act or speak in a compromising way for the Organization.

After having traced the main general characteristics of a civil servant, a distinction can be made. Civil servants can be distinguished between persons who have a 'trust relationship' and those who have an 'employment relationship' with the Organization. The first ones seat at the higher level of the hierarchy of the Organization, and their positions are generally provided by the text of the Constitution. Their mandate is temporary and member states are normally involved in their election. The second ones can either occupy high positions or be in charge of a less responsible activity, as translation. Their activity is similar to that of a public administration servant[56].

Another characteristic of WHO staff is that it must be recruited with a view to making it not only efficient, but also internationally representative. The geographic distribution has to be considered as one of the criteria in the nomination of new personnel, taking into account the huge number of member states. The WHO Secretariat "should reflect the composition of its membership, a majority of which are developing countries", states the Assembly in a resolution adopted at the WHA in 2002[57]. It should also maintain a certain balance concerning the presence of women and men.

As far as it concerns the staff having an employment relationship with the Organization, the contracts can be fixed-term or temporary appointment. A fix-term appointment is a time-limited appointment for one year or more. A temporary appointment is an appointment for a period not exceeding 11 months. The number of the short-term contracts has recently increased.

As a last characteristic, the Secretariat is mainly composed of medical professionals. This has led David Pitt to describe it as a 'medical mafia'[58]. The last years have seen the number of other specialisations to rise within the WHO personnel. This change is originated by a transformation of the concept of health towards an holistic perspective. Health becomes of great interest not only for medical doctors, but also for economists, lawyers, sociologists and even political scientists.

Table 1: Data relative to the Secretariat (as of 31 December 2001)

2.3.2. Functions

The Secretariat is the permanent structure of the Organization. The World Health Assembly and the Executive Board meet respectively once and twice a year, and for such a short time that it is difficult for them to carry out the whole work of the Organization[59]. As a consequence, it becomes indispensable to have an organ which works constantly on the day-to-day issues of the Organization.

Even if the task of preparing the proposed budget, the financial report and the general programme of work belongs theoretically to the WHA, the staff of the WHO is practically in charge of that.

The Secretariat prepares an incredible amount of documents, as research pamphlets, resolution projects, decisions and recommendations for the WHA and the EB. To give an example, prior to the WHA meetings, it prepares and circulates position papers for comment by member states about important issues. This process is very useful because it helps reducing conflict during the week the WHA is held. During the meetings, the Secretariat is responsible for circulating documents, reports and resolutions of the WHA and its committees; it is also in charge of preparing records of their proceedings and translating all information into the working languages of the WHA. Once resolutions have been adopted, the Secretariat contributes in making them effective and it evaluates the results[60].

Concluding, the main functions of the Secretariat at a global level are: to provide support to the WHA, EB, Regional and Country Offices; to globally stimulate thought and action by generating, crystallising and promoting ideas; to collect, analyse, synthesise and disseminate valid information on health and related matters; to identify, generate and transfer appropriate technology; to support global advisory group; to deal with global planning, management monitoring and evaluation; to administer global and inter-regional programmes; to foster the international transfer of resources for health, to prepare programme budget proposals for submission to the EB and to the WHA, to cooperate with the UN system and selected NGOs[61].

2.3.3. Method of work: staff regulations

According to article 35, "the Director-General shall appoint the staff of the Secretariat in accordance with staff regulations established by the Health Assembly". The criteria to be followed for the nomination of the personnel are efficiency, integrity, internationally representative character and as wide geographical basis as possible[62]. Furthermore, art. 36 states that "the condition of service of the staff of the Organization shall conform as far as possible with those of other United Nations Organizations"[63]. The Staff Regulations and Rules cover different aspects of the WHO staff working condition, from their duties and privileges, to salary, recruitment and appointment. They also deal with social security issue and travel and transportation[64].

As it concerns the day-to-day work of the Secretariat, we had the opportunity to directly assist to the activity of the Traditional Medicine Team and of the Department of Noncommunicable Disease Prevention and Health Promotion.[65].

While everyone agrees on the data given above, concerning composition, functions and methods of work of WHA, EB and Secretariat, a debate arose relatively to the balance of power among them. Many authors are sceptical also relatively to the effectiveness of the WHA and EB few and short meetings.

With respect to the WHA, authors wonder "whether it is at all possible for 192 nations to agree on any substantial issue and conduct meaningful policy discussions at the same time as they are supposed to govern a huge and highly professional bureaucracy"[66].

As far as it concerns the EB, Beigbeder affirms that "la brève durée de ses réunions ne lui permet pas de procéder par lui-même aux études et aux rapports qui lui sont demandés"[67]. According to this author, the work, which the EB should be theoretically in charge of, is in practice carried out by the Secretariat[68]. The EB "n'a pas le moyens ni le temps nécessaires pour appliquer les décisions et directives de l'Assemblée. Cette fonction ne peut être mise en œuvre que par le secrétariat, le Conseil conservant une fonction générale de contrôle"[69]. According to the Swedish Foreign Ministry, the problems concerning the EB would be even wider: "the EB suffers from several weaknesses, such as vague and ineffective procedures, lacking analytical material to support decision-making, a high turnover of board members and a task that is much larger than many of the members have a reasonable chance to prepare themselves for"[70]. Some of these issues would originate from having too little time to be effectively in shape and in touch with the strategic challenges of the Organization.

At the same time, looking at the amount of work which the Secretariat is in charge of, one could think that the WHO is driven more by the Secretariat itself than by those organs who should be the most important in determining the policies of the Organization. In particular the Director-General would be the one in charge of directing the Organization towards the preferable way. This would, however, mean that changing of the WHO Director-General would lead to a total changing in the policy direction of the Organization. The very last part of this work will analyse the last Director-General election, and it will try to verify or falsify this hypothesis[71].

The debate leads to a legitimate question: who drives WHO? Is it the WHA? Is it the EB? Is it the Secretariat and mainly the Director-General? If such a debate rises, it is apparently not so obvious to consider the WHA as the most powerful organ. The WHO is an intergovernmental organisation and this implies that WHO is its member states, not 32 out of 192, not its Secretariat. To the question, who drives WHO, the answer should point at the organ which mostly represents the member states: the WHA. However, from conversations I had with members of the Secretariat, this deep true does not seem so evident. Different authors give different answers, and this could actually be the topic for another thesis. Many authors consider the Director-General's position as extremely influential, and think that s/he could easily overtake the real needs of member states to pursue her/his personal interests. A further theory is that the WHO is basically a donor driven Organization[72], because of the tremendous increase of the extrabudgetary fund. But we will have time to discuss this interesting issue in the next parts[73].

Print this page

Edited by Aldo Campana,