The World Health Organization is not performing well enough across the board because it is over-extended and needs to trim the scope of its operations, WHO Director-General Margaret Chan said on Monday.

In a critical assessment of the United Nations body she has headed since 2006, Chan described wasteful overlap with other health financiers and said the WHO needed to concentrate on areas where it can make the most impact.

"We are not functioning at the level of top performance that is increasingly needed, and expected," she told the WHO's executive board, which is reviewing a proposed $4.54 billion program budget for 2010-2011.

"This Organization is over-extended. We are constantly asked to do more and more. This has a limit. We are there," Chan said, describing the range of WHO activities fighting contagious and non-communicable diseases, supporting vaccines, responding to disasters, improving primary health care and setting standards.

The Geneva-based body has also confronted the global tobacco industry and keeps watch on the health impacts of actions by leading food, alcohol and agri-business companies such as Nestle, Diageo and Cargill.


While it has been very effective in some areas, including the battle against tropical diseases, "this is not the case in all the areas covered by our last program of work," Chan said.

"WHO needs to change at the administrative, budgetary and programmatic levels. We do not need to change the Constitution, but we do need to undergo some far-reaching reforms," she said.

The U.N. agency's 2010-2011 budget was initially proposed at $5.84 billion but was reduced after the global financial crisis. Its program budget in 2008-2009 was $4.23 billion.

Chan told the executive board that the WHO as well as other international health financiers such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the vaccine body GAVI are facing "serious funding shortfalls."

"The financial crisis was a jolt," she said, describing the need for continual funds to replace insecticide-treated bednets, complete the drive to eradicate polio and guinea worm, and secure vaccines for every new generation of babies.

Chan said it was critical to avoid duplication with private-public partnerships as well as various charities, foundations and donor governments.

"The demands on WHO, and on countries, have been overwhelming," said Chan, noting that Vietnam hosted more than 400 donor missions to review health projects in 2009, and Rwanda has to report to various donors on 890 health indicators.

Chan, who fought SARS and bird flu as a former Hong Kong health director, and later led the charge against H1N1 pandemic flu in 2009, did not name areas to cut. But she suggested the WHO should invest less in areas where others are very active.

"The level of WHO engagement should not be governed by the size of a health problem. Instead, it should be governed by the extent to which WHO can have an impact on the problem. Others may be positioned to do a better job," she said.

"In some areas, our engagement should be that of a watchdog," she said, calling on the WHO's 193 member states to express their views about the shape of an overhaul. "I will not make decisions about changes at WHO on my own."