WORLD HEALTH 

ORGANIZATION

Reform Agenda 

Developed, but U.S. 

Actions to Monitor 

Progress Could be 

Enhanced

Report to the Subcommittee on Oversight 

of Government Management, the Federal 

Workforce, and the District of Columbia, 

Committee on Homeland Security and 

Governmental Affairs, U.S. Senate

July 2012

GAO-12-722

United States Government Accountability Office

GAO
United States Government Accountability Office

Highlights of GAO-12-722, a report to the 

Subcommittee on Oversight of Government 

Management, the Federal Workforce, and the 

District of Columbia, Committee on Homeland 

Security and Governmental Affairs, U.S.

Senate

July 2012

WORLD HEALTH ORGANIZATION 

Reform Agenda Developed, but U.S. Actions to 

Monitor Progress Could Be Enhanced

Why GAO Did This Study

WHO is the directing and coordinating 

authority for global health within the 

United Nations (UN) system. In 2012, 

member states approved a reform 

agenda addressing three areas: (1) 

priority-setting, to refocus its efforts 

and establish a process to determine 

priorities; (2) governance, to improve 

the effectiveness of its governing 

bodies and strengthen engagement 

with other stakeholders; and (3) 

management, including human 

resources, results-based planning, and 

accountability. The United States is a 

key participant in WHO’s governing 

bodies and the largest donor, 

contributing about $219 million, or 22 

percent, to WHO’s assessed budget 

for 2010 and 2011, and more than 

$475 million, or about 16 percent, to 

WHO’s voluntary budget. As the 

largest financial contributor to the UN, 

the United States has advocated for 

comprehensive management reform 

throughout the UN system, including 

WHO. This report examines (1) the 

steps WHO has taken to develop and 

implement a reform agenda that aligns 

with the challenges identified by 

stakeholders and (2) the input the 

United States has provided to WHO 

reforms. GAO analyzed WHO and U.S. 

government documents and 

interviewed officials and stakeholders 

in Washington, D.C., and Geneva, 

Switzerland.

What GAO Recommends

GAO recommends that the Secretary 

of State enhance State’s guidance on 

completing its assessment tool for 

monitoring WHO’s progress in 

implementing transparency and 

accountability reforms. State generally 

concurred with GAO’s 

recommendation. 

What GAO Found 

In May 2012, 194 member states approved components of the World Health 

Organization’s (WHO) reform agenda, encompassing three broad areas—

priority-setting, governance, and management reforms—that generally address 

the challenges identified by stakeholders. According to WHO officials, member 

state representatives, and other stakeholders, some of the challenges facing 

WHO include its (1) lack of clear organizational priorities; (2) lack of predictable 

and flexible financing; and (3) highly decentralized organizational structure. In 

developing its reform agenda, WHO consulted with member states, employees, 

and other parties to gather their views and feedback. In addition, WHO has 

commissioned three ongoing evaluations to provide input into the reform 

process. The first stage of one of the planned evaluations was conducted by 

WHO’s External Auditor, which concluded in March 2012 that WHO’s reform 

proposals are comprehensive in addressing challenges faced by the 

organization. WHO continues to consult with member states on priority-setting 

and governance proposals, which generally require extensive deliberation and 

consensus from member states. In November 2011, the WHO Executive Board 

approved WHO’s management reform proposals in several areas, and requested 

further development of proposals in other areas. In May 2012, WHO developed a 

high-level implementation and monitoring framework that includes reform 

objectives, selected activities, 1-year and 3-year milestones, and intended 

impacts. Certain factors could impede WHO’s ability to successfully implement its 

reform proposals, including the availability of sufficient financial and technical 

resources and the level of sustained support from internal and external 

stakeholders. 

The United States has provided input into WHO’s reform agenda, particularly in 

the areas of transparency and accountability, but the Department of State’s 

(State) tool for assessing progress in the area of management reform could be 

enhanced. On priority-setting, the United States has advocated for WHO to 

maintain its focus on certain functions such as setting regulations and standards 

for international health. In consultations on governance, the U.S. delegation to 

WHO has commented on a range of proposals WHO has put forth, including 

those on engagement with other global health stakeholders. On management 

reforms, the United States has supported an agenda for greater transparency 

and accountability. The U.S. delegation has advocated for a number of reforms 

to improve WHO’s internal and external oversight mechanisms and supported 

reforms in budgeting, planning, and human resources. Additionally, State has 

established an assessment tool to measure progress on transparency and 

accountability mechanisms, which is a useful tool for guiding U.S. priorities and 

engagement with WHO, and could be helpful for monitoring WHO’s progress in 

implementing certain management reforms. However, we found weaknesses in 

State’s assessment tool, including an unclear basis for State’s determinations on 

certain elements in its assessment of WHO, as well as a lack of clarity in the 

definitions used in the assessment. According to State officials, State provides 

guidance to officials completing these assessments but acknowledged that the 

process does not fully mitigate risks to data reliability.

View GAO-12-722. For more information, 

contact Thomas Melito at (202) 512-9601 or 

melitot@gao.gov.
Page i GAO-12-722 World Health Organization

Letter 1 

Background 3

WHO Developed a Reform Agenda that Generally Aligns with the 

Challenges Identified by Stakeholders 11

The United States Has Provided Input into WHO’s Reform Agenda, 

Particularly in Transparency and Accountability Proposals, but 

State’s Tool for Monitoring Progress Could be Enhanced 23

Conclusions 29

Recommendation for Executive Action 29

Agency Comments and Our Evaluation 30

Appendix I Scope and Methodology 32

Appendix II GAO Assessment of State’s UNTAI Assessment Tool 34

Appendix III Comments from the Department of State 36

Appendix IV Comments from the World Health Organization 41

Appendix V GAO Contact and Staff Acknowledgments 43

Related GAO Products 44

Tables

Table 1: WHO Voluntary Contributions Received from Top 10 

Donors, 2010-2011 Biennium 7

Table 2: WHO Funding by Strategic Objective, 2010 to 2011 8

Table 3: WHO’s Areas of Reform and Rationale for Reform 12

Contents
Page ii GAO-12-722 World Health Organization

Figures

Figure 1: WHO Regions, Budgets, and Staffing Levels 5

Figure 2: WHO Biennial Program Budgets, from 2004 through 2011, 

by Funding Type 6

Figure 3: Timeline of WHO Consultations with Internal and 

External Stakeholders, 2011-2012 15

Abbreviations

CDC Centers for Disease Control and Prevention 

HHS Department of Health and Human Services 

JIU United Nations Joint Inspection Unit 

NIH National Institutes of Health 

PAHO Pan American Health Organization 

State Department of State 

UN United Nations 

UNTAI United Nations Transparency and Accountability 

 Initiative 

USAID U.S. Agency for International Development 

USUN-Geneva U.S. Mission to the United Nations in Geneva 

WHO World Health Organization 

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

copyrighted images or other material, permission from the copyright holder may be 

necessary if you wish to reproduce this material separately.
Page 1 GAO-12-722 World Health Organization

United States Government Accountability Office

Washington, DC 20548

July 23, 2012

The Honorable Daniel K. Akaka

Chairman

The Honorable Ron Johnson

Ranking Member

Subcommittee on Oversight of Government Management,

 the Federal Workforce, and the District of Columbia

Committee on Homeland Security and Governmental Affairs

United States Senate

The World Health Organization (WHO) is the directing and coordinating 

authority for global health within the United Nations (UN) system. In this 

capacity, WHO is responsible for providing leadership on important global 

health matters such as setting standards and guidelines for international 

health, providing technical support on public health to countries, and 

monitoring and assessing global health trends. The United States is a key 

participant in WHO’s governing bodies and the largest donor to WHO, 

contributing about $219 million, or 22 percent, to WHO’s regular, 

assessed budget for 2010 and 2011,1 as well as more than $475 million, 

or about 16 percent, to WHO’s voluntary budget.2

In January 2010, WHO’s Director-General initiated discussions with 

member states on the predictability and flexibility of WHO’s financing and 

how its funding could be better aligned with its priorities. Through a series 

of continued consultations and deliberations, member states and other 

stakeholders raised a wide range of other concerns, including questions 

about WHO’s core business in an increasingly complex and changing 

global health environment, its role in global health governance, and its 

organizational effectiveness and efficiency. Accordingly, WHO developed 

an agenda that expanded beyond financing concerns to address three 

broad areas of reform: (1) priority-setting, to refocus its efforts on what it 

can do best and establish a process to determine its priorities; (2) 

 

1

WHO’s biennial budget is based on a 2-year budget period.

2

WHO’s budget is comprised of assessed contributions from member states, which are 

based on the assessed dues for each country, as well as voluntary contributions provided 

by member states and other entities on a voluntary basis. Voluntary contributions are 

often specified for certain issues such as particular diseases. 

 
 

Page 2 GAO-12-722 World Health Organization

governance, to improve the effectiveness of its governing bodies and 

strengthen its engagement with other global health stakeholders, 

including nongovernmental organizations and private industry; and (3) 

management, to address issues such as human resources, results-based 

planning, and accountability. Implementation of WHO’s reform agenda 

remains in the early stages.

As the largest financial contributor to the UN, the United States holds a 

strong interest in the progress of UN reform initiatives and has advocated 

for comprehensive management reform at UN agencies, including WHO. 

Accordingly, the U.S. Department of State (State) developed the United 

Nations Transparency and Accountability Initiative (UNTAI), to promote 

greater efficiency, effectiveness, transparency, and accountability among 

UN agencies, including WHO. As part of this initiative, State developed an 

assessment tool that it uses to conduct annual assessments to measure 

UN agency performance and progress in eight goals related to 

transparency and accountability. Additionally, the U.S. Department of 

Health and Human Services (HHS) is responsible for coordinating U.S. 

government input into the policies and decisions of health-related 

international organizations, including WHO.

As part of our continuing work on UN management reform,3

To address these objectives, we reviewed relevant WHO documents and 

U.S. government data and documents including position papers, talking 

points, and speeches, and met with officials from State and HHS, 

including the Centers for Disease Control and Prevention (CDC), and the 

U.S. Agency for International Development (USAID). We also assessed 

the UNTAI assessment tool, which State uses to measure the 

performance and progress of UN agencies, including WHO, on 

transparency and accountability. In Washington, D.C., and during 

fieldwork in Geneva, Switzerland, in December 2011, we interviewed 

WHO officials and officials at the U.S. Mission to the UN in Geneva 

(USUN-Geneva), as well as representatives from 15 other member state 

this report 

examines (1) the steps WHO has taken to develop and implement a 

reform agenda that aligns with the challenges identified by the 

organization, its member states, and other stakeholders; and (2) the input 

the United States has provided to WHO reforms.

 

3

See Related GAO Products at the end of this report. 
 

Page 3 GAO-12-722 World Health Organization

missions, and a range of other global health stakeholders. In addition, we 

held telephone or in-person meetings with officials from each of the six 

WHO regional offices as well as five country offices. We conducted this 

performance audit from August 2011 to July 2012 in accordance with 

generally accepted government auditing standards. Those standards 

require that we plan and perform the audit to obtain sufficient, appropriate 

evidence to provide a reasonable basis for our findings and conclusions 

based on our audit objectives. We believe the evidence obtained provides 

a reasonable basis for our findings and conclusions based on our audit 

objectives. (see app. I for further details on our objectives, scope, and 

methodology).

To improve U.S. assessment of WHO reform, we are recommending that 

the Secretary of State enhance its guidance on completing State’s 

assessment tool for monitoring WHO’s progress in implementing 

transparency and accountability reforms. We requested comments on a 

draft of this report from the Departments of State and HHS, USAID, and 

WHO. State and WHO provided written comments that are reprinted in 

appendixes III and IV of this report. State generally endorsed the main 

findings and conclusions of our report. State agreed that its process for 

conducting its assessment for monitoring progress in implementing 

transparency and accountability reforms could be strengthened and 

accepted GAO’s recommendation to revise its guidance for completing 

these assessments. State also offered some clarifications and additional 

context regarding its assessments. WHO also concurred with the main 

conclusions of our report and noted that the conclusions broadly 

converge with those of the evaluation conducted by WHO’s External 

Auditor. In addition, State, HHS, USAID, and WHO provided technical 

comments that we incorporated into this report, as appropriate.

WHO was established in 1948 as the directing and coordinating authority 

on global health within the UN system. WHO’s stated mission is the 

attainment by all peoples of the highest possible level of health. WHO 

experts produce health guidelines and standards and assist countries in 

addressing public health issues. WHO membership is comprised of 194 

countries and associate members that meet every year at the World 

Background 

WHO Structure and 

Governance
 

Page 4 GAO-12-722 World Health Organization

Health Assembly, WHO’s supreme governing body, to set policy and 

approve the budget.4 The work of the World Health Assembly is 

supported by an Executive Board that meets at least twice a year and is 

composed of 34 members who are technically qualified in the field of 

health and who hold 3-year terms. The main functions of the Executive 

Board are to carry out the decisions and policies of the World Health 

Assembly, provide advice, and facilitate its work. WHO is headed by the 

Director-General, who is appointed by the World Health Assembly every 5 

years.5 WHO is staffed by approximately 8,000 health and other experts 

and support staff, working at WHO headquarters in Geneva, Switzerland; 

six regional offices;6

 

4

“Associate members” refers to territories that are not responsible for the conduct of their 

international relations that may be admitted to WHO upon application made on their behalf 

by the member or other authority responsible for their international relations. 

and 147 country offices. Each WHO region has a 

regional committee comprised of representatives from the region’s 

member states, which formulates policies and programs and supervises 

the work of the regional offices. The regional committees also provide 

input into global policy and program development through regional 

consultations. WHO country offices support host countries in policy 

making, capacity building, and knowledge management, among other 

things, in the public health sector. Figure 1 shows the WHO regions, their 

program budgets for 2010 through 2011, and staffing levels.

5

The current Director-General was appointed by the World Health Assembly in November 

2006, and appointed for a second term at the 65th World Health Assembly in May 2012. 

Her current term runs through June 2017.

6

WHO regional offices are located in Brazzaville, Congo (African region); Cairo, Egypt 

(Eastern Mediterranean region); Copenhagen, Denmark (European region); Manila, 

Philippines (Western Pacific region); New Delhi, India (South-East Asian region); and 

Washington, D.C. (region of the Americas). The Pan American Health Organization 

(PAHO), the specialized health agency of the Inter-American System, also serves as the 

WHO regional office for the Americas as part of the UN system. 
 

Page 5 GAO-12-722 World Health Organization 

Figure 1: WHO Regions, Budgets, and Staffing Levels 

Notes: The Pan American Health Organization (PAHO), which serves as the WHO regional office for 

the Americas, receives funding directly from WHO, in addition to collecting its own assessed and 

voluntary contributions as a function of its separate role as a public international health organization 
 

Page 6 GAO-12-722 World Health Organization

for the Americas. The budget and staffing figures above indicate the portion of the WHO budget and 

staff allocated to PAHO. However, PAHO’s budget also includes funds collected directly from 

member states in the Americas.

Staffing data are as of December 31, 2011, and do not include 329 staff who work on WHO special 

programs and collaborative arrangements.

WHO’s total program budget for the 2010-2011 biennium was about $4.5 

billion, with staff costs of more than 50 percent of its budget. For the 

2010-2011 program budget, the portion of assessed contributions was 

about 21 percent of the total (approximately $900 million), while voluntary 

contributions accounted for about 79 percent of the total (approximately 

$3.6 billion). Voluntary contributions have increased from about 69 

percent in 2004 to 2005 to 79 percent in 2010 to 2011 (see fig. 2).

Figure 2: WHO Biennial Program Budgets, from 2004 through 2011, by Funding 

Type 

WHO Budget
 

Page 7 GAO-12-722 World Health Organization

During the 2010-2011 biennium, the largest annual assessed 

contributions from member states came from the United States 

($219 million), Japan ($135 million), Germany ($77 million), United 

Kingdom ($62 million), and France ($59 million).7

Table 1: WHO Voluntary Contributions Received from Top 10 Donors, 2010-2011 

Biennium 

While member states 

are the only entities that provide assessed contributions to WHO’s 

program budget, voluntary contributions come from a diverse group of 

more than 400 entities, including member states, foundations, 

nongovernmental organizations, UN agencies, and private sector 

companies. During the 2010-2011 biennium, the United States was the 

largest donor of voluntary contributions to the WHO, followed closely by 

the Bill and Melinda Gates Foundation. During this time period, the top 10 

donors to the WHO provided over two-thirds of its total voluntary 

contributions (see table 1).

U.S. dollars in millions

Donor

Voluntary 

contributions

Percentage of 

total 

Cumulative 

percentage

United Statesa $475 15.5 15.5

Bill & Melinda Gates Foundation 467 15.2 30.7

United Kingdom 307 10.0 40.7

Canada 181 5.9 46.5

Rotary International 117 3.8 50.3

Norway 116 3.8 54.1

United Nations Development 

Program 

110 3.6 57.7

The GAVI Allianceb 99 3.2 60.9

European Commission 97 3.1 64.1

Australia 96 3.1 67.2

Other 1,007 32.8 100.0

Total WHO voluntary contributions $3,069 100 100

Source: WHO data.

Notes: Funding data represent actual donor contributions to the WHO.

 

7

Figures are rounded. 
 

Page 8 GAO-12-722 World Health Organization

a

U.S. voluntary contributions are primarily provided by USAID and CDC. According to USAID and 

CDC officials, for 2010 through 2011, USAID provided about $268 million in voluntary contributions 

and CDC provided approximately $158 million. In addition, the United States provides additional 

voluntary funding to WHO through other offices, including State’s Bureaus of Population, Refugees, 

and Migration, and International Security and Nonproliferation; the National Institutes of Health; and 

the Food and Drug Administration.

b

The GAVI Alliance was formerly known as the Global Alliance for Vaccines and Immunization. The 

GAVI Alliance is a public-private partnership focused on saving children’s lives and protecting 

people’s health by increasing access to immunization in poor countries.

According to WHO officials, most of WHO’s voluntary contributions 

budget is designated by donors for specific diseases and projects. WHO’s 

financial reporting identifies 13 areas, known as strategic objectives, 

among which its funding is distributed (see table 2). WHO’s program 

budget for 2010 through 2011 was about $4.5 billion. More than half of 

that amount was allocated for communicable diseases, HIV/AIDS, 

tuberculosis, and malaria, and WHO’s enabling and support functions.

Table 2: WHO Funding by Strategic Objective, 2010 to 2011 

U.S. dollars in millions

Strategic objective

Program

budget

Percentage of 

program 

budget

Communicable diseases $1,268 28

HIV/AIDS, tuberculosis, and malaria 634 14

Enabling and support functions 524 12

Health systems and services 474 10

Emergencies and disasters 364 8 

Child, adolescent, maternal, sexual and 

reproductive health, and healthy aging

333 7 

WHO leadership, governance, and partnerships 223 5 

Risk factors for health 162 4 

Chronic noncommunicable conditions 146 3 

Nutrition, food safety, and food security 120 3 

Medical products and technologies 115 3 

Healthier environment 114 3 

Social and economic determinants of health 63 1 

Total $4,540 100

Source: WHO data.

Note: Totals may not add due to rounding.
 

Page 9 GAO-12-722 World Health Organization

In January 2010, the WHO Director-General convened representatives of 

member states for a high-level consultation on the predictability and 

flexibility of WHO’s financing, and other global health challenges such as 

WHO’s changing role in the international health arena and WHO 

priorities. While discussions to reform WHO initially began with a focus on 

its lack of predictable and flexible financing and the need for better 

alignment between its objectives and resources, WHO’s reform efforts 

have evolved to address more fundamental questions about its priorities, 

internal governance, role and engagement with other actors in the global 

health arena, and the managerial reforms needed to make the 

organization more effective and accountable. In 2010, WHO became 

concerned with its financial position, particularly due to increased costs 

resulting, in part, from a decline in the value of the U.S. dollar. In 

response, the organization implemented several cost-saving measures, 

such as reducing travel and publications costs.8 WHO’s financial 

concerns at the time and the results of two external evaluations of the 

organization served as additional rationales for WHO to undertake a 

broad management reform agenda.9 In May 2011, the World Health 

Assembly passed a resolution endorsing WHO’s overall direction of 

reform.

The United States is a major participant in WHO’s governing bodies, with 

HHS, State, USAID, and CDC playing key roles in participating in and 

representing U.S. interests in WHO. The Secretary of HHS leads the U.S. 

delegation to the World Health Assembly, and the Director of HHS’s 

Office of Global Affairs serves as the U.S. Representative to the WHO 

Executive Board.

10

 

8

Due to financial concerns, WHO conducted a staffing review in 2011 that resulted in the 

abolishment of 200 positions based in Geneva. During this period, 43 positions were 

created in WHO’s administrative and information technology center in Kuala Lumpur, 

Malaysia, to accommodate functions previously performed in Geneva. WHO expects 

these decisions to result in long-term cost savings. 

HHS is responsible for coordinating U.S. government 

input into the policies and decisions of health-related international 

organizations, including WHO. Programmatically, HHS collaborates 

9

Multilateral Organization Performance Assessment Network, Common Approach: World 

Health Organization, 2010, January 2011: and the United Kingdom Department for 

International Development, Multilateral Aid Review, March 2011. 

10Member states are elected to serve 3-year terms on the Executive Board; the United 

States is currently serving a 3-year term that runs from 2010 through 2013.

Origins of WHO Reform

U.S. Participation in WHO
 

Page 10 GAO-12-722 World Health Organization

closely with WHO through its agencies and offices, including CDC and 

the National Institutes of Health (NIH). HHS’s efforts in conjunction with 

WHO occur in areas such as HIV/AIDS, tuberculosis, mental health, 

malaria, and polio eradication. HHS also participates in the governing 

bodies of certain regional offices, including the regional offices for the 

Americas and the Western Pacific.

HHS works closely with State’s Bureau of International Organization 

Affairs, which has responsibility for issues related to budgets, audits, 

human resources, and financial management. Preparation for the 

governing body meetings, such as the World Health Assembly, is a 

process that includes coordination among HHS, State, USAID and other 

stakeholders throughout the year in the development of U.S. policy 

positions and programmatic strategies. In addition to governing body 

meetings, USUN-Geneva leads day-to-day engagement with WHO 

officials, with support from HHS, CDC, State, and USAID. There are 35 

CDC staff assigned to WHO offices throughout the world, including 9 staff 

at WHO headquarters in Geneva working in areas such as measles, flu, 

and polio. According to HHS officials, other U.S. agencies also 

periodically work with WHO on health issues. For example, the 

Department of Defense works with WHO on health security and disease 

detection, and in September 2011, WHO and the U.S. government signed 

a memorandum of understanding regarding cooperation on global health 

security initiatives. In addition, USAID has several ongoing grants to 

WHO, including headquarters and the country and regional offices, in

areas such as influenza, malaria, maternal and child health, and 

HIV/AIDS.

The United States has long supported UN reform initiatives and has 

advocated for comprehensive management reform at UN agencies, 

including WHO. In 2005, a number of management reforms were 

introduced to improve transparency and accountability initiatives at the 

UN. However, other entities in the UN lagged far behind in improving 

transparency and accountability, according to the U.S. Mission to the UN 

and officials from State’s Bureau of International Organization Affairs. As 

a result, in 2007, the United States developed UNTAI to promote more 

efficiency, effectiveness, transparency, and accountability among UN 

agencies, including WHO. UNTAI identifies eight goals for which member 

states can exercise greater oversight and increased transparency and 

accountability to ensure efficiency and effectiveness. These goals include 

public access to all relevant documentation related to operations and 

activities, whistleblower protection policies, financial disclosure programs, 

U.S. Support for UN 

Reform 
 

Page 11 GAO-12-722 World Health Organization

an effective ethics office, independence of the respective internal 

oversight bodies, and adoption of international accounting standards.

As part of this initiative, State conducts regular assessments to measure 

UN agency performance and progress in the eight goals laid out by 

UNTAI. The assessment presents information concerning the status of 

each assessed agency against specific benchmarks established by State. 

These assessments are intended to help the U.S. government identify 

weaknesses and prioritize engagement at individual UN agencies. In 

2011, State established UNTAI phase 2 and revised the UNTAI goals and 

benchmarks from UNTAI phase 1. UNTAI phase 1 sought to extend 

reforms already in place at the UN Secretariat to the rest of the UN 

system, while UNTAI phase 2 was designed to build on UNTAI’s 

successes and focus on further raising accountability standards for the 

UN system. For example, UNTAI phase 2 added oversight of 

procurement because the United States has identified this as a high-risk 

area. Other changes to the UNTAI assessment tool include enterprise risk 

management and ethics issues such as nepotism, post-employment 

restrictions, and conflicts of interest.

WHO developed a reform agenda that generally aligns with the 

challenges identified by stakeholders. In May 2012, member states 

approved components of WHO’s reform agenda, encompassing three 

broad areas—priority setting, governance, and management reforms—

that generally align with challenges identified by stakeholders. According 

to WHO officials, member state representatives, and other stakeholders, 

some of the challenges facing WHO include (1) its lack of clear 

organizational priorities; (2) lack of predictable and flexible financing; and 

(3) highly decentralized organizational structure. In developing its reform 

agenda, WHO consulted with member states, employees, and other 

parties to gather their views and feedback. In addition, WHO has 

commissioned three ongoing evaluations to provide input into the reform 

process. The first stage of one of the planned evaluations, conducted by 

WHO’s External Auditor and completed in March 2012, concluded that 

WHO’s reform proposals are generally comprehensive in addressing 

challenges raised by member states and other stakeholders.11

 

11WHO’s External Auditor, currently the Comptroller and Auditor General of India, 

authored the Evaluation Report of Stage 1 of Reform Proposals of WHO, 2012. 

WHO 

WHO Developed a 

Reform Agenda that 

Generally Aligns with 

the Challenges 

Identified by 

Stakeholders 
 

Page 12 GAO-12-722 World Health Organization

continues to consult with member states on priority-setting and 

governance proposals, which may require extensive deliberation and 

consensus from member states. In November 2011, the WHO Executive 

Board approved WHO’s management reform proposals in several areas, 

and requested further development of proposals in other areas. In May 

2012, WHO developed a high-level implementation and monitoring 

framework that includes reform objectives, selected reform activities, 1-

year and 3-year milestones, and intended results. Certain factors could 

impede WHO’s ability to successfully implement its reform proposals, 

including the availability of sufficient financial and technical resources and 

the extent of support from internal and external stakeholders.

In May 2012, member states approved components of WHO’s reform 

agenda that encompass three broad areas—priority-setting, governance, 

and management. In the area of priority-setting, WHO seeks to focus its 

efforts and narrow the scope of its work to what it can do best. WHO also 

seeks to improve member states’ governance of the organization and 

strengthen its leadership role in the global health arena. Management 

proposals include efforts to increase WHO’s effectiveness by improving 

its financing, human resources policies, results-based planning, and 

accountability and transparency mechanisms. Table 3 outlines WHO’s 

three areas of reform and some of WHO’s rationales for the reforms in 

each area.

Table 3: WHO’s Areas of Reform and Rationale for Reform

Area of reform Rationale for reform

Priority-setting

• Establishment of organizational 

priorities

• WHO priority-setting has not been sufficiently selective or strategically focused. As a 

result, WHO is overcommitted and works in too many global health areas. 

Governance

• Effectiveness of WHO internal 

governance structures

• WHO’s internal governance structures need to have a more strategic and disciplined 

approach to priority-setting.

• Oversight of the programmatic and financial aspects of the organization needs to be 

enhanced.

• The efficiency and inclusivity of the intergovernmental consensus-building process needs 

to be enhanced.

• The duration, timing, and sequencing of the sessions of the WHO governing body 

meetings are not optimal. 

• WHO’s engagement with external 

stakeholders

• WHO’s role in global health governance needs to be clarified and strengthened.

• The global health community has greatly expanded, leading to a number of global health 

organizations with overlapping roles and responsibilities. 

WHO’s Reform Agenda 

Covers Three Broad Areas
 

Page 13 GAO-12-722 World Health Organization

Area of reform Rationale for reform

Management

• Alignment of WHO headquarters, 

regional, and country offices

• WHO has a decentralized organizational structure, and roles and responsibilities of the 

three levels of the organization need to be better defined.

• Programs and offices tend to work independently of one another.

• WHO financing • WHO faces a misalignment between what its governing bodies approve in terms of 

strategic direction, the budget for the organization, and the resources available.

• Voluntary contributions, which represent the major source of WHO’s funding, are often 

highly specified and not aligned with WHO’s program budget.

• The current level of assessed contributions is not sufficient to carry out WHO’s work.

• The cost of WHO’s administration is not adequately financed. 

• Human resources policies and 

management

• WHO faces a mismatch between its funding and human resources policies. WHO’s 

human resources policies focus on long-term employment while the organization’s funding 

is largely for short-term projects.

• The process of recruiting staff is overly complex and lengthy.

• Performance management tools are not sufficiently used to evaluate staff performance. 

• Results-based management • WHO faces challenges in measuring its contributions to health outcomes.

• WHO resources, outputs, and outcomes are not clearly linked. 

• Accountability and transparency • WHO audit and oversight system has limited capacity.

• WHO lacks timely, validated information about its results and resources to provide to 

member states and governing bodies.

• Enforcement of WHO’s current accountability and transparency mechanisms is not robust.

• WHO’s current policies on conflicts of interest and information disclosure are insufficient 

to deal with the growing complexities of global health. 

• Independent evaluation • WHO does not have an evaluation policy that has been endorsed by its governing bodies, 

nor does it routinely make its evaluation reports public.

• WHO lacks an established mechanism for oversight of evaluation by the governing 

bodies. 

• Strategic communications • WHO is unable to project a coherent sense of the organization and its achievements. 

Source: GAO summary of WHO information.

WHO’s reform agenda generally aligns with the challenges identified by 

WHO officials, member states, and other global health organizations we 

interviewed. According to WHO officials, member state representatives, 

and other stakeholders, some of the challenges facing WHO include (1) 

its lack of clear organizational priorities, (2) lack of predictable and flexible 

financing, and (3) highly decentralized organizational structure. For 

example, WHO officials and several global health stakeholders stated 

that, because most of WHO’s funding comprises voluntary contributions 

specified for certain activities, WHO’s ability to allocate resources 

according to its priorities are limited. WHO officials further commented 

that, while maternal and child health activities and achieving the healthrelated UN Millennium Development Goals are priorities for the 

WHO Undertook 

Consultations in 

Developing a Reform 

Agenda that Generally 

Aligns with Challenges 

Identified by Stakeholders
 

Page 14 GAO-12-722 World Health Organization

organization, these areas are generally underfunded because donors 

specify funding for other program areas. In addition, stakeholders stated 

that WHO’s decentralized organizational structure and autonomous 

regional offices limit the regional and country offices’ accountability to 

WHO headquarters and the coherence of WHO’s efforts.

WHO took a number of steps to consult with member states, employees, 

and other parties to gather their views and feedback on its reform 

agenda. These consultations are in accordance with a WHO Executive 

Board decision in May 2011 to establish a transparent, member-statedriven, and inclusive process of consultation to support the development 

of its reform agenda and proposals. Accordingly, in a previous GAO 

report, we reported that early, frequent, and clear, two-way 

communication of information with employees and stakeholders is 

considered a good practice when undergoing a major organizational 

change because it allows stakeholders to provide input and take 

ownership of the change.12

 

12GAO, Results-Oriented Cultures: Implementation Steps to Assist Mergers and 

Organizational Transformations,

Figure 3 provides a timeline of WHO 

consultations with internal and external stakeholders on its reform 

agenda.

GAO-03-669 (Washington D.C.: Jul. 2, 2003). 
 

Page 15 GAO-12-722 World Health Organization

Figure 3: Timeline of WHO Consultations with Internal and External Stakeholders, 2011-2012

We previously reported that a successful organizational transformation 

must involve employees and their representatives from the beginning to 

promote their ownership of and investment in the changes occurring in 

the organization.13

 

13

We also identified the use of employee teams 

GAO-03-669. 

WHO Took Steps to Consult 

with Internal Stakeholders
 

Page 16 GAO-12-722 World Health Organization

comprising a cross-section of individuals who meet to discuss solutions to 

specific issues related to organizational change as a promising practice. 

We found that WHO has taken steps to develop and communicate its 

reform plans with internal stakeholders, including WHO employees at its 

regional and country offices. Specifically, WHO established a task force 

on reform consisting of staff members from headquarters, regional 

offices, and country offices to ensure organization-wide representation. 

The task force met twice in June and September 2011 and offered their 

views on WHO’s organizational effectiveness. According to WHO, the 

task force’s feedback was incorporated in WHO proposals presented for 

the November 2011 special session on reform. In addition, WHO has a 

dedicated intranet site for staff to comment on the WHO reform process, 

and WHO officials conducted six town hall meetings with staff since 

January 2011 to update them on the progress of reform.

WHO used a variety of means to consult with external stakeholders, such 

as member states, on its reform agenda. As decided at the May 2011 

Executive Board session, WHO used private web-based consultations to 

collect feedback from member states from June through November 2011 

and from January through February 2012. WHO also held a 3-day special 

session of the Executive Board in early November 2011 that was focused 

on reform. During this session, the WHO Director-General presented 

WHO’s proposals for reform, based on its consultations with member 

states, as well as a high-level road map for further development of the 

proposals. The Executive Board made decisions related to the three 

areas of reform and identified further work to be carried out by the WHO 

Secretariat. WHO also formally and informally briefed member state 

missions on its reform proposals and the progress of its reform plans. For 

example, WHO regional committee meetings that occurred during the fall 

of 2011 served as platforms for consultations with their member states. 

According to WHO officials, because reform has generally been a 

member state-driven process, WHO consultation with nongovernmental 

organizations and private industry has been more limited than its 

engagement with member states. However, WHO invited 

nongovernmental organizations in “official relations” with WHO to submit 

their comments on its reform agenda.14

 

14Nongovernmental organizations in “official relations” with WHO are those organizations 

that fulfill a set of WHO criteria, such as having an international scope of work and 

focusing on development work in health and health-related fields. Such organizations

have the right to appoint a representative to participate, without right of vote, in WHO 

meetings. 

According to WHO officials, it has 

WHO Consulted with External 

Stakeholders through Various 

Means 
 

Page 17 GAO-12-722 World Health Organization

also convened three informal dialogues with nongovernmental 

organizations since late 2011. 

At the November 2011 special session on reform of the WHO Executive 

Board, the Board decided to commission three ongoing evaluations to 

provide input to the reform process. WHO commissioned a two-stage 

independent evaluation, the first stage of which was conducted by WHO’s 

External Auditor during February and March of 2012. The first stage of 

the evaluation consisted of a review of the comprehensiveness and 

adequacy of WHO’s reform proposals in finance, human resources, and 

governance. The External Auditor concluded that WHO’s reform 

proposals were generally comprehensive in addressing concerns raised 

by member states and other stakeholders. The External Auditor also 

concluded that WHO followed an inclusive process of deliberations and 

that it held a wide range of consultations with stakeholders, but that it 

could have taken additional steps to consult with non member state 

donors to the organization. The External Auditor recommended that WHO 

develop plans to prioritize the implementation of its various reform 

proposals; identify desired outputs, outcomes, and impact; explain the 

implications of new changes to affected parties; and maintain regular 

communication with those concerned about the progress of WHO’s 

reform proposals.

Stage two of the evaluation is intended to focus, in particular, on the 

coherence between and functioning of WHO’s three organizational 

levels—headquarters, regions, and country offices and build on the 

results of the stage one evaluation. The second stage of the evaluation is 

also intended to inform reform discussions at the May 2013 World Health 

Assembly.

In addition, at the request of the WHO Executive Board, the UN Joint 

Inspection Unit (JIU) is conducting evaluations of WHO’s management 

and administration practices and of the decentralization of WHO offices.15

 

15The JIU is the only independent external oversight body of the UN system. It is 

mandated to conduct evaluations, inspections, and investigations of the UN system, 

including the specialized agencies. The JIU conducted earlier reviews of WHO’s 

decentralization and management and administration issues. See Joint Inspection Unit, 

Decentralization of Organizations within the United Nations system. Part III: The World 

Health Organization (JIU/REP/93/2), and Joint Inspection Unit, Review of Management 

and Administration in the World Health Organization (WHO) (JIU/REP/2001/5). 

The objectives of the JIU reviews are to (1) assess the management and 

WHO Commissioned 

Independent Evaluations to 

Provide Input to the Reform 

Process 
 

Page 18 GAO-12-722 World Health Organization

administration practices in WHO and identify areas for improvement; and 

(2) assess the degree of decentralization and delegation of authority 

among the WHO headquarters and the regional and country offices, as 

well as current coordination mechanisms and interactions among the 

three levels. The results of the JIU reviews are intended to provide input 

into WHO’s decisions on reform. JIU aims to present a report covering its 

two reviews to the WHO Executive Board in January 2013.

In May 2012, member states endorsed components of WHO’s reform 

agenda and requested additional work in certain areas. According to 

WHO, some of the reform proposals can be implemented relatively 

quickly while others require more detailed consideration and planning. 

WHO officials stated that decisions regarding WHO priority-setting and 

governance are driven by member states and will require their extensive 

deliberation and consensus. WHO continues to consult with member 

states on priority-setting and governance proposals, while taking steps to 

further develop and implement its management reform proposals.

According to WHO officials, the organization is trying to identify criteria for 

establishing its priorities and determine the global health areas it should 

focus on and where it is best placed to add value. Since WHO’s creation 

in 1948, many other global health efforts have been initiated; thus, there 

is a need to ensure that WHO’s work is focused on the areas in which it 

has a “unique function” and comparative advantage. Accordingly, WHO 

aims to establish a clear set of priorities to guide its resource allocation 

processes and results-based planning activities. Over 90 member states 

convened at a session on priority-setting in February 2012. They reached 

consensus on the criteria and the categories of work that will serve as 

guidance for the development of WHO’s priorities, as laid out in its 

strategic framework and program budget to be approved by the World 

Health Assembly in May 2013. Agreed-upon criteria for determining 

WHO’s priorities include current health problems, including the burden of 

disease at the global, regional, or country levels; the needs of individual 

countries as articulated in their WHO country strategies; and WHO’s 

comparative advantage, including its capacity to gather and analyze data 

in response to current and emerging health issues. WHO has also 

established five technical categories that will provide the primary structure 

of its program budget and include (1) communicable diseases; (2) 

noncommunicable diseases; (3) promoting health through the life course; 

(4) strengthening of health systems; and (5) preparedness, surveillance, 

and response. WHO will define priorities in each of these categories. 

However, according to WHO, even when priorities are identified, there is 

Reform Proposals for 

Member State 

Consideration Have Been 

Developed

WHO Has Identified Criteria for 

Establishing Its Priorities
 

Page 19 GAO-12-722 World Health Organization

no guarantee that funding for priority areas will be available in part due to 

the common practice of specifying voluntary funds for particular activities.

WHO has developed proposals for some of its governance reforms; 

however, other areas will require further development, consultation, and 

member state consensus. Proposals to improve WHO’s governance are 

two-fold and entail (1) improving the effectiveness of WHO’s governing 

bodies, including its Executive Board, World Health Assembly, and 

regional committees; and (2) strengthening WHO’s leadership role in the 

global health arena. According to WHO, the Executive Board is currently 

prevented from fully exercising its oversight and executive role due to the 

demands it faces in preparing the agenda and work of the World Health 

Assembly. According to WHO, the number of agenda items before the 

World Health Assembly has risen over time, and a large number of 

resolutions have been adopted, some in areas that are not high priorities 

for global health. To increase the strategic decisionmaking of WHO 

governing body meetings, WHO proposals include structuring debate 

around its priorities. WHO proposals for harmonizing the operations of its 

regional committees include aligning their meeting agendas and 

connecting their work more closely with that of the Executive Board. WHO 

also plans to strengthen the oversight role of its committee that reviews 

program, budget, and administrative issues.

Although WHO aims to strengthen its engagement with the many 

stakeholders directly involved in the global health sector and to improve 

the coherence of their efforts, it lacks a current proposal on how to 

achieve these aims. WHO’s constitution describes two of its functions as 

(1) acting as the directing and coordinating authority on international 

health work and (2) establishing and maintaining effective collaboration 

with the UN, specialized agencies, and other global health organizations. 

Given the growing number of institutions—including foundations, 

partnerships, civil society organizations, and the private sector—that have 

a role in influencing global health policy, WHO reports that it is trying to 

determine how it can engage with a wide range of stakeholders. 

According to WHO, at the same time, it does not want to undermine its 

intergovernmental nature or open itself to undue influence by parties with 

vested interests.

In 2011, WHO proposed a forum to explore ways in which the major 

actors in global health could work more effectively together; however, 

WHO stakeholders did not support this proposal. WHO’s concept paper 

proposed the idea of a “World Health Forum,” an informal, multistakeholder body composed of representatives of governments, civil 

WHO Has Developed Some 

Governance Proposals, 

although Some Areas Require 

Further Development, 

Consultation, and Member 

State Consensus
 

Page 20 GAO-12-722 World Health Organization

society organizations, private sector entities, and other relevant 

stakeholders. However, according to WHO, feedback from member states 

on this proposal was generally unsupportive because they did not want to 

create a forum that could potentially impinge upon the intergovernmental 

nature of WHO. In addition, some nongovernmental organizations were 

concerned that the proposed forum would allow private sector interests to 

influence decision-making in WHO. However, pharmaceutical industry 

representatives stated that the private sector has an important role to play 

in public health policy-making decisions. In May 2011, a group of 

nongovernmental organizations wrote a letter to WHO expressing 

concerns regarding the role of private bodies in the financing and 

governance of WHO. The nongovernmental organizations also expressed 

concern that the WHO reform proposals at the time did not adequately 

address the issue of how WHO planned to manage potential conflicts of 

interest for private institutions.

According to WHO, more discussion and consultation is necessary to 

identify how it will strengthen its engagement with external stakeholders. 

Since WHO set aside its World Health Forum proposal, WHO plans to 

consult with nongovernmental organizations on how it can effectively 

interact with them. In May 2012, member states requested that WHO 

present a draft policy document on its engagement with nongovernmental 

organizations to the Executive Board in January 2013. WHO also plans to 

hold a series of structured consultations concerning its relationship with 

private commercial entities and to develop a draft policy document on its 

guidelines for interacting with private entities to be presented to the 

Executive Board in May 2013.

WHO concerns in the area of global health governance also include a 

concern that, in light of the growing expansion of the number of global 

health initiatives and partnerships, a number of global health 

organizations have overlapping roles and responsibilities. For example, 

WHO recognizes a need to delineate the roles and responsibilities 

between itself; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; 

and the GAVI Alliance, particularly in the area of providing technical 

assistance at the country level. WHO is involved in several formally 

structured partnerships, some hosted by WHO and others by independent 

entities that include WHO as part of their governing bodies. WHO reports 

that it aims to strengthen the Executive Board’s oversight over its 

partnerships.
 

Page 21 GAO-12-722 World Health Organization

Management reforms encompass a broad range of areas, including 

efforts to (1) improve the predictability and flexibility of WHO’s financing; 

(2) improve its human resource policies and practices; (3) strengthen 

WHO’s results-based management, accountability, and transparency 

systems. According to WHO, the provision of stronger and more effective 

support to countries is a key outcome of its management reforms. At the 

November 2011 special session of the Executive Board, the Board 

approved WHO’s management reform proposals in several areas and 

requested the development of proposals in other areas. To improve the 

predictability and flexibility of its financing, WHO proposed setting up a 

dialogue with donors after the approval of its program budget by the 

World Health Assembly, followed by a financing dialogue in which donors 

publicly make funding commitments that are aligned with the budget. To 

improve its human resource policies and practices, WHO proposed the 

development of a revised workforce model and contract types; 

streamlined recruitment and selection processes; improved performance 

management processes; a staff mobility and rotation framework; and 

enhanced staff development and learning opportunities. To strengthen 

WHO’s accountability, and transparency systems, WHO proposed a 

strengthened internal control framework and conflict of interest policy; 

increased capacity of its audit and oversight office; improved monitoring 

and reporting; and the establishment of an information disclosure policy 

and an ethics office. WHO has begun implementing some of its 

management reform proposals. For example, according to WHO, it took 

steps to strengthen the staffing of its internal audit and oversight office 

and developed a draft formal evaluation policy for consideration and 

approval by the WHO Executive Board. According to WHO officials, 

although member states approved the implementation of many WHO 

management reform proposals, they requested that WHO further develop 

its proposals to increase the flexibility and transparency of WHO financing 

and present its proposals to the Executive Board in January 2013.

Multiple challenges could affect the success of WHO reform 

implementation. WHO developed a high-level implementation and 

monitoring framework that included reform objectives, selected activities, 

1-year and 3-year milestones, and intended results for consideration by 

the May 2012 World Health Assembly. For example, to improve WHO’s 

human resources practices, WHO set a 1-year milestone of conducting 

regular reviews of its staffing levels and a 3-year milestone of 

comprehensively integrating its human resources planning into its 

program planning and budgeting processes. WHO’s intended result for 

these efforts is staffing that is more closely matched to needs at all levels 

WHO Management Proposals 

and Actions Encompass a Wide 

Range of Areas 

Multiple Challenges Could 

Impede the Successful 

Implementation of WHO 

Reform 
 

Page 22 GAO-12-722 World Health Organization

of the organization. We previously reported that, when undergoing an 

organizational change, it is important to establish implementation goals, a 

timeline, estimated costs for achieving the goals, and performance 

measures—all of which help build momentum and monitor progress.16

• Availability of sufficient resources. According to WHO officials, 

implementation of its reform proposals will require financial and 

technical resources, and some of its reform proposals have significant 

resource implications, which must be carefully considered.

While the framework contains some of these elements, WHO has not yet 

identified the estimated costs for the implementation of its reform program 

or defined performance measures, which would serve as an objective 

means by which to track the organization’s progress in achieving its 

reform objectives. WHO officials have noted that they are currently 

developing an implementation plan that will include input from its member 

states and regional and country offices. Officials also noted that the 

components of its reform agenda will be implemented at various stages, 

and that as its reform efforts proceed, WHO will provide periodic updates 

on its progress to its governing bodies. Key challenges that could impede 

WHO’s ability to successfully implement its reform proposals include the

following:

17

• Extent of support from internal and external WHO stakeholders. 

Changes to WHO’s established structures and processes will require 

support and commitment from WHO’s internal and external 

stakeholders. Stakeholders raised concerns that, due to the 

autonomous nature of WHO’s regional offices, WHO’s reform 

proposals might not be implemented uniformly across the entire 

organization. In addition, WHO proposals to increase delegation of 

authority and strengthen its country offices will require the support of 

WHO’s regional governing bodies and offices. WHO will require the 

support and consensus of member states to carry its reform proposals 

forward.

 

16GAO-03-669. 

17WHO’s budget for the development phase of the reform is about $6.27 million and 

includes costs for consultations and meetings of the governing bodies, secretariat costs, 

and the independent evaluation. According to WHO, member states have provided about 

$3.04 million in funding thus far, resulting in a funding gap of about $3.23 million.
 

Page 23 GAO-12-722 World Health Organization

The United States has provided input into WHO’s reform agenda, 

particularly in the areas of transparency and accountability, but State’s 

tool to assess the progress of management reforms could be enhanced. 

On priority-setting, the United States has advocated for WHO to maintain 

its focus on certain functions such as setting norms and standards for 

international health. On consultations on governance, the U.S. delegation 

has commented on a range of proposals put forth by WHO, including 

those on engagement with other global health stakeholders. On 

management reforms, the United States has supported increased 

transparency and accountability mechanisms at WHO; however, State’s 

tool for monitoring progress in this area could be enhanced.

In priority-setting consultations, the U.S. delegation has advocated for 

WHO to maintain its focus on normative functions such as setting 

standards and guidelines, as well as other areas such as health security 

and communicable diseases. According to talking points used in 

preparation for governing body meetings, the U.S. delegation has 

stressed the need for WHO to remain focused on its core functions of 

setting standards and guidelines for global health. HHS officials noted 

that one of the main challenges facing WHO is the development of a 

narrower set of clear priorities and the need to focus on areas where it 

has a strategic advantage. According to State and HHS officials, the 

United States advocated that WHO maintain its focus on normativesetting functions such as setting norms and standards for international 

health. HHS officials stated that WHO is uniquely positioned to be the 

international authoritative body for establishing rules and technical 

standards and conducting monitoring activities. For example, WHO is the 

major international counterpart for CDC on outbreak control and 

identifying potential global health threats. Officials from State and USUNGeneva also stated that U.S. priorities for WHO are focused on its 

normative functions of setting standards and guidelines. For example, 

State officials noted that the U.S. government wants WHO to focus on its 

processes to ensure safe medicines and vaccines, including WHO’s drug 

prequalification process and essential medicines list. These U.S. officials 

stated that WHO’s main mission should be to remain the international 

authority for global health on norms and standards.

The United States Has 

Provided Input into 

WHO’s Reform 

Agenda, Particularly 

in Transparency and 

Accountability 

Proposals, but State’s 

Tool for Monitoring 

Progress Could be 

Enhanced 

The United States Has 

Provided Input on WHO 

Consultations on PrioritySetting and Governance 
 

Page 24 GAO-12-722 World Health Organization

The U.S. delegation also advocated for a number of other health priorities 

for WHO, including improving health security and preventing 

communicable diseases. According to talking points used in preparation 

for governing body meetings, the U.S. delegation highlighted the 

importance of including health security and communicable diseases 

among WHO’s priorities. In addition, State and USUN-Geneva officials 

cited health security as a key U.S. priority for WHO. State officials noted 

that U.S. priorities for global health involve protecting the health of 

Americans at home and abroad; the health security functions of WHO are 

thus important for achieving this goal. An official from USUN-Geneva 

noted that health security involves a number of components such as 

enhancing pandemic preparedness, setting international health norms, 

and eradicating certain diseases such as small pox, and that WHO is in a 

unique position to provide leadership in these areas. HHS and State 

officials also stated that WHO is a critical partner with the United States in 

fighting communicable diseases such as polio and influenza. A State 

budget document stated that the U.S. benefits from WHO-sponsored 

cooperation on vital aspects of global health security, including containing 

the HIV/AIDS pandemic, preventing the spread of avian influenza and 

other emerging diseases, and addressing long-term threats to health such 

as bioterrorism and the spread of chronic diseases.

The United States has provided input on a range of WHO proposals in the 

governance area, according to a U.S. government document used in 

preparation for governing body meetings. For example, the U.S. 

delegation supported WHO proposals to improve engagement between 

WHO and outside stakeholders, such as other global health 

organizations. In addition, the United States commented on WHO 

proposals related to the frequency of governing body meetings and the 

linkages between regional and global policies and strategies. Specifically, 

the United States favors having the regions adapt global policies and 

strategies, rather than repeating the process of policy and strategy 

development at the regional level. In governance consultations, the U.S. 

delegation also pushed for a greater effort to define WHO’s strategic 

engagement in partnerships and the degree to which the partnerships 

meet WHO’s interests.
 

Page 25 GAO-12-722 World Health Organization

The United States has supported an agenda for greater transparency and 

accountability for WHO management reforms. According to State officials, 

State’s Bureau of International Organization Affairs takes the lead for the 

U.S. government on issues related to management reform and is 

responsible for pursuing management reforms throughout the UN system, 

including WHO. U.S. officials mentioned a number of U.S. goals in this 

area, including improving internal and external oversight mechanisms, 

budgeting and planning processes, and human resources and 

administrative reforms. According to State officials, cost effectiveness, 

efficiency, accountability, and monitoring and evaluation are key U.S. 

priorities for WHO reform.

The U.S. delegation has taken steps to advocate for a number of reforms 

to improve WHO’s internal and external oversight mechanisms. According 

to State officials, the United States encouraged the reestablishment of an 

independent audit committee for WHO. The previous audit committee 

was disbanded in 2005 amid concerns about its effectiveness, and a 

revamped audit committee was established in 2009. Officials also noted 

that State supports WHO in establishing a dedicated ethics office, which 

is currently under consideration as part of the proposed reforms. For 

example, according to WHO officials, the U.S. delegation introduced a 

proposal that would require the newly formed ethics office to report 

directly to the Program Budget and Administration Committee, thereby 

enhancing the independence of the office. In addition, according to a 

USUN-Geneva official, the United States pushed for improved 

independent evaluation at WHO, and WHO agreed in November 2011 to 

conduct an independent evaluation as an input into the reform process.

According to officials from USUN-Geneva, two additional managementrelated goals for the United States include improvements in the budgeting 

and planning process and human resources and administrative reforms. 

Specifically, the United States has emphasized that WHO makes the 

necessary changes to its budgeting and planning system to ensure that 

WHO resources are aligned with its stated objectives. For example, 

according to WHO officials, the U.S. delegation offered an amendment at 

the May 2012 Executive Board meeting to hold a special meeting of the 

Program Budget and Administration Committee in late 2012 in order to 

discuss WHO financing as well as other reform issues. The U.S. 

delegation also has advocated for human resources and personnel 

reforms to ensure that WHO staff have the appropriate skill set for the 

organization’s current needs. In particular, according to talking points 

prepared for governing body meetings, the United States pushed for a 

new workforce model to distinguish long-term functions from time-limited 

The United States Has 

Supported a Management 

Reform Agenda for Greater 

Transparency and 

Accountability, but State’s 

Tool to Assess Progress in 

These Areas Could be 

Enhanced 
 

Page 26 GAO-12-722 World Health Organization

projects and for a skills profile of staff at each level of the organization as 

a way to improve the organization’s effectiveness and flexibility. Officials 

from USUN-Geneva have met with officials from the WHO human 

resource office to advocate for reforms in this area. The United States 

also advocated to harmonize recruitment policies, increase the speed of 

hiring, improve performance management processes, and enhance staff 

development and learning. USUN-Geneva officials noted that WHO is 

taking steps to respond to the concerns and proposals raised by the 

United States and other member states as part of the reform agenda.

State established an assessment tool to measure progress on 

transparency and accountability mechanisms, a tool that could assist in 

monitoring the progress of management reforms. State’s UNTAI tool is 

used to assess approximately 20 UN agencies, including WHO, to 

monitor progress on eight goals related to transparency and 

accountability, with a number of specific benchmarks in each category. 

For example, the UNTAI goal “effective oversight arrangements” contains 

six benchmarks, including whether the external audit reports are publicly 

available online and if there are term limits for the external auditor. 

According to State officials, the UNTAI tool is not intended to cover the 

full range of U.S. goals and priorities in the area of management reform. 

For instance, the assessment tool does not cover certain U.S. priorities 

such as human resources and personnel systems, which is another key 

component of management reform.

UNTAI is a useful tool for guiding U.S. priorities and engagement on 

certain management issues. According to State officials, State assigned 

WHO “above average” scores on UNTAI criteria relative to other UN 

organizations, and the assessment identified certain areas for 

improvement. State’s UNTAI assessment scored WHO well in areas 

related to whistleblower protection and conflicts-of-interest policies. 

However, the WHO UNTAI assessment identified areas for improvement 

in certain areas, such as maintaining an independent ethics function. 

According to State officials, as a result of the goals laid out in UNTAI, the 

U.S. delegation pushed for the establishment of an independent audit 

committee at WHO. A USUN-Geneva official noted that the UNTAI 

assessment is used to guide U.S. priorities and engagement on issues 

related to transparency and accountability and to sharpen the U.S. 

position in these areas.

To conduct the UNTAI assessment, officials can use a number of 

strategies, according to State officials. State officials at the mission carry 

out the assessments, either by completing the tool themselves, or 
 

Page 27 GAO-12-722 World Health Organization

providing it to the UN organization to complete. For example, State 

officials at the mission can collect information to complete the 

assessment by interviewing officials from the UN agency, such as 

representatives of an ethics or management office. In some cases, the 

UNTAI assessment tool is provided to UN agency representatives as a 

self-assessment exercise. According to State officials, the mission vets 

the completed assessments and sends them to Washington for review. 

For example, the most recent UNTAI assessment for WHO, covering 

fiscal year 2011, was completed by WHO representatives and verified by 

officials from USUN-Geneva and State in Washington, D.C.

According to State officials, State has provided some general guidelines 

for completing UNTAI assessments to State officials at the mission in 

addition to providing technical and agency-specific advice on an asneeded basis. State provided information on the UNTAI goals and 

benchmarks through cables to officials in the field in 2008 and 2011. 

State officials noted that questions about the assessment tool are 

answered through correspondence between the missions and State in 

Washington. In addition, some State officials at the mission choose to 

provide additional information with the assessment; however, State does 

not require that supporting documentation accompany the assessments. 

State officials at the mission completing the assessments are asked to 

defend the assigned ratings to State officials in Washington and make an 

evidence-based case for the assigned scores. According to State officials, 

State consulted with officials in the field to develop the assessment tool 

and such a consultative process helped to facilitate a shared 

understanding among those completing and reviewing the assessments. 

State officials also noted that the process of reviewing the UNTAI reports 

in Washington helps to minimize errors, omissions, and inconsistencies, 

but that this process does not fully mitigate risks to data reliability. State 

officials mentioned that they are considering distributing a list of 

frequently asked questions to officers in the field to aid in completing the 

assessment in the upcoming fiscal year. In addition, State officials we 

spoke with stated that the UNTAI tool was updated for 2011 and that they 

recognize that areas for improvement and clarification may still exist, as 

they often do with surveys and data collection instruments. An official at 

USUN-Geneva welcomed improved guidance noting that this would assist 

officials in the field in completing the assessment tool.

We found some weaknesses in State’s UNTAI assessment of WHO, 

including an ambiguous rationale for State’s scores on certain 

benchmarks. In reviewing State’s WHO UNTAI assessment, we could not 

find support for State’s scoring on 14 of 50 benchmarks. For example, we 
 

Page 28 GAO-12-722 World Health Organization

could not find support for State’s determination that WHO’s evaluation 

and management functions are autonomous. The comments submitted 

with the UNTAI assessment stated that most evaluation is decentralized 

and commissioned under individual technical areas. Therefore, the 

evaluation function is not functionally separate at an organizational level 

from those responsible for the design and implementation of the 

programs and operations evaluated, as specified in the UNTAI 

benchmarks. In addition, State’s WHO UNTAI assessment concluded that 

WHO consistently and objectively applied its policy on program support 

costs, which was approved by the member states; however, this policy 

does not appear to be consistently applied. The program support cost 

policy requires that 13 percent of all voluntary funding contributions are 

allocated to reimburse WHO for administering projects of voluntarily 

funded programs. However, according to WHO officials, many donors 

negotiate a program support charge averaging around 7 percent, rather 

than the standard rate of 13 percent, for their voluntary contributions.

We also found that State’s definitions of certain benchmarks used in 

State’s UNTAI tool were unclear and may lead to data reliability concerns. 

We analyzed State’s UNTAI tool to assess whether the tool is likely to 

gather accurate and consistent data. We found that 15 of 50 benchmarks 

in the UNTAI assessment tool required the judgment of the reviewer, due 

to the subject matter expertise required to complete the assessment, the 

lack of clarity on the benchmark definitions, or both. Certain benchmarks 

require an understanding of specific subject areas to accurately 

determine whether the benchmark has been met, and not all State 

officials completing the assessments have the required expertise in each 

area to make an accurate judgment. For example, the benchmark 

indicating whether or not the organization has an independent, 

transparent, effective, and fair bid protest process requires some 

knowledge related to acquisition and procurement rules to make such a 

determination. In addition, certain benchmarks use ambiguous or 

indefinite terminology, requiring the assessor to define the meaning of the 

terms before they can assess whether the benchmark has been met. For 

example, the determination of whether the organization has adequate 

staff and financial resources allocated to the evaluation function requires

some judgment about the definition of adequate in this context. The 

UNTAI tool does not provide sufficient guidance to reviewers to assist in 

making these judgments and does not require documentation from the 

assessor to explain how such a judgment was made. See appendix II for 

further information on GAO’s analysis of the benchmarks in State’s 

UNTAI assessment tool.
 

Page 29 GAO-12-722 World Health Organization

WHO has undertaken an ambitious and comprehensive agenda for 

reform; however, as with other organizations undergoing major 

transformational change such as broad reforms, WHO faces potential 

challenges throughout implementation. WHO’s high-level implementation 

and monitoring framework includes important elements for planning 

organizational change, such as reform objectives, 1-year and 3-year 

milestones, and intended results. In addition, WHO is currently 

developing a detailed implementation plan, which would help WHO 

achieve its goals, including the creation of performance indicators to 

measure progress and identification of the estimated costs for 

implementing its broad reform agenda. Thus, success of WHO reform 

depends on the ability of WHO to sustain its efforts to establish such a 

comprehensive reform implementation plan, as well as other essential 

elements including consensus from member states and other internal and 

external stakeholders. The U.S. delegation has participated in numerous 

consultations on WHO reform and has been supportive of reforms to 

improve the efficiency and effectiveness of the organization. The United 

States has been particularly supportive of WHO’s focus on its core 

functions of setting standards and guidelines, as well as a set of reforms 

improving the transparency and accountability mechanisms of the 

organization. State’s UNTAI assessment is a useful tool for shaping U.S. 

engagement with WHO and monitoring WHO progress in implementing 

certain management reforms related to UNTAI goals and benchmarks. 

However, there are weaknesses in the UNTAI assessment tool that 

generate concerns over the reliability of the information generated in 

these assessments, including the ambiguous rationale for State’s scores 

in particular areas and the lack of clarity in the definitions of certain 

benchmarks. Therefore, ensuring that the performance information 

resulting from the UNTAI assessment is useful and accurate is crucial for 

State’s ability to continue advocating for improvements at WHO and 

monitor WHO reform implementation in certain areas of management 

reform.

To improve U.S. assessment of WHO reform, we recommend that the 

Secretary of State enhance its guidance on completing State’s 

assessment tool for monitoring WHO’s progress in implementing 

transparency and accountability reforms by including, for example, a 

requirement to collect and submit supporting documentation with 

completed assessments.

Conclusions 

Recommendation for 

Executive Action
 

Page 30 GAO-12-722 World Health Organization

We requested comments on a draft of this report from the Departments of 

State and HHS, USAID, and WHO. State and WHO provided written 

comments that are reprinted in appendixes III and IV of this report. HHS 

and USAID did not provide written comments on this report. 

State generally endorsed the main findings and conclusions of our report 

and concurred that WHO has undertaken an ambitious and 

comprehensive agenda for reform. State also agreed that the United 

States has advocated for and provided input into WHO’s reform agenda, 

particularly in the areas of management, budgeting and planning, priority 

setting, governance, and financing. State agreed that its process for 

conducting its UNTAI assessment could be strengthened and accepted 

our recommendation to revise its guidance for completing these 

assessments. State noted that it is in the process of updating its 

assessment tool and plans to issue expanded guidance prior to the fiscal 

year 2012 ratings. State also clarified the context regarding its 

assessments. State noted that we overstated the need for subject matter 

expertise in determining whether some benchmarks on the UNTAI 

assessment tool have been met. We recognize that some officers in the 

field completing the assessment may benefit from the expertise of those 

in the Bureau of International Organization Affairs. However, we

maintain that the UNTAI tool does not provide sufficient guidance to 

reviewers to assist in making these judgments and that this could lead to 

potential data reliability concerns. Furthermore, according to an official at 

USUN-Geneva, improved guidance would be welcome and would help

officials in the field complete the assessment tool. In addition, State 

mentioned the need to balance the requirement for supporting 

documentation with the need to minimize the reporting burden on 

missions, WHO, and other UN organizations. We recognize State’s

concern about overburdening missions with reporting requirements and 

maintain that revised guidance would benefit both the missions and 

officers in Washington in preparing and reviewing these assessments. 

In its comments, WHO concurred with the main conclusions of our report 

and stated that our review provides an important framework against which 

WHO and its member states can evaluate the reform’s direction. WHO 

agreed that the reform proposals respond to the challenges identified by 

stakeholders, and that the consultation process has been inclusive and

transparent. In addition, WHO noted that our conclusions broadly 

converge with those of the evaluation conducted by WHO’s External 

Auditor. WHO also recognized that the development of a detailed 

implementation plan will be critical to ensure successful institutional 

change. 

Agency Comments 

and Our Evaluation
 

Page 31 GAO-12-722 World Health Organization

State, HHS, USAID, and WHO also provided technical comments that we 

have incorporated into this report, as appropriate.

As agreed with your offices, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies to interested congressional 

committees, the Secretaries of State and HHS, the Administrator of 

USAID, the U.S. Permanent Representative to the UN in Geneva, the 

Director-General of WHO, and other interested parties. In addition, the 

report will be available at no charge on the GAO website at 

http://www.gao.gov.

If you or your staff have any questions about this report, please contact 

me at (202) 512-9601 or melitot@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made major contributions to this report 

are listed in appendix V. 

Sincerely yours,

Thomas Melito

Director, International Affairs and Trade
Appendix I: Scope and Methodology

Page 32 GAO-12-722 World Health Organization

This report examines (1) the steps the World Health Organization (WHO) 

has taken to develop and implement a reform agenda that aligns with the 

challenges identified by the organization, its member states, and other 

stakeholders; and (2) the input the United States has provided to WHO 

reforms.

To assess the steps that WHO has taken to develop and implement a 

reform agenda that aligns with the challenges identified by the 

organization, its member states, and other stakeholders, we conducted 

interviews in Washington, D.C., and in Geneva, Switzerland, with WHO 

officials, representatives of member states to the WHO, and a range of 

WHO stakeholders. We obtained their views on the challenges WHO 

faces and whether these challenges align with those addressed in WHO’s 

reform agenda. We also solicited their views on the steps WHO has taken 

to consult with internal and external stakeholders in developing and 

implementing its reform agenda. We interviewed WHO officials based in 

its headquarters office, six regional offices, and five country offices, 

including representatives of WHO’s reform team, task force on reform, 

and headquarters staff association. We interviewed officials from the U.S. 

Departments of State (State), Health and Human Services (HHS), 

Centers for Disease Control and Prevention (CDC), U.S. Agency for 

International Development (USAID), and officials representing 15 other 

member states to WHO. We interviewed representatives from institutions 

such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the 

GAVI Alliance;1

To examine U.S. support for WHO reforms, we met with officials from 

State, HHS, CDC, and USAID. We also conducted field work in Geneva, 

Switzerland, to meet with officials from USUN-Geneva, WHO, and other 

nongovernmental organizations, such as Doctors without 

Borders and the Institute of Medicine; and the Bill & Melinda Gates 

Foundation, one of the largest donors to the WHO. We also met with 

representatives of UN agencies, such as UNAIDS and the United Nations 

Development Program; private sector entities, including U.S. and 

international pharmaceutical research associations; and two research

centers that review global health issues. In addition, we reviewed WHO 

documents on its reform agenda and process, including its evaluation 

plans and its implementation and monitoring framework for reform.

 

1

The GAVI Alliance was formerly known as the Global Alliance for Vaccines and 

Immunization.

Appendix I: Scope and Methodology
Appendix I: Scope and Methodology

Page 33 GAO-12-722 World Health Organization

member state missions to learn about U.S. participation in WHO reform 

discussions and collaboration with other WHO member states. We 

collected and reviewed relevant U.S. government documents, including 

budget documents, strategies, position papers, talking points, and 

speeches. Based on interviews with U.S. government officials and U.S. 

government documents, we conducted an analysis to identify possible 

U.S. government priorities for WHO reform. We also collected and 

analyzed data from State, HHS, CDC, and USAID on U.S. funding 

contributions to WHO. We determined that these data were sufficiently 

reliable for the purposes of presenting specific agency contributions to 

WHO.

To examine State’s United Nations Transparency and Accountability 

Initiative (UNTAI) tool to measure the performance and progress of UN 

agencies, including WHO, on transparency and accountability, we 

interviewed State officials at State’s Bureau of International Organization 

Affairs, which developed and uses the assessment tool. To examine the 

results of State’s assessment of WHO using the UNTAI tool, we 

interviewed officials at USUN-Geneva who are involved in completing the 

assessment of WHO. We also systematically reviewed State’s WHO 

UNTAI report to verify the basis for State’s determinations on each 

benchmark. Specifically, we examined State’s assigned score for each 

benchmark against the information WHO provided, noting benchmarks 

where the support for State’s determination was not clear. In addition, we 

reviewed the specific benchmarks used in State’s UNTAI tool to 

determine potential threats to the accuracy and consistency of the 

resulting assessments. To do so, we developed definitions of the types of 

judgment necessary to implement the tools, and two analysts 

independently applied those definitions to each benchmark. They then 

met to compare and resolve any differences. The two analysts agreed 

upon resolutions until there was 100 percent agreement on the coding. 

Finally, we met with officials from State’s Bureau of International 

Organization Affairs about the results of our review of the benchmarks 

and our analysis of WHO’s assessment results.

We conducted this performance audit from August 2011 to July 2012 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe the 

evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.
Appendix II: GAO Assessment of State’s 

UNTAI Assessment Tool

Page 34 GAO-12-722 World Health Organization

We performed a review of State’s United Nations Transparency and 

Accountability Initiative (UNTAI) assessment tool to better understand its 

potential usefulness for supporting State’s monitoring of management 

reforms. The usefulness of the data collected by the tool is affected by the 

degree to which the resulting data are complete and accurate,1 which 

requires that the data gathered are clear and well defined enough to 

attain consistent results.2 We reviewed the specific benchmarks used in

State’s UNTAI tool to determine potential risks to the accuracy and 

consistency of the resulting assessments.3

In conducting our analysis, we developed a methodology for determining 

if the benchmarks in the assessment were clear and sufficiently defined to 

yield similar results when applied by different individuals. We found that 

the largest area of concern resulted from the judgment required when 

evaluating benchmarks. (A full description of our coding methodology and 

analysis can be found in app. I).

We identified the following two types of judgment necessary to implement 

the tool for 15 UNTAI benchmarks:

1. Subject matter expertise - Benchmarks that require an understanding 

of a specific area of knowledge to make an accurate determination. 

These are benchmarks for which professional judgment is necessary 

to accurately determine if the benchmark has been met. For example, 

one benchmark related to the training and qualification of procurement 

officials would require subject matter expertise in procurement to 

understand what qualifications or training might be appropriate for 

procurement professionals.

 

1

Government Performance: GPRA Modernization Act Provides Opportunities to Help 

Address Fiscal, Performance, and Management Challenges, GAO-11-466T (Washington, 

D.C.: Mar. 16, 2011).

2

Auditing and Financial Management: Assessing the Reliability of Computer-Processed 

Data, GAO-09-680G (Washington, D.C.: Jul. 1, 2009).

3

Other factors relating to usefulness of information include completeness, timeliness, and 

ease of use. We limit the focus to accuracy and consistency because UNTAI is not the 

only tool State uses to monitor management reforms, and because determining whether 

the information produced using UNTAI is complete, timely, or easily used depends on the 

information State may obtain through other methods.

Appendix II: GAO Assessment of State’s 

UNTAI Assessment Tool

GAO’s Assessment 

Methodology 
Appendix II: GAO Assessment of State’s 

UNTAI Assessment Tool

Page 35 GAO-12-722 World Health Organization

2. Definitional judgment - Benchmarks that require a determination of 

scope, size, or meaning. These are benchmarks in which ambiguous

terminology or imprecise terms are used, which the assessor must 

define to assess whether the benchmark has been met. For example, 

this benchmark would require definitional judgment to determine if the 

level of qualifications and training would make an individual “qualified 

and trained.” Definitional judgment would also be needed to determine 

the proportion of the total number of professionals who must be 

“qualified and trained” for the agency to meet that benchmark.

We determined that 35 of the 50 benchmarks in UNTAI (70 percent) 

require neither subject matter expertise nor definitional judgment. Of the 

remaining 15 benchmarks, 5 (10 percent) require both definitional 

judgment and subject matter expertise to be assessed, 4 (8 percent) 

require subject matter expertise, and 6 (12 percent) require definitional 

judgment, which may affect the accuracy and consistency of the results 

for those benchmarks.

Of the nine benchmarks where subject matter expertise was required, we 

found knowledge would be needed in five relevant areas to complete the 

assessment: training and development, acquisitions and procurement, 

UN policies and practices, auditing and evaluation, and accounting 

standards. The accuracy and consistency of the individual determinations 

will depend, in part, on the assessors’ expertise in these five areas, and 

on their definitional judgment relative to other assessors. For example, 

one benchmark asks whether “funding arrangements facilitate effective 

and independent evaluations of the organization’s activities.” This 

benchmark requires subject matter expertise related to auditing and 

evaluation and definitional judgment about effectiveness to accurately 

assess the relevant UN agency. This judgment creates the potential that 

two assessors with different levels of subject matter expertise and who 

apply different definitional judgments could rate the same program 

differently. The potential variation in judgment and knowledge of the 

assessor could make the overall score of the UN agency vary from 2 to 5 

points on UNTAI’s 5-point scale. Guidance on how to assess each of 

these benchmarks would serve to mitigate the need for judgment and 

reduce the risk of inconsistency in the assessments.

Judgment Is Needed for 15 

of 50 Benchmarks in 

State’s Assessment Tool
Appendix III: Comments from the Department 

of State

Page 36 GAO-12-722 World Health Organization

Appendix III: Comments from the 

Department of State

Note: GAO comments 

supplementing those in 

the report text appear at 

the end of this appendix.
Appendix III: Comments from the Department 

of State

Page 37 GAO-12-722 World Health Organization
Appendix III: Comments from the Department 

of State

Page 38 GAO-12-722 World Health Organization

See comment 1.

See comment 2.
Appendix III: Comments from the Department 

of State

Page 39 GAO-12-722 World Health Organization
Appendix III: Comments from the 

Department of State

Page 40 GAO-12-722 World Health Organization

The following are GAO’s comments on the Department of State’s letter 

dated July 9, 2012. 

1. We recognize that some officers in the field completing the assessment 

may benefit from the expertise of those in the Bureau of International 

Organization Affairs. However, we maintain that the UNTAI tool does not 

provide sufficient guidance to reviewers to assist in making these 

judgments and that this could lead to potential data reliability concerns. 

Furthermore, according to an official at USUN-Geneva, improved 

guidance would be welcome and would help officials in the field complete 

the assessment tool. 

2. We recognize State’s concern about overburdening missions with 

reporting requirements and maintain that revised guidance would benefit 

both the missions and officers in Washington in preparing and reviewing 

these assessments.

GAO Comments
Appendix IV: Comments from the World Health 

Organization

Page 41 GAO-12-722 World Health Organization

Appendix IV: Comments from the World 

Health Organization
Appendix IV: Comments from the World Health 

Organization

Page 42 GAO-12-722 World Health Organization
Appendix V: GAO Contact and Staff 

Acknowledgments

Page 43 GAO-12-722 World Health Organization

Thomas Melito, (202) 512-9601, or melitot@gao.gov

In addition to the contact named above, Joy Labez (Assistant Director), 

Diana Blumenfeld, Debbie Chung, Lynn Cothern, Karen Deans, Mark 

Dowling, Etana Finkler, Emily Gupta, Steven Putansu, Jena Sinkfield, 

R.G. Steinman, Teresa Tucker, and Sarah Veale made key contributions 

to this report. Gifford Howland and Kara Marshall provided additional 

technical assistance.

Appendix V: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments 
Related GAO Products

Page 44 GAO-12-722 World Health Organization

United Nations: Improved Reporting and Member States’ Consensus 

Needed for Food and Agriculture Organization’s Reform Plan.

GAO-11-922. Washington, D.C.: September 29, 2011.

UN Internal Oversight: Progress Made on Independence and Staffing 

Issues, but Further Actions Are Needed. GAO-11-871. Washington, D.C.: 

September 20, 2011.

United Nations: Management Reforms and Operational Issues. 

GAO-08-246T. Washington, D.C.: January 24, 2008.

United Nations: Progress on Management Reform Efforts Has Varied.

GAO-08-84. Washington, D.C.: November 14, 2007.

United Nations Organizations: Oversight and Accountability Could Be 

Strengthened by Further Instituting International Best Practices.

GAO-07-597. Washington, D.C.: June 18, 2007.

United Nations: Management Reforms Progressing Slowly with Many 

Awaiting General Assembly Review. GAO-07-14. Washington, D.C.: 

October 5, 2006.

United Nations: Weaknesses in Internal Oversight and Procurement 

Could Affect the Effective Implementation of the Planned Renovation.

GAO-06-877T. Washington, D.C.: June 20, 2006.

United Nations: Oil for Food Program Provides Lessons for Future 

Sanctions and Ongoing Reform. GAO-06-711T. Washington, D.C.: May 

2, 2006.

United Nations: Internal Oversight and Procurement Controls and 

Processes Need Strengthening. GAO-06-710T. Washington, D.C.: April 

27, 2006.

United Nations: Funding Arrangements Impede Independence of Internal 

Auditors. GAO-06-575. Washington, D.C.: April 25, 2006.

United Nations: Lessons Learned from Oil for Food Program Indicate the 

Need to Strengthen UN Internal Controls and Oversight. GAO-06-330. 

Washington, D.C.: April 25, 2006.

United Nations: Procurement Internal Controls Are Weak. GAO-06-577. 

Washington, D.C.: April 25, 2006.

Related GAO Products
Related GAO Products

Page 45 GAO-12-722 World Health Organization

United Nations: Preliminary Observations on Internal Oversight and 

Procurement Practices. GAO-06-226T. Washington, D.C.: October 31, 

2005.

United Nations: Sustained Oversight Is Needed for Reforms to Achieve 

Lasting Results. GAO-05-392T. Washington, D.C.: March 2, 2005.

United Nations: Reforms Progressing, but Comprehensive Assessments 

Needed to Measure Impact. GAO-04-339. Washington, D.C.; February 

13, 2004.

United Nations: Reform Initiatives Have Strengthened Operations, but 

Overall Objectives Have Not Yet Been Met. GAO/NSIAD-00-150, 

Washington, D.C.; May 10, 2000.

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