The World Health OrganisationChange in an International Organisation

KAAN AYDIN ATAOGLU S14123053 SWATI GHOSH S14143635SHREYANS JAIN S14137993SHAHISTA KARIM S14140896CYNTHIA SHONTAN S14137935 CHOOTHAM THAMMPALO S14135090

DEVELOPING HUMAN CAPABILITIES

TABLE OF CONTENTS

1. Introduction: Current organisation structure and external challenges

2. Challenges faced by WHO

3. The change path required at WHO

4. The progression of changes implemented by Dr. LEE

5. Dr. BRUNDTLAND’s strategy

6. Future Challenges faced and alternative ideas

7. References

Current organisational structure of WHO

Director General

Headquarter

Assistant Director General

(9)Representative

s (3)

Regional offices (6)

Country offices (5000-5500 employees

across 150 offices)

According to Barbara W. Keats and Michael A. Hitt (1998), the structure, the performance and the strategy of an organisation relies heavily on the external environment .

7 key functionsResearchAdvocacy & Commu-nicationImplementationPolicy developmentTechnical assistanceMonitoring & EvaluationCoordination & Part-nership

Figure 1: Present Organisation structure of WHO

• Increase of new disease and Spreading of other diseases

HIV/AIDS Eating habits (obesity, underweight) 1billionHeart attack, cancer and malnutrition 30 million

• Government’s funding scheme

• Non state actors presence

External challenges

SWOT Analysis

Strength Weakness• Government stake-holding• Global authoritative body of health care• Global presence• Higher recognition due to the background (Dr.

Brundtland)• Increase in allocation of funds

• Good leadership (Dr. Lee)• Motivation • Decentralised structure• Proper use of the allocated funds• Special programs to aid the operation

• Bureaucratic organisational structure• Authoritative leadership • Lack of motivation, trust

Opportunity Threat• Affordable healthcare solutions achievable if effective

policies are implemented by Government and private sectors

• Effective managerial accountability in achieving WHO’s mandate

• More NGOs, IOs and private sectors in same segment• Vulnerable political, economic and social condition• Rapid increase of incurable and dissemination

diseases worldwide

BEFORE

AFTER

Change path required at WHO Centralised organisation

Centralised organisation is when the decisions are taken only a the top level of the organisation and this decision is applicable for the organisation as whole. (Siggelkow & Levinthal 2003)

Disadvantages according to Chand (n.d)

Delay in work : centralisation impacts the performance because the transmission of the information from the bottom to the head office is long

Lack of supervision : as the decision are made from the top, employees are under pressure and are not supervised properly

No subordinate's initiative: they are required to do such works which they were asked for. Workers work like machine which results in no involvement in work and no motivation

Figure 2: Centralised Organisation structureSource: www.learnmanagement2.com

Change path required at WHO New organisation structure : Decentralised

organisation Decentralised organisation is when decision making has been separated into a number of subunits, or divisions, each making its own decisions.(Siggelkow & Levinthal 2003) Advantages of Decentralisation

Flexibility: Each departement has its own task and are ready to face any changes as they have the required skill for the work

Better control and supervision : workers are supervised and followed step by step. The subordinates at the lowest levels will have the authority to make independent decisions. As they are in a position to make amendments and take corrective action.

Quick decision making: the decision are taken at the closer level of the area therefore initiatives are quicker since they do not come from the top of the hierarchy.

Executive development and Motivation : employees get the opportunity to improve themselves as they are able to take initiatives. The result is also that it will enhance the motivation within the organisation

Figure 3: Decentralised Organisation structureSource: en.wikipedia.org

Progression of change process implemented by Dr. LEE

Change Plan

• Dr Lee and his transition team involved an external consultant McKinsey to create new ideas on strategic plan.

• Launched a phase “Listening and Learning”

• Adaptation required and how to implement them was developed for W.H.O

• Reorganized the DG’s office, introduced a new leadership team to carry out the tasks

Launched “Roll-out Phase I” integrating 5 Core Priorities in changing the WHO which are:

▫Decentralization▫Human resource reforms▫IT investment▫Administrative efficiency▫Accountability

Progression of change process implemented by Dr. LEE

Transition process

Progression of change process implemented by Dr. LEE

Managed change process

Decentralization

Human Resource Reforms

IT Investment

Administrative Ef-ficiency

Accountability

Budget were decreasedResources 19%

Assistant DGSeveral Programs

Performance auditing

Motivated effect

Staff trainingImproved IT

infrastructureSHOC

Mobility program

Figure 4: Initiation of Change path

Dr. Bruntdland’s Strategies

•Team of external experts to emphasize the issue of health system performance and mental health

•Initiation of framework convention of tobacco control

•Launched the commission on macroeconomics and health

•Built a strong base of technical experts

•Introduced focus programs for specific countries Figure 5: Top Down Approach Source: Disabled Village Children (2015)

Factors affected Dr. Bruntdland’s Strategies

•Leadership role for an outsider of W.H.O fraternity

•Passive support from endangered employees

•Faced antagonised powerful groups

•Questioning towards normal work pattern

•Unacceptable organisational reform model by existing employees

Figure 6: Actual plan vs Real time scenarioSource: Richard (2015)

Issues faced by BRUNDTLAND during her tenure• Bureaucratic, top-down and compartmentalized organization

• Poorly synchronized, unhealthy relation between HQ and the country offices

• Cluster organization - the principal work units are permanent and temporary teams of individuals with complementary skills(britannica.com)

• Majority of staff were temporary, short term. Only 36% of long term employees

• Lack of motivational factors, insufficient training and need of morale issues (Schaefer, 2012 )

• No performance measurement metrics

Figure 6: Bureaucratic organisationSource:

IssuesIssues Description

Poor availability of skilled personnel In certain countries, HR would be unable to employ competent personnel, since lack of locally available people

Poor management in certain countries/regions Due to lack of skilled personnel and poor infrastructure, the management would be inefficient in under developed countries

Loss of global vision Countries with independent operations would work in ideas of its own, will have agendas of its own, will work on local health concerns. This will loss of its global mandate.

Lesser funds for R&D Due to maximum distribution of funds to countries, R&D would greatly be affected. Local R&D would be carried by the countries, not global

Disparity Due to above points, there’ll be disparity amongst countries. As certain countries with better infrastructure and availability of skilled personnel would be able to farewell. whereas, poorer countries would still face the old issues.

Issues grouped

Issues Description Academic

Inequitable distribution of resources and inefficient human resource capacity

There are controversies when decentralisation is planned, in terms of distribution of Authority, Responsibility, and Resources

• Costa-Font, 2012• Kolehmainen-Aitken,1999

Loss of Global Mandate The countries with independent operations would have it’s local political influence. This will lead to loss of WHO’s global mandate.

• C Darras, 1997• Mosca, 2006

Alternatives

• Staffing matched to the needs at all levels of the Organization: WHO must attract, retain and develop talent at all levels of the Organization

• Independent R&D body: Creating an independent R&D body with its own budget and staffed by skilled personnel from throughout the world, with mandate of R&D on global issues

• Effective managerial accountability, transparency and risk management: WHO needs to strengthen accountability through integrated and effective risk management

• Special funds for poorer countries and regions: Adequate funds from the budget should be alloted to develop the skill and infrastructure in poorer countries and regions Bossert et al. 2003

Figure 6: Equality in decision-makingSource: Graupp, p., Jakobsen, g. And vellema, j. (2014)

“Increasing the Equity and Accessibility of Health Services (IEAHS)” (Krishna Regmi, 2014) Synchronising the Health services of local, national and

international government Equitable resources based on the needs

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University.• Acharya, A., What are the advantages and disadvantages of centralization of authority ? Available at:

http://www.preservearticles.com/201101143291/advantages-and-disadvantages-of-centralisation-of-authority.html [Accessed March 17, 2015].

• Barbara W. Keats and Michael A. Hitt(Sep., 1988), The Academy of Management Journal, Vol. 31, No. 3 pp. 570-598• Chand, S., Decentralisation: Meaning, Advantages and Disadvantages of Decentralisation. Available at:

http://www.yourarticlelibrary.com/organization/decentralisation-meaning-advantages-and-disadvantages-of-decentralisation/25703/ [Accessed March 16, 2015].

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http://www.businessknowhow.com/manage/hire-temp.htm [Accessed 15 Mar. 2015].• Mosca, I., 2006. Is decentralisation the real solution? A three country study. Health policy (Amsterdam, Netherlands), 77(1), pp.113–20.

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Myths and Realities about the Decentralization of Health Systems. Boston:Management Sciences for Health. Pp. 39–64• Joan Costa-i-Font, 2012. "Fiscal Federalism and European Health System Decentralization: A Perspective," Europe in Question Discussion

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