Introduction to comments on 'Outsourcing: how to reform WHO for the 21st century'

In 6 months, WHO will have a new Director General, who will likely start off by promising and identifying areas for reforms. One intent of such reforms will likely be to improve efficiency within the organisation. The commentary by Negin and Dhillon sought to provide one example of how WHO could improve efficiency—outsourcing functions for which WHO may not have a comparative advantage. The article received much attention on social media; it was described by Anant Bhan on Twitter as a provocative argument with some merit,¹ and Laurie Garrett compared outsourcing by WHO to the experience of outsourcing public sector functions, in an ironic tweet: “Yeah, works so well for prisons, security details, food safety.”²

While the argument for and against outsourcing have merit, it appears they are not being considered in ongoing conversations about WHO reforms. Contrarily, these discussions have seemed to favour an ever-expanding organisation; a preference that certainly has implications for efficiency and effectiveness; implications that are worth taking seriously in a global health landscape with ever-increasing number of actors. We present three important comments on Negin and Dhillon's article; all disagreeing with their argument, but nonetheless recognising an urgent need for change at the WHO. Their perspectives will be important for the incoming Director General, as much as Negin and Dhillon's response to these comments. Featuring this series of comments and response demonstrates our commitment at BMJ Global Health to being a forum for discussion and debate on issues such as this; issues in global health that do not get enough attention. We will do this from time to time.