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For decades, failures by the to respond to global health crises have drawn criticism and calls for reform by policy experts, governments and independent financial donors from across the world that contribute three-quarters of its US$4 billion annual budget.

Serious recent failures that have drawn fire include shortcomings in its response to the Ebola pandemic, health crises in Sri Lanka in 2009, Haiti in 2010, in 2013 and its current response to drug-resistant Tuberculosis in .

鈥淎n outsourcing approach would allow WHO to maintain global leadership and oversight but would utilise external expertise more appropriately,鈥� say authors and Dr Ranu Dhillon from Harvard University.

鈥淭his would allow the WHO to be leaner and more focused, and would increase the contribution of other actors. We believe such reform is essential to the future of the WHO and of global health action.鈥澛�

Most current proposals to reform the WHO focus on ways it could be made more effective and attract more funding. But Negin and Dhillon say more financial muscle and incremental reforms will no longer meet the challenges of preventing, predicting and responding to today鈥檚 globalising health crises.

鈥淲hen the WHO was established, there were few global health actors,鈥� says Professor Negin, who heads the university鈥檚 .

鈥淚ts unique positon meant it could bring the world鈥檚 best minds and skills to bear on global health issues. Today, global health issues occur in a complex, multi-actor arena where rival multilateral organisations have taken control over much of the global health action and agenda.

鈥淕iven the emergence of new global stakeholders and the realisation that the WHO is struggling to meet its mandate, we need solutions that focuses not only on what the WHO should do to strengthen itself but one that leverages the expertise that exists in the sector.鈥�

Negin鈥檚 co-author, says the WHO should 鈥渙utsource a number of its functions to other global agencies that are already leading the way. This would allow it to focus on a small number of core activities where it has comparative advantage and to coordinate or orchestrate the broader array of global health actors to take on other activities.鈥�

Negin and Dhillon say current WHO-functions that should be outsourced include technical matters such as research and surveillance, and on-the-ground responses to health issues and crises.

They point to agencies such as the , and 聽as better placed and qualified to execute many WHO tasks.聽

鈥淭he WHO was never intended to be an implementer of global health activities,鈥� says Negin.

In fact, its emphasises that its principal functions are co-ordination, collaboration with specialised agencies, providing assistance, and promoting co-operation 鈥� all of which resonate with the idea of WHO providing leadership but outsourcing key activities.

鈥淩e-positioning it as a regulator, orchestrator and clearing house of expertise would dovetail with its global reach and mandate but acknowledges its limitations.鈥�

Indeed, states on its website that subcontracting is a good model in complex environments: 鈥淚n addition, as new independent or autonomous actors come on stage, it becomes less easy to rely on hierarchical authority.

"This compels health actors to reconsider their relations. It is increasingly common for such relations to be based on contractual arrangements, which formalize agreements between actors, who accept mutually-binding commitments.鈥�

Though evidence is limited, the authors say outsourcing has been shown to be a in health systems that are in transition, especially in post-conflict or fragile states.聽

Reference: Negin J, Dhillon RS. Outsourcing: how to reform WHO for the 21st century. 2016;1:e000047