Peabody J W
General Internal Medicine Division, Veteran's Administration, West Los Angeles, CA, USA.
Soc Sci Med. 1995 Mar;40(6):731-42. doi: 10.1016/0277-9536(94)00300-i.
The World Health Organization's (WHO's) nearly half century amelioration of suffering stands as a singular achievement in international cooperation. But after 45 years, the Organization has grown into a complex bureaucracy with an outdated organizational structure. A multidisciplinary framework, which emphasizes organizational theory, yields some insights into these problems. Using this approach, this paper examines the structure, culture, mission, and rules of WHO, and adds a perspective, not otherwise found in the literature, to the growing debate on the future of the Organization. Previous studies of international organizations have explained their behavior as the consequence of the dominant external interests of powerful members. This perspective suggests that organizations like WHO have fewer options and less control of their policies and output. By contrast, there has been very little analysis explaining how international organizations function internally. This paper refutes an exclusively external perspective and shows that the internal organization is also important to understanding WHO. Several conclusions are drawn from this perspective. WHO's organizational myths, as a politically neutral technical agency staffed with uniquely qualified staff, need to be validated and enhanced to attract funding. A new organizational structure, based on an 'open systems' model, is proposed. This strategy would strengthen the WHO Representative Country Offices, redefine staff objectives, close the Regional Offices, and establish open, public elections of the Director General. Traditional WHO culture should only be used for health problems that are well matched to WHO's critical tasks. For more complex social and economic issues, newer, often non-medical, approaches are needed. The internal and external rules, which shape the incentives of WHO staff and leaders, need to be realigned to close the gap between WHO's myths and its day to day work. In the short run it is possible for WHO to do more with its limited budget if it changes its organizational structure; in the long run a reorganized WHO will be able to garner more funding and attract wider international participation.
世界卫生组织（WHO）近半个世纪来致力于减轻痛苦，这是国际合作中的一项非凡成就。但45年后，该组织已发展成为一个结构过时的复杂官僚机构。一个强调组织理论的多学科框架为理解这些问题提供了一些见解。运用这种方法，本文审视了WHO的结构、文化、使命和规则，并为关于该组织未来的日益激烈的辩论增添了一个文献中未有的视角。以往对国际组织的研究将其行为解释为强国主导的外部利益的结果。这种观点表明，像WHO这样的组织选择更少，对其政策和产出的控制也更少。相比之下，很少有分析解释国际组织在内部是如何运作的。本文驳斥了仅从外部视角的观点，并表明内部组织对于理解WHO也很重要。从这个视角得出了几个结论。WHO作为一个由资质独特的工作人员组成的政治中立技术机构的组织神话，需要得到验证和强化以吸引资金。基于“开放系统”模型提出了一种新的组织结构。这一策略将加强WHO国家代表处，重新定义工作人员目标，关闭区域办事处，并建立总干事的公开选举。传统的WHO文化只应用于与WHO关键任务高度匹配的健康问题。对于更复杂的社会和经济问题，需要更新的、通常是非医学的方法。塑造WHO工作人员和领导人激励机制的内部和外部规则需要重新调整，以弥合WHO的神话与其日常工作之间的差距。从短期来看，如果WHO改变其组织结构，它有可能用有限的预算做更多的事情；从长远来看，一个重组后的WHO将能够获得更多资金并吸引更广泛的国际参与。
