Godlee F
Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA 02215.
BMJ. 1994 Dec 17;309(6969):1636-9. doi: 10.1136/bmj.309.6969.1636.
The acid test of WHO's effect on the world's health is its impact at country level. Unless it has an impact there, all of its declarations, its debates at the World Health Assembly, its conferences, its pamphlets, its political manouvering in Geneva and the regions, all of these come to nothing. Working as it does through national governments, WHO insists that it has no role in directly managing or delivering health care. Judging WHO's impact in individual countries is therefore difficult--its approaches are largely indirect, and initiatives may take years to bear fruit. But from the meagre resources that WHO makes available at country level it is clear why its country operations are criticised as the weakest link in an already weak chain of influence from its headquarters in Geneva to the people in its member states. Poorly funded, undertrained, and with no clear strategy to follow, its staff at country level stand little chance of making an impact.
对世卫组织对全球健康影响的严峻考验在于其在国家层面的影响力。除非它在国家层面产生影响，否则其所有宣言、在世界卫生大会上的辩论、会议、宣传册以及在日内瓦和各区域的政治运作都将毫无意义。由于世卫组织通过各国政府开展工作，它坚称自己在直接管理或提供医疗保健方面没有作用。因此，评判世卫组织在各个国家的影响很困难——其方式大多是间接的，举措可能需要数年才能见效。但从世卫组织在国家层面所提供的微薄资源来看，就清楚为何其国家业务被批评为从日内瓦总部到成员国人民的本就薄弱的影响力链条中最薄弱的环节。资金不足、培训欠缺且没有明确的战略可依循，其在国家层面的工作人员几乎没有机会产生影响。
