How WHO went from health to sickness

The vast, multi-headed organisation known as the United Nations is pushing 50 and many of its agencies are bogged down by a multinational bureaucracy seemingly impervious to reform and riddled with practices that threaten the very future of the world body.

The World Health Organisation is a study in how corruption and sleaze can eat the heart out of an international organisation. It was once known for scientific excellence and for stamping out killer diseases such as smallpox. Today it is caught in the worst financial and political crisis of its 47-year history. Millions of pounds are unaccounted for in a main regional office and there is a breakdown of communication between the organisation's deeply unpopular director general, Dr Hiroshi Nakajima, and donors.

Meanwhile, as diplomats and doctors squabble over the organisation's future leadership, in the US Congress, where the right-wing majority now holds sway and is on the lookout for excuses to hack the UN down to size, the knives are out for the WHO and other UN bodies.

The rot at the heart of large international organisations is not petty thieving or large rackets aimed at skimming UN aid. The overriding problem is that most of the organisations have ossified and are virtually incapable of reform from within. So many of the UN's 17 agencies are stuffed with mediocre staff (appointed through political patronage rather than on merit) that even those with good leaders are in trouble.

Ironically, the WHO has always been a relatively low spending but effective organisation with a budget of a mere $1.8bn a year compared with the NHS's $60bn. For most of its life it has provided the leadership needed to tackle infectious diseases, drug misuse and the health consequences of wars and natural disasters, none of which respect national boundaries.

All that changed, however, under the leadership of the controversial Mr Nakajima, who became director general in 1988, amid allegations of bribery and vote-rigging by his sponsor, Japan. But Mr Nakajima did not cause the WHO's problems. He is the product of a system that rewards patronage and provides little room for accountability.After his election an audit carried out by Britain's auditor general, Sir John Bourn, found that the executive board of WHO, which nominated Dr Nakajima for the job, was riddled with potential conflicts of interest. Many members had benefited from a bonanza of personal contracts funded by the Japanese government.

Under Mr Nakajima's weak leadership, the WHO has fallen into a policy vacuum and lost the initiative on major health issues. It is almost silent in the debate on population control and its alcohol and tobacco campaigns have been condemned as insipid and ineffective. Unchallenged, the drinks and tobacco industries are busy targeting new markets in Eastern Europe and the developing world. From being one of the UN family stars, the WHO has lost all momentum.

Last week Sir John resigned as external auditor after Mr Nakajima's office refused to co-operate following a new report alleging fraud, mismanagement and a shocking lack of controls at the organisation's Congo regional headquarters. There followed a slanging match at the World Health Assembly, the annual meeting of 190 member states. Things unravelled rapidly for Mr Nakajima when several African nations accused him of uttering racist slurs against African staff and demanded his resignation.

Regional organisations such as the EU have started to take over some of WHO functions, speeding up the process of decline. All UN organisations face the same quandary - change quickly or die slowly.

Leonard Doyle