ArticlePDF Available

Successful governance reform and its consequences: How the historical drive for shorter meetings and more time efficiency reverberates in contemporary World Health Assemblies


Abstract and Figures

The paper argues the working methods of the World Health Assembly (WHA) have been a recurrent object of reform discussions and that the vision that WHAs should become shorter has been a constant driver for them. It shows also how the vision of shorter WHAs was turned into reality and to what extent the consequences of these past reforms still reverberate today. With a view to the current debates, the paper suggests contemporary WHAs cannot be understood without considering past practices, and that some present problems are the (un)intended consequence of previous reforms. The paper concludes that reform is an inherent element of WHO governance: this kind of “self-reflection” will continue to be a time-consuming assignment for decision-makers also after the seventieth anniversary of the organization.
Content may be subject to copyright.
Successful Governance Reform and Its Consequences:
How the Historical Drive for Shorter Meetings and More Time
Efficiency Reverberates in Contemporary World Health Assemblies
Julian Eckl
The paper argues the working methods of the World Health Assembly (WHA) have been a
recurrent object of reform discussions and that the vision that WHAs should become
shorter has been a constant driver for them. It shows also how the vision of shorter WHAs
was turned into reality and to what extent the consequences of these past reforms still
reverberate today. With a view to the current debates, the paper suggests contemporary
WHAs cannot be understood without considering past practices, and that some present
problems are the (un)intended consequence of previous reforms. The paper concludes that
reform is an inherent element of WHO governance: this kind of “self-reflection” will
continue to be a time-consuming assignment for decision-makers also after the seventieth
anniversary of the organization.
While the World Health Organization (WHO), its reform, and its place in global health
governance enjoy intensive attention in scholarly debates,1 the present article takes the
experiences of practitioners including their continuous reform discussions as a point of
departure and analyses the history of WHO-governance reform in this light. Such an
inductive approach that starts with the lived realities of practitioners is common among
ethnographers regardless of their specific disciplinary background.2
The article complements research that emphasises the value of disentangling
apparently monolithic international organizations in order to explain specific outcomes. At
the same time, its starting point differs from most other research since the disentangling is
largely a consequence of methodology and was not primarily motivated by specific WHO-
related expectations. In particular, the article starts neither from concerns over WHO
fragmentation (as a consequence of regionalization and donor influence), nor from the
principal-agent relationship between member states and WHO, nor from the structural
conflicts among member states.3 Rather, it starts from ethnographic and
ethnomethodological concerns with “lived order” and “political work” that foreground the
fact that also prestigious work is earthly quotidian work where people have to overcome
practical challenges and tend to achieve this in a systematic manner.4 In line with this
reasoning, the article focuses on a specific aspect of WHO work, namely the multilateral
governing of the WHO whose key site (or workplace) is presumably the World Health
Assembly (WHA, or Assembly). The underlying analysis began with a visit to this central
site but it led subsequently to an interest in the historical dimension of present practices
and in the relationship of the WHA to other sites of WHO governance.
The role of the WHA as well as suggestions for its reform have been considered in the
literature before, but the WHA’s changing temporal organization and the consequences of
these reforms have so far not been systematically analysed.5 The project from which the
article emerged has a background in political science and its beginnings date back to 2010.
Starting from the discussions on competing fora and overlapping competencies, the project
was set up as a political ethnography in the course of which sites of global health governance
are visited in order to study the way in which the practitioners themselves try to come to
terms with the fragmented nature of the global health governance architecture.6 While this
underlying question plays an important sensitizing role, the project follows an open
research design as suggested by ethnographers and by proponents of grounded theory
that allows the researcher to investigate further those issues that emerge “on the way” rather
than sticking to predefined questions that were derived from the existing scholarly
literature.7 By the same token, the sites to be studied are selected incrementally following
a logic of holistic reconstruction and a logic of empirical comparison.8 For the purpose of
the article, the project period from 2014 onwards is particularly relevant since the analysis
of WHO-related sites started then.
As a consequence of the flexibility that open research designs allow for, it is common
for the research process and focus to change in ethnographic studies. Following this and
other traditions in ethnographic writing, the article will begin with a description of my first
visit to a WHA and how this drew my attention to the issue of WHO reform, or, more
specifically, WHA reform. The interest in reform, in turn, raised the question of how reform
efforts previously emerged and correspondingly, the article then considers the history of
WHA reform. The particular focus of the historical analysis will be on how temporal factors
influenced and importantly still influence practitioner behaviour. The article then
concludes with revisiting the contemporary concerns around WHO reform in light of the
historical analysis, and considers some of the implications that arise.
From a methodological point of view, the article begins with material generated via
participant observation before undertaking an analysis of historical documents, and then
returns to insights gained from participant observation. In this way, the article illustrates
the seamless complementarity of these two methods: participant observation generated
questions that were then addressed through document analysis, and subsequently
(re)embedded the findings from participant observation. The complementarity of these two
methods is not particularly surprising from the perspective of disciplines that have long
relied on ethnography, but scholars of political science and international relations might
find this illustration useful since it emphasises that ethnography should not be reduced to
participant observation.9 While each step in the research process leads to several follow-up
questions, the article as a whole addresses the following closely interrelated questions: What
characterises the temporal organisation of the WHA, how did it develop historically, and
what consequences follow from it under contemporary conditions?10 The analysis will show
that in spite of an increasing number of WHO member states and WHA agenda items, the
WHAs have become progressively shorter. It will also reconstruct through which reforms
this was made possible and what other consequences these reforms had. For example, it will
conclude that the growing complexity and multi-sited nature of the WHA poses a challenge
to in-depth discussions and blurs the roles and responsibilities of the delegates. The partial
outsourcing of decisions to other formal bodies such as the Executive Board (EB) or to
informal meetings has greatly transformed the role of the WHA within the WHO. Through
an ethnographic focus on organizational practices, scholars can capture such subtle
transformations and the contradictory and unintended outcomes of organizational reform.
The WHA is the WHO’s supreme decision-making body and it was therefore an instinctive
location to start an analysis of WHO-related sites of global health governance.11 In preparing
for my first visit to a WHA in 2014, I consulted the preliminary issue the World Health
Assembly Journal in order to develop a sense of how the WHA was going to be organized
on a day-to-day basis.12 The information contained in the document was concise and
straight forward but in the section ‘Date, location and working hours’ I was surprised to read
that the working hours of the WHA were from 09:00 to 12:00 and from 14:30 to 17:30.
Somewhat puzzled, I wondered whether six hours per day were really a sufficient amount of
daily working hours and what happened outside of them. After all, how would people spend
their time during a lunch break that lasted for two and a half hours?
While the opening sections of the Journal had created the impression that the WHA
was a leisurely environment, it did not take long to appreciate that the Assembly was much
more complicated. Going through the subsequent section ‘Tentative programme of work of
the Health Assembly’ it became clear that even during the official working hours there were
parallel and overlapping meetings. For example, Committee A seemed to begin its work
while the plenary meeting was still underway. Moreover, not all meetings would run the
entire allocated time, and some meetings seemed to be prioritized since no other meetings
were scheduled in parallel. My initial impression of the WHA was further undermined when
I considered the sections ‘Technical briefings’ and ‘Other meetings’ where two things
became clear. First, there had actually been preparatory meetings in the days leading up to
the WHA and, second, there was going to be a multitude of meetings before 9:00, during
the lunch break, and after 17:30. But this was just the beginning.
As I realized when actually attending the WHA, the Journal covered only those
meetings that had been planned beforehand, that took place in the Palais des nations (or at
WHO headquarters), and that were somewhat formalized. It did not cover the multitude of
additional parallel meetings as well as side-events outside of the Palais. Moreover, the
official working hours could be formally expanded by setting up evening sessions and also
drafting meetings or other gatherings could run late into the night. Finally, on top of all this
there would be countless informal meetings and conversations in the hallways, cafés, and
restaurants. In short, even the complex account in the rear sections of the Journal provided
only a partial overview of proceedings.
While I had for a moment feared that the WHA might consist of long breaks and
uneventful sequences, it turned out to be a busy and bustling site where it was entirely
possible to miss a key event by being at the wrong place at the wrong time. Instead of having
to find activities to occupy my time over lunch, I found it increasingly difficult to eat at all.
These time pressures only worsened the longer I attended the WHA, as I learned about more
and more of the parallel processes. Towards the end of the WHA and even more so at the
next WHA in 2015, I struggled to access formal meetings as there were either overlaps with
side-events or I found myself remaining in hallways and social areas to talk with individual
participants. These experiences revealed the WHA to be not just one, but multiple sites of
In stark contrast to the usual bustle, the WHA concurrently gave the impression of a
void ritual. While such moments were not limited to plenary meetings, it was in the
Assembly Hall in particular where this emerged. First, while on the first day of the WHA
and during some specific agenda items on subsequent days the Assembly Hall might be
filled with delegates and spectators, for the majority of the time the room was less than half
full. Moreover, a significant proportion of the work in the Assembly Hall appeared to have
been pre-approved, as though decisions had been taken elsewhere previously. But even
when an exchange of views was foreseen, there was still no real interaction or discussion.
Rather, it was an endless array of speeches that had been written beforehand and read out
by delegates who came to the rostrum one after the other. In such moments, the comment
of an interlocutor who had claimed that the Assembly Hall was referred to as “the cage” by
some delegates gained some plausibility. In other words, there were phases during which
the setting was stilted and time seemed to stand still.
The fragmented nature of the WHA, the time pressure that the parallel processes put
on delegations and on individual delegates as well as (their contrast to) the WHA’s ritualized
aspects are among the reasons for which there is also a constant debate among the
practitioners on the need to reform the WHA in particular and the WHO in general.
Actually, I found it striking to see how many of the participants engaged in discussions on
the structure rather than on the content of the policy-making process. While the criticism
of the participants varied strongly, for example, in its radicalness or in the degree to which
they considered the WHO as capable of reform, it became difficult to imagine that one could
attend a WHA without facing some version of internal criticism. From this perspective, the
most recent WHO reform process that emerged a few years ago had to be seen as a catalyst
rather than the sole reason for such discussions.13
Through conversations with delegates as well as based on my own experiences at the
WHA, I started to develop an interest in the question of how the relationship between the
seemingly constant debates about reform and the present state of affairs had developed
historically. There were two considerations in particular that arose my interest. First, it
would have been strange if previous generations of participants had not reflected on their
work in a similar manner since some of the enabling factors for such reflections had not
changed. For example, the professional diplomats among the participants had also
previously been assigned to Geneva for a time-limited period, which implied that, like now,
there would have been a constant influx of novices who would not necessarily take
everything for granted and would have to go through the same learning process I had
experienced. Second, it occurred to me that some of my interlocutors expressed opinions
that the governance processes could be improved along one specific dimension, namely,
time efficiency. This one-dimensional take on the issue interpreted reform as a case of
optimization where (political) trade-offs and unintended consequences are not necessarily
considered. If past reforms had followed a similar line of thought, it appeared quite likely
that some of the present problems with the WHA could be the (un)intended consequences
of previous reforms.
These considerations made it apparent the synchronic account that was based on
participant observation should be complemented with a diachronic element that needed a
research design of its own while the field research could be continued (i.e. additional sites
such as meetings of the Executive Board [EB], but also later WHAs were, visited). With a
view to the newly added historical dimension, the following question had to be addressed in
a first step: How should the past reforms be identified, and more specifically, how should
the documents be identified that contain information on the substantive content of these
past reforms as well as on the accompanying discussions? The sampling strategy that was
eventually chosen could be called diachronic snowballing since it took changes to the rules
of procedure of the WHA as a starting point for the identification of reform debates.
The idea behind this strategy was that, even though reform discussions will usually be
broader than the eventual changes, some traces of previous discussions should still be found
in amendments to the WHA rules of procedure. Once these had been identified via specific
WHA resolutions, it should be possible to identify the WHA’s at which reform discussions
had occurred. Moreover, the additional resolutions, background documents (including EB
documents), and discussions offered the prospect to cross-reference failed reform attempts.
This sampling strategy seemed to be particularly apt for an ethnographic study of past
reforms since it would be possible to identify changes in formal rules (i.e. amendments to
the rules of procedure), and allow to understand past practices as described in resolutions,
background documents, and accompanying discussions. This method of diachronic
snowballing proved productive and I successfully located multiple documents.14
Facing this rich corpus of text, I narrowed the focus of my analysis to the temporal
considerations that prompted this study: time and timing, which also included discussions
surrounding time efficiency. From here, resolutions were given first priority while
background documents such as verbatim and summary records were selectively consulted
when other documents did not provide enough detail to understand the changes which had
been made or the rationales behind them. Finally, falsificatory reading, which encourages
the analyst to continuously search for evidence that refutes rather than confirms the
interpretation of a text, was applied when analysing the documents, thereby avoiding
premature interpretations.
The rules of procedure as they can be found in the 48th edition of the Handbook of Basic
Documents (2014) served as the starting point for the diachronic snowballing described
above. While this sampling strategy worked as envisioned, a small adjustment was required
due to the fact that WHA8 (1955) made such extensive amendments to the rules of
procedure that eventually a completely new text was adopted and only the amendments to
the WHA8 text are documented in contemporary editions of the Handbook of Basic
Documents. As a result, the sampling strategy was adjusted to accommodate the fact that
the pre-WHA8 text of the rules of procedure and any associated amendments had to be
reconstructed from historical editions of the Handbook of Basic Documents.15
Following this new strategy, 42 resolutions were identified on the basis they amended
either the rules of procedure that had been adopted at WHA1 (1948) or the revised rules of
procedure adopted by WHA8. These 42 resolutions were passed at 32 different WHAs and
there are only two phases during which no changes to the rules of procedure were made for
more than three years in a row: 1989 to 1994 and 1998 to 2003. This shows that even if one
relies on the very narrow indicator of “resolutions passed that changed the rules of
procedure”, governance reform has been a constant feature of WHA history.16 At times this
was also noted by the participants themselves and, for example, in 1979 the EB considered
“that the method of work of the Health Assembly need not be reviewed every year, and that
it would be desirable to have such a review undertaken only in the light of experienced [sic]
gained over a period of several years”.17
Drawing on the identified documents, time and timing emerged as a recurrent theme in the
historical reform discussions. The duration and frequency of WHAs proved to be of
particular concern. Somewhat confusingly, however, a number of the statements on the
issue proved contradictory. On the one hand, some documents argued that measures should
be taken to prevent the WHAs from becoming longer. These contrasted with other
documents that argued the WHAs should be shortened. Reading these contradictory
concerns, it became clear that a meaningful analysis of time and timing could not be
conducted without understanding how the duration of the WHAs developed historically.
Such knowledge would be particularly relevant in order to judge whether the goals of the
reforms were achieved, namely whether member states had succeeded in reducing,
maintaining, or extending the duration of WHAs.
How much time does it take to govern?
From here, I consulted the official records of all past WHAs paying particular attention to
the duration of each WHA (in days from the opening to the closure). These results are
summarised in Figure 1.
As this data clearly shows, the WHAs’ duration has been progressively reduced even
though there were also long periods during which their length was kept relatively constant
or varied only marginally. In other words, the past vision that future WHAs should be
shorter has clearly influenced behaviour. When it comes to time and timing as an object of
reform, the questions that arise include: when did this vision emerge, did it undergo
changes, and through which more specific reforms did it become a reality? In the following,
I present the most relevant time-and-timing-related reforms as they have been extracted
from the sample. While chronology will be the main ordering principle, the reconstruction
of the main themes will sometimes make it necessary to depart from a strict chronology.
There are six main themes that emerged from the material and will be discussed in the
following: the general vision (or grand strategy), the speaking time and the duration of
interventions, the introduction of a biennial rhythm, the political will to fix and limit the
duration of WHAs, the general scheduling of meetings that included discussions on the
desirability of parallel meetings in particular, and, finally, the role of the technical
discussions that became eventually technical briefings.
Figure 1. Duration of each WHA in days
Source: (WHO’s WHA documents; graph: author)
How can governance be made more time-efficient?
The amount of time spent at WHAs was identified as a concern early in the history of the
WHO and there are two visions, or grand strategies, that emerged for dealing with the time
problem. While it was not the first occasion at which they were discussed, the two
alternatives were explicitly outlined at EB11 (1953). The goal of the first strategy was to
reduce the duration of individual WHAs,18 whereas the second proposal was to lessen their
frequency by changing to biennial WHAs.19 No amendments were approved at WHA6
(1953) which followed EB11, but member states did request “the Director-General to
continue to prepare and organize the sessions of the Health Assembly with a view to limiting
their duration to a reasonable minimum compatible with the agenda of the session”20 and
postponed the discussions on the frequency of WHAs.21 WHA11 (1958) and WHA12 (1959)
revisited the proposals again and concluded that biennial WHAs were not feasible. A
reduction of the duration, however, was considered more feasible even though it was also
acknowledged that the increasing number of WHO members largely as a consequence of
decolonization would make this challenging.22
The reduction of the length of WHAs as the preferred alternative remained on the
agenda of WHA13 (1960) and WHA14 (1961) but did not lead to major changes.23 This was
despite the fact that fear over increased membership leading to protracted WHAs was
repeatedly discussed. In the following year, WHA15 (1962) effected an amendment to the
rules of procedure and introduced the possibility the President of the WHA would limit the
speaking time or close the list of speakers.24 This specific proposal was further clarified at
WHA20 (1967) that recommended to limit speaking time for general discussions in the
plenary to ten minutes; in the same resolution, member states decided that “delegates
wishing to do so may submit prepared statements, preferably of not more than twenty
typewritten pages, double-spaced, for inclusion in extenso in the verbatim records of the
plenary meetings”.25 WHA23 (1970) appealed to limit speakers’ length of time to make
interventions in the main committees,26 a point that was reiterated again a couple of years
later at the WHA25 (1972).27 The arrangements for the plenary meetings, however,
remained in place until WHA50 (1997) when the speaking time was reduced to five minutes
and the length of written statements to 600 words.28 This is still common practice today and
resolution WHA50.18 continues to be quoted when the President of the WHA explains how
the general discussion in the plenary (usually Item 3 on the agenda) will be conducted. In
the main committees, the current practice is to limit speaking time to three minutes.29
Around the same time at which the first arrangements on speaking time emerged,
another novel proposal began to be discussed, namely, a biennial programme and budget.
While this idea had been first tabled at WHA22 (1969) it was not enacted (on a trial basis)
until WHA25 (1972) with the intended purpose of improving the efficiency of the WHA.30
In particular, by distinguishing between WHAs that would undertake “a full review of the
proposed programme budget for the following biennium” and alternative meetings that
would only conduct “a brief review of the changes in the programme budget for the second
year of the biennium”,31 the general distinction between budget and non-budget WHAs
emerged a practice that is still retained. Following a trial period, the biennial rhythm was
introduced in earnest for the 1980-1981 biennium (i.e. for WHA33 and WHA34).32 Once
introduced, WHA33 (1980) revived the former proposal of biennial WHAs and
recommended the necessary changes to the WHO’s Constitution.33 While this
recommendation was not implemented,34 it reinforced the idea that less time was needed in
non-budget years, which led eventually to a difference in duration between budget and non-
budget WHAs.
The difference in duration was, however, not merely the consequence of a division of
labour between budget and non-budget WHAs. It was just as much the consequence of the
political will to fix and limit the duration of WHAs. As discussed above, debates regarding
the preferred length of WHAs had arisen early in the history of the WHO. It was, however,
only at WHA30 (1977) that an important change in practice emerged. Until then, it had been
common practice that the EB determined the starting date of each WHA, while the closing
date was set in the course of the WHA. Following a recommendation by the General
Committee, WHA30 requested the EB “to fix also the duration of each session”.35 This
innovation allowed EB63 (1979) to specify that WHAs should normally not last longer than
three weeks.36 The aforementioned WHA33 (1980) that recommended the introduction of
biennial WHAs also expressed the belief that while waiting for the necessary constitutional
changes, non-budget WHAs should be limited to no more than two weeks.37 While rejecting
the idea of biennial WHAs, WHA34 (1981) specified the two-week limit for non-budget years
should be introduced from 1982 onwards (also on a trial basis).38 Finally, WHA36 (1983)
confirmed the decision and set a maximum duration for budget years by stating that, in odd-
numbered years, WHAs should be limited “to as near to two weeks as is consistent with the
efficient and effective conduct of business”.39
As can be seen from Figure 1, in the two biennia following the introduction of the
biennial planning rhythm (i.e. WHA35 [1982] to WHA38 [1985]), the new rhythm had an
initial, albeit temporary impact on WHA duration. This impact then dissipated for almost a
full decade before returning in the 1992-1993 biennium (WHA45 and WHA46). Since that
time, the trend whereby WHA duration fluctuates between two and three-weeks length,
depending on whether it is a budget planning year, has been evident.
The biennial rhythm strategy, the limitation of speaking time, and the political will to
limit the duration of WHAs were accompanied by several additional changes that are
important for understanding the continuous reduction of time allocation for WHAs. Two
additional changes are especially notable. The first was the introduction of parallel meetings
a practice which is now common. The utilization of parallel meetings and the manner in
which they were conducted initially proved so controversial that there was a period whereby
the decision to allow them was temporarily reversed. The initial step was taken by WHA28
(1975) that de-prioritised the plenary meetings thereby permitting the main committees to
work in parallel.40 WHA32 (1979) by contrast decided that “neither main committee of the
Health Assembly shall meet during plenary meetings of the Health Assembly” and
discontinued the practice.41
The decision was based on a recommendation of EB63 (1979) that considered a report
by the director-general on this matter. In the report, the director-general outlined
supportive and critical perspectives on parallel meetings, but the report seemingly
concluded to be in favour of them. In particular, the observation “that this procedure had
the effect of leaving the Assembly Hall almost empty, since most delegations did not have
sufficient members to attend two meetings held simultaneously” was put in perspective by
stating that “it is possible that as in earlier years, when no committees met during the
general discussion in plenary, this impression may sometimes be conveyed by the large size
of the hall”.42
While WHA32 (1979) had agreed with the critics of parallel meetings described in the
director-general’s report, the decision to discontinue parallel meetings was short-lived.
WHA35 (1982) reintroduced parallel meetings and went beyond even previous provisions
by allowing the plenary and one of the main committees to work in parallel to the technical
meetings.43 While WHA35 had introduced these changes on a trial basis and had applied
them immediately to its own proceedings, WHA36 (1983) made the changes permanent.44
WHA36 (1984) linked these changes explicitly to the political will to limit the duration of
the WHA and the graph in Figure 1 highlights that, starting with WHA35 when the changes
were introduced on a trial basis, these efforts were also met with success.
The second notable change was the move away from technical discussions over multiple
days to technical briefings during lunch breaks as they are common now. This change in
practice was initiated at WHA44 (1991) when it was decided to conduct technical
discussions only in even-numbered years. 45 WHA48 (1995) went one step further deciding
that, “from [WHA49] in May 1996, and on a trial basis, Technical Discussions will be
replaced by a limited number of well-organized technical briefings and by informal forums
for dialogue”.46 While the decision led to a phase during which different kinds of formats
were tested, the abandonment of the technical discussions was still a major change. The
magnitude of this shift can be illustrated by recapitulating the technical discussions during
WHA8 (1955) that were particularly elaborate (and even a continuation of the technical
discussions from the preceding WHA7 [1954]).47 WHA8 took place in Mexico City and the
topic of the technical discussions was “public-health problems in rural areas”. The technical
discussions started with two days (Saturday and Sunday) of field trips to rural areas in
Mexico, continued with half a day of discussion during the week that followed and were
concluded during a final session of one and a half hours on the subsequent Saturday.
Overall, the time spent on the technical discussion at WHA8 was reported as the equivalent
of two working days and there were no parallel meetings during these discussions. While
the field trips as such seem to have been rather unusual, it was common for decades that the
technical discussions would last for the equivalent of around two working days and there
were repeatedly comments suggesting that even more time would have been needed.48 In
any event, the shift by WHA48 from technical discussions to technical meetings over lunch
has certainly contributed to shortening WHA duration.
As noted above, these changes in WHA practice reveal the working methods of the
WHA have been under continuous reform. For the purpose of this article, the analysis of
these reforms focused on time and timing, which proved to be a recurrent theme. In light of
the contradictory predictions about the future duration of WHAs, it was initially unclear
how the duration of the WHAs had evolved over time, but as Figure 1 shows, there was
actually a long-term trend towards ever shorter WHAs. Figure 1 further reveals that, over
the years, the biennial rhythm that was introduced in earnest for the 1980-1981 biennium
(WHA33 and WHA34) increasingly determined WHA duration. The progressive reduction
of WHA duration was not an accidental outcome, but reflected a conscious (collective)
decision of member states. While it is rather obvious that the self-set goals were reached,
we can now turn to the question of what further consequences the changes had and how
they reverberate in contemporary WHAs.
This involves another round of combining methods; so far, document analysis has
added historical depth to the initial participant observation described at the beginning of
the article; in the following, the discussion of the (un)intended consequences of past reforms
will build on these insights while being enriched with relevant insights from participant
observation that, as mentioned earlier, continued in parallel to the historical research and
is still on-going. Most importantly for the present purpose, I have not only revisited the
WHA in subsequent years but have also observed the proceedings of the other key decision-
making bodies (or sites) in the WHO’s annual policy cycle, i.e. meetings of the EB, meetings
of the EB’s Programme, Budget, and Administration Committee (PBAC), and meetings of
Regional Committees (RCs).49
When WHA participants read through the preliminary issue of the World Health Assembly
Journal, they interpret an artefact that indirectly documents decades of reform. For
example, the fact that (the latest possible) end date of the WHA has been set before the WHA
has even started was once a novelty; similarly, the way in which plenary meetings and
meetings of the main committees are scheduled, alongside the rule that no more than two
of these meetings should take place simultaneously, are the consequence of efforts to use
time efficiently while trying to limit the amount of parallel processes; furthermore, the
technical briefings over lunch reflect more recent reforms to the WHA.
There are, however, also various other artefacts and practices that one inevitably comes
across when attending a WHA and that appear in a new light when placed in broader
historical context. For example, both plenary meetings and the meetings of the main
committees are governed by a ‘traffic light’ system. At the beginning of a speaker’s
intervention the light is green before eventually turning yellow and then red when the
speaking time is over. While it is not common to interrupt speakers, once an overlong
intervention has been concluded, the Chair will often comment on the fact that the traffic
light had already turned red. As strange as this system might appear to outside observers,
and as restricting as the time limit might be for individual participants, from a historical
perspective it is a wonderful illustration of the time pressure under which the WHA
If one considers how successfully the WHA has been shortened in spite of the fact that
ever more states have joined the organisation and even though the number of agenda items
has substantially increased, it is striking that the desire for an abbreviated WHA still
remains. It is not uncommon, for instance, to find delegates and observers who argue that
the WHA is too long and that it has to become more efficient. There are two considerations
in particular that help to make sense of this striking observation.
First, (time-)efficiency is an open-ended project since it sets a relative goal and does
not contain a self-evident cut-off point at which the envisioned goal has been reached.51 By
the same token, after each round of reform, increased efficiency can be pursued anew.
Second, this self-perpetuating logic of ‘increasing efficiency’ is also propelled by paradoxical
effects of the continuous reform efforts. Such effects are particularly obvious in the case of
plenary meetings that run in parallel to other meetings, are attended by few participants,
and are effectively devoid of any genuine debate. The outcome is a combination of measures
to guarantee time efficiency has created practices that are not just highly scripted but also
lacking the attention of a broader audience. A lack in audience, in turn, will inevitably be
seen as a lack of relevance, thereby reinforcing the impression of ritualized proceedings. The
end result is paradoxical situation whereby reform, in the pursuit of efficiency, has turned
some activities into ‘mere rituals’ which, in turn, has led to further discussions about the
need for greater efficiency or abandoning these activities altogether.52
In addition, past reforms have led to further (presumably) unintended consequences
for WHA proceedings. As predicted and outlined in the historical records, delegations
struggle with the parallel processes and with the crowded WHA programme that, at times,
stretches beyond the official working hours. This understandably adversely affects small
delegations in particular, and undermines the principle of member state equality. Yet, when
viewed collectively the effect on all delegations has been to negate traditional boundaries
between delegates, alternates, and advisers as envisioned in the WHO Constitution and in
the rules of procedure. For individual delegations it is often more important to be constantly
represented in meetings rather than having a particular person in a specific formal role
present.53 This tendency to treat all members of a delegation as interchangeable in order to
participate in parallel processes does, however, not always overlap with the participants’
own perspective and there are regularly moments at which they consider themselves to be
at the wrong place at the wrong time or at which they wonder why another country sent an
unexperienced intern to a discussion they view as crucial.
Another issue that affects all delegations and by default the WHA is the tension
between an enabling environment for serious discussions and the constant pressure to move
forward on the agenda. While lengthy discussions are generally feared by WHA participants,
discussion and debate is understandably important for achieving consensus and improving
the quality of an outcome. If, however, the evaluation of WHA proceedings focuses primarily
on time efficiency there is the danger of marginalizing the value of discussion; the shift from
technical discussions to technical briefings could be interpreted as one illustration of this
phenomenon. While it can be appreciated that longer discussions do not automatically
guarantee better debate or consensus, a focus on efficiency invites more attention being
allocated to temporal considerations than quality. As illustrated by Figure 1, the fact that
WHA duration has been reduced might be interpreted by some as having enhanced the
efficiency of the annual meetings. It does not, however, automatically follow that the quality
of discussions or their outcome has been enhanced by these reforms, as this is ultimately
subject to divergent frames of reference and competing political perspectives.
Indeed, the amount of time available for discussion can be an important prerequisite
for reaching consensus, which has become the WHA’s preferred mode of decision-making.
From this perspective, lengthy discussions are not necessarily the consequence of poor
organization but can be a sign of genuine disagreement over competing ideas, values and/or
methods. If there is no time to reach a genuine consensus, a decision may still be taken but
might lead to a less than ideal outcome. Alternatively, the required time might be gained by
setting up a drafting group which will add to the aforementioned challenge of parallel
processes, or the issue might be postponed to a later WHA and in extreme cases to a
completely different decision-making body resulting in an ‘outsourcing’ of discussions.
It is within this context that the EB has become to some extent a ‘mini-WHA’ in that
even member states that are not among the EB’s 34 elected members attend its meetings
and participate in the discussions. Similarly, while the Programme, Budget and
Administration Committee is officially a committee of the EB, it has not only become a key
preparatory meeting for the EB in January but also for the WHA in May. Moreover, like the
EB, the PBAC is not only attended by its 14 elected members but also by other member
states. In both cases, the rising number of member states who attend are evidence of the
increasing significance attributed to these bodies as sites of governance. Moreover, while a
discussion of specific agenda items by the EB and/or by PBAC does not formally preclude
discussions at the subsequent WHA, there is nevertheless a preference to not ‘re-open’ the
debate in order to save time.
From this perspective, it is reasonable to conclude that while both increased WHO
membership and agenda items did not prevent reducing the WHA’s duration, time pressure
has necessitated shifting some of the discussions that would otherwise be had in the WHA
to other WHO sites of governance. Further, in spite of the expanding numbers of member
states who attend the EB and PBAC, it is still often the case that fewer member states are
represented at these meetings when compared to the WHA where all 194 member states
hold a seat. In other words, while legitimate concerns were previously raised about
increasing WHO membership and WHA duration, the ‘solution’ to the problem seems to
have been to move discussions to bodies with a smaller, less representative membership
The rising relevance of the EB and the PBAC, as well as the number of associated WHO
intergovernmental meetings, highlights the temporal constraints that have been
increasingly placed on the WHA. Yet, the trend described above of moving to alternative
sites of governance is, in fact, even more complex and ambiguous. For example, the
importance of the WHA as a forum for discussion and debate appears to largely depend on
the specific agenda item. While some issues seem to have been effectively settled before the
WHA, others are allocated time for discussion.54 Moreover, there has been a discernible
trend whereby the number of registered participants is increasing over time. If this
phenomenon is taken as an indicator of relevance, then the WHA is growing in importance
as a site of governance. At the same time, these numbers have to be treated with care since
the WHA, as described above, comprises several parallel processes and some participants
may be highly selective in which meetings they decide to attend.
Having said this, the ambiguity of the WHA can also be interpreted as the consequence
of an on-going struggle over time as a source of power. Specifically, representative bodies
need to be able to control their proceedings and manage their time effectively, as it ensures
a measure of independency and can assist in meeting internal standards of inclusiveness
and quality.55 Conversely, representational bodies are also dependent on their operating
environment to provide them with the necessary resources to conduct their work, but this
environment can be prone to change. For example, a view may develop amongst the
members of a representational body that much less response time is needed or that
competing institutions will fulfil the tasks even better. Against this background, it could be
argued that the WHA has been able to retain its unique position in the WHO’s annual policy
cycle even though some discussions have moved to other WHO meetings.
At the same time, shifting the level of analysis offers yet another interpretation on the
utility of the reforms described above. If the WHO is viewed in its entirety as the decision-
making body, it could be argued the internal reforms such as permitting some discussions
to be held outside the WHA have allowed the organization to take on more contemporary
challenges issues that the WHA would not otherwise have the capacity to deal with. In
other words, in spite of the much-quoted fragmented nature of global health governance
and the WHO in particular, the WHA in teamwork with other WHO bodies has been
able to defend its role, ensure its continued relevance, and structure the global annual
health-policy cycle. Indeed, this is arguably evidenced by the fact that other global health
meetings are still organized around the WHA and by the aforementioned continuous
increase in participants.56 This success comes however at the price of a relative loss of
significance within WHO, the ‘cost’ of including parallel processes as well as other measures
to increase efficiency, and at the risk of continuous criticism concerning its efficiency.
Lastly, there are also significant implications for inclusiveness and transparency when
important discussions occur outside of the WHA. As noted above, the PBAC and EB are
traditionally attended by less member states than the WHA. Importantly, however, there is
also a distinction in the types of member states attending these meetings: elected members
that participate with certain privileges including the right to vote, and all other member
states. For non-governmental organizations (NGOs) in official relations with the WHO it
also makes a difference where discussions take place: while they are permitted to participate
in the WHA and EB meetings in reading statements, they are not permitted to attend PBAC
meetings and some other WHO intergovernmental meetings. This situation is similar for
members of the general public in that while the WHA and EB are accessible and now
webcast, PBAC meetings are closed and webcasting practices have varied. The lack of
transparency is even more severe in the case of intergovernmental meetings, which are
neither open to the public nor webcast.
Moreover, there is a negative correlation between the importance of discussions and
their preservation in the WHO’s official records. The most comprehensively documented
aspect of WHO’s annual policy cycle are the ritualized plenary meetings in the Assembly
Hall whereby verbatim records preserve member states’ interventions. Since WHA64 (2011)
the WHO secretariat has also sought to make these interventions available as audio files. By
contrast, the proceedings of the main committees and the EB are documented as summary
records while the PBAC produces only a condensed report of its meeting. Intergovernmental
meetings usually generate an outcome document while the discussions that were held to
arrive at that consensus are not captured. In other words, there is a great variation in the
degree to which the official records are rich in detail or a mere summary of key points.
Finally, in the case of all of the other parallel processes at the WHA, the situation is even
worse for a retrospective analyst since even the ones mentioned in the Journal will usually
not be documented systematically, if at all.
As may be appreciated, therefore, the implications arising from the overwhelming focus
on time efficiency undermine the concept and practice of legitimate governance. This can
even lead to situations in which one reform effort undermines another. Webcasting of
governance meetings, for instance, was introduced only recently, but since this practice
applies to some meetings while excluding others, the ever increasing relevance of non-
webcast meetings undermines the organization’s overall reputation as a site of transparent
governance.57 While the present article with its focus on practical challenges that WHA
participants face collectively leans towards interpreting such contradictory outcomes as
the unintended consequences of one-sided reform efforts, it could be argued they reflect the
structural conflicts and power relations among member states. From a structural
perspective, there is a reasonable chance that the undermining of inclusiveness and
transparency is not a coincidence but the consequence of the ever-present tendency towards
informal governance that privileges structurally powerful states.58 Regardless of whether
these changes were brought about intentionally or not, the negative consequences on
inclusiveness and transparency as well as the aforementioned challenges they pose for less
resourceful delegations in particular are significant in any event.
One consequence of the various reform efforts described above is that the lived experience
of participants attending a WHA will vary considerably. Depending on which of the multiple
parallel meetings participants attend, and depending on what particular aspect of the
WHO’s work a participant is interested in, a WHA can appear as either a highly satisfactory
and dynamic event, or as an arduous ritual with a lot of scope for further shortening. In the
latter case, many participants would probably consider the plenary meetings as the most
obvious feature of the WHA for further reform. Yet conversely, the pervasive ambiguity of
the WHA can conceivably be best illustrated by the role of the technical briefings if the
topic is of particular interest, the technical briefing can be an exciting experience. Where
participants attend out of duty though it is entirely possible the presentations appear as dull
and overlong. This multiplicity of perspectives and experiences has two implications that
point into two different directions regarding future reform discussions.
Firstly, it raises the question of whose WHA matters and what kind of participants
should find it appealing. In slightly simplistic terms, the WHA could either be seen as a
forum that attracts people with a keen substantive interest in specific issues of global health
by offering them an environment in which they can contribute to discussions and engage in
mutual learning (not only in the course of technical briefings but also during meetings of
the main committees), or it could be seen as a forum in which generalists efficiently take
decisions and pass resolutions. Delegations try to bridge these two worlds by including
people from different ministries and with different backgrounds but they can still not evade
this tension and I have often been struck by the divergent perspectives on WHA priorities
even within delegations. Taking these divergent perspectives into account and considering
that the supporters of efficiency in particular have been listened to for decades, it seems
important that assessments of the WHA also consider the requirements of (public health)
experts and the functions of the WHA beyond taking decisions and passing resolutions in
the narrow sense of these terms.
While such a reluctance to try to optimize the WHA along one dimension stands in
contrast to calls for a further increase in time efficiency, the second aspect that has to be
discussed in this context points into the opposite direction. Indeed, it seems quite likely that
the multiplicity of perspectives will reinforce the aforementioned self-perpetuation of the
‘efficiency project’ thereby keeping time and timing as well as WHA governance high on the
agenda well into the future, even though this part of WHO reform has arguably been much
more successful in reaching its objectives than others.59 The lived reality of governing the
WHO is something that all WHA participants can relate to; the multiple dimensions of the
WHA, the fact that the search for consensus can quickly become time consuming, and the
consideration that ‘delays’ in consensus-seeking will usually be interpreted as being caused
by others, make it very likely that all participants will at one moment or another have had a
somewhat frustrating experience with the WHA. From this perspective, it looks likely that
the notion of accelerating the process will, also in the future, appeal to most participants;
although the underlying sense of redundancy will probably have emerged at different
occasions and for divergent reasons.
This suggests that, in the case of WHA governance reform, the participants do not need
any scholarly encouragement for reform at all; quite to the contrary, it might sometimes be
helpful to remind them of the consequences of past reforms and of the typical drivers for
reform. A key problem might actually be that the participants think too much about the
question of how to improve the WHA further and thereby lose sight of the multitude of
other, more substantive challenges that the WHO faces in its daily work but which are often
beyond the personal (and procedural) experiences of WHA participants. The crux of the
matter is that WHA reform has certainly led to time efficiency but constant reform and
continuous reform discussion cost also time and energy. Moreover, their (un)intended
consequences create new challenges.
Julian Eckl is a post-doctoral researcher and lecturer at the University of Hamburg.
1 See Kelley Lee, The World Health Organization (WHO) (London: Routledge, 2009); Kelley Lee, Sue
Collinson, Gill Walt and Lucy Gilson, “Who should be doing what in international health: A confusion
of mandates in the United Nations?”, British Medical Journal (BMJ) 312, no. 7026 (1996): 302-307;
Devi Sridhar and Lawrence O. Gostin, “World Health Organization: Past, present and future”, Public
Health 128, no.2 (2014): 117-118; D.J. Hunter, T. Schrecker and R. Alderslade, “Governance for health
in a changing world: Special issue”, Public Health 129, no. 7 (2015): 831-832.
2 See Giampietro Gobo, Doing Ethnography (London: Sage, 2008) and Robert M. Emerson, Rachel I.
Fretz and Linda L. Shaw, Writing Ethnographic Fieldnotes, Second Edition (Chicago: University of
Chicago Press, 2011).
3 See Nitsan Chorev, The World Health Organization between North and South (Ithaca: Cornell
University Press, 2012), Erin R. Graham, “International organizations as collective agents:
Fragmentation and the limits of principal control at the World Health Organization”, European
Journal of International Relations 20, no. 2 (2014): 366-390, Tine Hanrieder, International
Organization in Time: Fragmentation and Reform (Oxford: Oxford University Press, 2015).
4 Jörg Bergmann, “Studies of work”, in Handbuch Berufsbildungsforschung, edited by Felix Rauner
(Bielefeld: W. Bertelsmann, 2006), 639-646, Melvin Pollner and Robert M. Emerson,
“Ethnomethodology and ethnography", in Handbook of Ethnography, edited by Paul Atkinson,
Amanda Coffey, Sara Delamont, John Lofland and Lyn Lofland (London: Sage, 2001), 118-13, and
Kendra Coulter and William R. Schumann eds., Governing Cultures: Anthropological Perspectives
on Political Labor, Power, and Government (Basingstoke: Palgrave, 2012).
5 Ilona Kickbusch and Mathias Bonk, “Making the World Health Assembly fit for the 21st century”,
BMJ 348, no. 7964 (2014): g4265, Ilona Kickbusch, Wolfgang Hein and Gaudenz Silberschmidt,
“Addressing global health governance challenges through a new mechanism: The proposal for a
Committee C of the World Health Assembly”, Journal of Law, Medicine, and Ethics 38, no. 3 (2010):
6 On the notion of political ethnography as a specific case of ethnography, see Edward Schatz ed.,
Political Ethnography: What Immersion Contributes to the Study of Power (Chicago: University of
Chicago Press, 2009) and Dvora Yanow, “What’s political about political ethnography? Abducting our
way toward reason and meaning”, Qualitative & Multi-Method Research 7, no. 2 (2009): 33-37.
7 See Gobo, 2008, Emerson, Fretz and Shaw, 2011, as well as Kathy Charmaz and Richard G. Mitchell,
“Grounded theory in ethnography”, in Handbook of Ethnography, edited by Paul Atkinson, Amanda
Coffey, Sara Delamont, John Lofland and Lyn Lofland (London: Sage, 2001), 160-174. For a defence
of open research designs see Herbert Blumer, “What is wrong with social theory?”, American
Sociological Review 19, no. 1 (1954): 3-10.
8 “Holism” is a classic ethnographic concern and “comparison” is a classic analytic strategy across the
social sciences. While the first logic encourages the researcher to study as many sites as possible in
order to give an encompassing account of global health governance, the second logic encourages the
researcher to think about these sites in comparative terms and to select them along the lines of
maximal and minimal contrast in order to identify the dimensions of the phenomena studied as well
as variation therein.
9 Even though the discussion on the potential contribution of ethnography to the study of
international relations is not new, it has become particularly visible in the last decade or so. For some
elder texts and studies, see for example, Michael N. Barnett, “The UN Security Council, indifference,
and genocide in Rwanda”, Cultural Anthropology 12, no. 4 (1997): 551-578, Carol Cohn, “Sex and
death in the rational world of defense intellectuals”, Signs: Journal of Women in Culture and Society
12, no. 4 (1987): 687-718, and Hugh Gusterson, “The virtual nuclear weapons laboratory in the New
World Order”, American Ethnologist 28, no. 2 (2001): 417-437; for more recent contributions, see,
for example, Morgan Brigg and Roland Bleiker, “Expanding ethnographic insights into global
politics”, International Political Sociology 2, no. 1 (2008): 89-90, Julian Eckl, “Responsible
scholarship after leaving the veranda: normative issues faced by field researchers and armchair
scientists”, International Political Sociology 2, no. 3 (2008): 185-203, Patrick Thaddeus Jackson,
“Can ethnographic techniques tell us distinctive things about world politics?”, International Political
Sociology 2, no. 1 (2008): 91-93, Jon Harald Sande Lie, “Challenging anthropology: anthropological
reflections on the ethnographic turn in International Relations”, Millennium: Journal of
International Studies 41, no. 2 (2013): 201-220, Iver B. Neumann, At Home with the Diplomats:
Inside a European Foreign Ministry, (Ithaca: Cornell University Press, 2012), Schatz, 2009, Niels
Nagelhus Schia, “Being part of the parade ‘going native’ in the United Nations Security Council”,
PoLAR: Political and Legal Anthropology Review 36, no. 1 (2013): 138-156, Finn Stepputat and
Jessica Larsen, “Global political ethnography: a methodological approach to studying global policy
regimes”, DIIS Working Paper (Kopenhagen: DIIS, 2015),, and Yanow, 2009. In spite of the increasing
interest, ethnographic research has not reached the scholarly mainstream in international relations
while other disciplines have relied on it for decades.
10 I would like to thank the anonymous reviewers and the guest editors for their helpful comments. I
am also grateful for comments that I received on two presentations that prepared the ground for the
present article: first at “MAGic2015: Anthropology and Global Health: Interrogating Theory, Policy
and Practice” in Brighton, United Kingdom, on 10 September 2015, and then at the annual convention
of the International Studies Association (ISA) in Atlanta, Georgia, USA, on 17 March 2016.
11 While I had first tried to register as an academic observer and then attempted to register as a
journalist, I was finally told that you could simply try to get one of a limited number of public badges.
In other words, attending the WHA turned out to be less bureaucratic than I had assumed but only for
those people who know how to get in while I had spent weeks trying various other ways, sending
emails that were never answered, and calling people who never picked up the phone.
12 On the eve of WHA67, the preliminary issue was available at the following URL: Presently, only the issues 1 through 6 can be downloaded
while the preliminary one has disappeared. For the complementing Guide for delegates to the World
Health Assembly, see A67/DIV./2, which is still available at the URL.
13 See WHA64.2 in particular, which is inter alia available at that contains a compilation of documents
related to the most recent reform process.
14 In addition to the documents identified in this manner, I have also found documents by
coincidence. Flipping through the pages of past WHA’s it proved impossible to find only the
documents that one had been looking for. Quite to the contrary, there were always headings and
passages that for one reason or another caught my spontaneous attention and proved eventually to
contain some information that spoke to my research interest. For example, the duration of speaking
time was a recurrent issue in the debates even when the substantive content of the debates was on a
different issue. While these additional finds were obviously accidental, they reinforced the impression
that WHA rules and practices have been a recurrent point of debate indeed.
15 The resolutions and other governance documents quoted in the following can be found in the
Official Records series for the time period 1948 to 1978. After the discontinuation of the Official
Records series, governance documents were published in separate volumes that are labelled
according to the following pattern [Number of WHA]/[Year of WHA]/REC/[Number of record for the
specific WHA] in the case of WHAs and analogical in the case of EBs. The resolutions are usually
contained in the first number of these records. For example, the resolutions for WHA42 that took
place in 1989 are contained in WHA42/1989/REC/1. Both the Official Records series and the
subsequent official records are continuously digitalized and will eventually all become available at For official records from the last decade, see also
16 In the historical documents, the terminology would usually be something like “improving the
methods of work” rather than “governance reform”.
17 EB63.R33.
18 See, in particular, EB11.R68; for earlier ideas in this regard, see also WHA5.49.
19 See, in particular, EB11.R69; for an earlier formulation, see also WHA3.96.
20 WHA6.58.
21 See WHA6.57.
22 While WHA11 focused on the frequency of WHAs (WHA11.25), WHA12 mentions both alternatives
in one resolution and opts for shorter meetings (WHA12.38).
23 See WHA13.40 and WHA14.51.
24 See WHA15.50.
25 WHA20.2.
26 See WHA23.1 that repeated an appeal of the preceding EB (EB43.R45).
27 See WHA25.33.
28 See WHA50.18.
29 The last two claims are based on my observations at WHA67 (2014) and WHA68 (2015). WHA69
(2016), which I watched via webcast, followed the practice as well but, at least in Committee A, the
speaking time was even reduced to two minutes for the final two days of the meeting. (The proposal
was made by the Chair at the end of an evening session at around 8:55 pm and when no one opposed
to it, the decision was met with applause.)
30 See WHA22.53 and WHA25.24.
31 WHA28.69.
32 See, in particular, WHA30.20 and WHA 30.22.
33 See WHA33.19.
34 See WHA34.28.
35 WHA30([decision] xvi).
36 See EB63.R33.
37 See WHA33.19.
38 See WHA34.29.
39 WHA36.16.
40 See WHA28.69.
41 WHA32.36
42 EB63/17
43 See WHA35.1.
44 See WHA36.16.
45 See WHA44.30.
46 See WHA48.17.
47 See Official Records of the World Health Organization 63.
48 In 1952, for example, the Director-General reported the following information on the technical
discussions at WHA5 to the EB: “The technical discussions covered two and a half days, in addition to
an evening meeting, and it would appear to be the general opinion of the members taking part in the
group discussions that insufficient time was allotted to them. The addition of at least another half day
would have been desirable” (EB10/20).
49 In the case of WHAs, EBs, and RCs, I have so far attended at least two meetings each in person and
watched additional ones via webcast; however, meetings of PBAC could only be observed online since
access is particularly restricted. For an article that emerged from the same phase of the project but
focuses on malaria policy and goes beyond WHO-related sites that are discussed here, see Julian Eckl,
“The social lives of global policies against malaria: Conceptual considerations, past experiences, and
current issues”, Medical Anthropology 36, online first (2017):
50 Drawing on what I could see via webcast, WHA69 (2016) seems to have introduced a small change
in the case of plenary meetings where the old traffic lights have been substituted with a countdown
clock. Interestingly enough however, the clock still relies on the on the old colour scheme but adds
blue to it: there is a blue ring around the clock when it has been reset (or stopped) and the ring turns
green once the clock has been started; later the ring turns yellow and at the very end red.
51 While formulations such as “efficiency” or “more efficient” are common in the documents, I have
also come across terms like “streamlining”, “rationalizing”, and, simply, “improving”.
52 Obviously human behaviour is inherently ritualized but there is a tendency to recognize rituals as
rituals when they do not “work properly”.
53 This point has been further elaborated in: Julian Eckl, “Doing being a delegate in multi- and
polylateral fora in the field of global health”, paper presented at the annual convention of the
International Studies Association (ISA) in Atlanta, Georgia, USA, 16 March 2016.
54 Moreover, there was also an important change into the opposite direction: The WHA has gained
importance through the new election process for the Director-General since the WHA will be able to
elect one of three candidates short-listed by the EB rather than following the previous practice of
formally appointing the single candidate nominated by the EB.
55 See Werner J. Patzelt and Stephan Dreischer eds., Parlamente und ihre Zeit: Zeitstrukturen als
Machtpotentiale [Parliaments and Their Time: Time Structures as Power Potentials] (Baden-Baden:
Nomos, 2009).
56 Actually, already in the late 1970s complaints about the competition between meetings were
expressed. For example, WHA32.26 contains the following two preambular paragraphs: “Considering
the increase in meetings on health matters organized at both the regional and international levels at
which countries are required to be represented; Bearing in mind the consequent heavy demands on
human and financial resources required for attending such meetings which may create problems,
particularly for developing countries;”
57 For the decision to introduce webcasting in the case of the WHA, see WHA67.2.
58 See, in particular, Randall W. Stone, Controlling Institutions: International Organizations and the
Global Economy (Cambridge: Cambridge University Press, 2011).
59 For the particularly divergent case of efforts to centralize WHO that could not even prevent the
further decentralization of the organization, see Hanrieder 2015.
... Another example is the United States' influence in making corporate compliance voluntary with respect to codes of marketing junk food to children, which has constrained WHO against the wishes of many other Member States (Haynes et al., 2013). Furthermore, one paper found that over the past decades formal WHO governance during the annual World Health Assemblies has fractured into numerous informal parallel meetings (Eckl, 2017). States with small delegations have been unable to represent themselves in all of them simultaneously (Hoffman and Røttingen, 2014;Eckl, 2017), which "undermines the principle of Member State equality" (Eckl, 2017). ...
... Furthermore, one paper found that over the past decades formal WHO governance during the annual World Health Assemblies has fractured into numerous informal parallel meetings (Eckl, 2017). States with small delegations have been unable to represent themselves in all of them simultaneously (Hoffman and Røttingen, 2014;Eckl, 2017), which "undermines the principle of Member State equality" (Eckl, 2017). ...
... Furthermore, one paper found that over the past decades formal WHO governance during the annual World Health Assemblies has fractured into numerous informal parallel meetings (Eckl, 2017). States with small delegations have been unable to represent themselves in all of them simultaneously (Hoffman and Røttingen, 2014;Eckl, 2017), which "undermines the principle of Member State equality" (Eckl, 2017). ...
Full-text available
The World Health Organization (WHO), the leading global authority in public health, routinely attracts loud calls for reform. Although Member States negotiate reform internally, academic debate is more public, and can generate ideas and provide independent accountability. We investigate why authors advocate for WHO reform so commonly. We wondered if this literature had potentially useful themes for WHO, what methods and evidence were used, and we wanted to analyze the geography of participation. We conducted a systematic review using four databases to identify 139 articles assessing WHO or advocating for reform. We discuss these using categories we derived from the management literature on organizational performance. We also analyzed evidence, country of origin, and topic. The literature we reviewed contained 998 claims about WHO's performance or reform, although there were no standard methods for assessing WHO. We developed a framework to analyze WHO's performance and structure a synthesis of the claims, which find WHO imperiled. Its legitimacy and governance are weakened by disagreements about purpose, unequal Member State influence, and inadequate accountability. Contestation of goals and strategies constrain planning. Structure and workforce deficiencies limit coordination, agility, and competence. WHO has technical and normative authority, but insufficient independence and legal power to influence uncooperative states. WHO's identity claims transparency, independence, and courage, but these aspirations are betrayed in times of need. Most articles (88%) were commentaries without specified methods. More than three-quarters (76%) originated from the US, the UK, or Switzerland. A quarter of papers (25%) focused on international infectious disease outbreaks, and another 25% advocated for WHO reform generally. Many criticisms cite wide-ranging performance problems, some of which may relate to obstructive behavior by Member States. This literature is incomplete in the geographic representation of authors, evidence, methods, and topics. We offer ideas for developing more rigorous and inclusive academic debate on WHO.
... A similar trend can be observed in the subfield of international relations where political scientists have been joined by a growing number of socio-cultural anthropologists with an interest in international organizations (M€ uller, 2013;Niezen and Sapignoli, 2017) and where international practice theory, which values ethnography's promise of studying practices first-hand, has seen a considerable rise (Bueger and Gadinger, 2018;see also De Pryck, 2021, in this issue). Finally, also in the field of global health governance, international organizations and publicprivate partnerships have been studied ethnographically (Eckl, 2017(Eckl, , 2021Irwin and Smith, 2019;Storeng and B ehague, 2016). While these works offer a wide range of rich insights, for example on the quotidian reproduction of order through repetitive activities or on the silencing of internal conflicts in external self-representations, this section will focus on ethnography's propensity to foreground the experienceable spatiotemporality of the phenomena studied, which is often only a latent theme in discussions on ethnography, in particular in debates among political scientists. ...
... The rationale for this design was that it would emulate the experience of the practitioners. While a more detailed account of the research design and the project's evolution can be found elsewhere (Eckl, 2017(Eckl, , 2021, the present section will give a descriptive account of what 'going on field research' implied in spatiotemporal terms and how the spatiotemporality of the phenomenon studied influenced the research process. The section that follows thereafter will discuss the spatiotemporal dimension of WHO and of global health governance that was thereby foregrounded. ...
... The section that follows thereafter will discuss the spatiotemporal dimension of WHO and of global health governance that was thereby foregrounded. Due to spatial constraints, both sections will focus primarily on the macro level which has received less attention in the literature than the micro level (Irwin and Smith, 2019;Eckl, 2017Eckl, , 2021. ...
Full-text available
Drawing on a long-term political ethnography of sites of global health governance, the paper makes methodological and substantive contributions. First of all, it shows that ethnography induces researchers to experience international organizations (IOs) and global governance as spatiotemporal phenomena. This experience overlaps with the lived realities of practitioners and spotlights aspects that are otherwise easily overlooked. Both practitioners and ethnographers have to be in specific spaces at particular times. This practical challenge illustrates that there are focal times and spaces, which are linked to the cyclical and sited character of global health governance. These focal times and spaces provide an important coordination mechanism and ease the general flow of knowledge – within IOs and between IOs and their environment. However, there is also the constant danger that they develop a self-referential life of their own and become disconnected from other processes. Similarly, not just researchers but also practitioners are struggling to develop a comprehensive understanding of IOs since they experience them only partially and in specific settings. Thus, a spatiotemporal account highlights both overlooked links and unexpected disconnections. The conclusion mentions that the current – COVID-19-induced – mainstreaming of digital technologies will impact the spatiotemporal dimension of global health governance.
... While diplomatic deliberation reduces the speed of decision-making, deliberation can increase the legitimacy and possibly also the quality of outcomes (Manin 1987;Hamlin and Pettit 1989;Franck 1990;Steffek 2000;Biegoń 2016;Eckl 2017). Diplomatic deliberation can be time-intensive 2 We use this definition since we are interested in the extent to which IO institutional design seeks to induce deliberation between diplomats as creating opportunities for the exchange and challenge of positions complemented by reasons, while we do not examine how exactly diplomats behave in these IOs in practice (i.e. ...
... On the other hand, swift decision-making is not the only criterion for a rational institutional design of IOs (Goodin 1995;Koremenos, Lipson and Snidal 2001;Panke 2016). States design IOs not only to allow for the efficient making of decisions, but also seek to ensure that the outcomes reflect the normative and legal convictions of the member states and address the underlying problems (Manin 1987;Müller 2004;Schneiderhan and Khan 2008;Risse and Kleine 2010;Eckl 2017). To pursue this aim, institutions include rules fostering diplomatic deliberation. ...
... While the exchange of principled positions and reasons between the actors can require considerable time and slow down the effectiveness of passing IO outcome documents -especially if IOs are large in size -deliberation can also have positive effects at the same time. Diplomatic deliberation can be conducive to IO decisions beyond the lowest common denominator since final outcomes are grounded in sound reasons (Eckl 2017). Ideally, diplomatic deliberation brings about outcomes in the interest of all stakeholders rather than outcomes that reflect the relative bargaining power of a few great players. ...
Full-text available
Whether we look at constitutions of states or founding treaties of International Organisations (IO), it is striking that many rules on interaction between delegates create room for deliberation, whilst simultaneously limiting the time for discussion. While the latter speeds up decision making, it risks reducing its quality and legitimacy by hampering the exchange and contestation of information and ideas. How are these competing elements balanced in IOs? Do IOs differ in this respect, and if so, how and why? The article draws on a unique and novel dataset and assesses variation in the extent to which institutional design fosters or inhibits diplomatic deliberation in more than 110 diverse IOs. To this end, the article uses a combination of theories of functionalism, rational choice institutionalism and liberal approaches on variation, fit, and mismatch of deliberative institutional design within and across IOs. The hypotheses are analysed with quantitative methods. The article shows that diplomatic deliberative institutional design elements are the most pronounced when IOs are small in size, deal in high politics, and are regional in character.
... Yet, this comes with strings attached: Usually, rules that seek to induce debate are likely to reduce the speed of decision-making and vice-versa (Rada 2000;Panke 2006a, b;Golub 2007). For instance, the World Health Organization (WHO)'s internal reforms were geared toward speeding up discussion between delegates in order to allow for greater efficiency of decision-making (Eckl 2017). On the one hand, extensive debates bring about the risk of reducing the speed of decision-making (Rada 2000;Golub 2007), thereby making IOs with extensive debates less efficient than IOs that limit the time for discussion considerably. ...
... In order to contribute to these strands of research, we study whether IOs are designed to induce discussion between delegates, although this reduces the speed of arriving at decisions (Eckl 2017). Specifically, we address the question if there are distinct patterns in the institutional deliberative design of IOs in the first part of the paper. ...
Full-text available
International organizations (IOs) constitute key arenas in which states discuss common issues. Such debates are central prerequisites for taking qualitatively good decisions. Yet researchers have not examined how IOs foster discussion through their institutional provisions. We conduct a factor analysis of institutional rules of 114 IOs which reveals that two ideal types how IOs seek to induce discussion exist: The first type creates room for debate in the negotiation stage of the policy cycle. In contrast, the second type gives member states a strong say in the agenda-setting, thereby facilitating debate. Why do IOs opt for either strategy? A limited policy scope, heterogeneity among actors, and diplomatic socialization increase the probability that IOs place emphasis on debate during negotiations, while a high number of members is the main reason for IOs to promote debate during agenda-setting. These choices reflect the strive of IOs to balance extensive debate with speedy decision-making.
... It also alerts to their historical emergence. In the case of the traffic lights, their omnipresence is a tangible consequence of decades-long reform efforts aimed at making WHO governance "more efficient" (Eckl 2017). Regarding general discussions in the plenary, no time limit had been set initially but speaking time was reduced incrementally to five minutes that were long common in the years before the COVID-19 pandemic; this amounts to a speech that is only as long as the text in this box since delegates are meant to read slowly to allow for simultaneous translation. ...
Full-text available
Scholars have studied international organizations (IOs) in many disciplines, thus generating important theoretical developments. Yet a proper assessment and a broad discussion of the methods used to research these organizations are lacking. Which methods are being used to study IOs and in what ways? Do we need a specific methodology applied to the case of IOs? What are the concrete methodological challenges when doing research on IOs? International Organizations and Research Methods: An Introduction compiles an inventory of the methods developed in the study of IOs under the five headings of Observing, Interviewing, Documenting, Measuring, and Combining. It does not reconcile diverging views on the purpose and meaning of IO scholarship, but creates a space for scholars and students embedded in different academic traditions to reflect on methodological choices and the way they impact knowledge production on IOs.
... Governing bodies [F1, F2] are formal forms of interaction between NPGH arenas and the international context that take place according to the conventions of the institutions being governed. Mandated with international authority on health, WHO is the most representative mura et al. 2013;van der Rijt and Pang 2015;Eckl 2017), but little about the EB. Similar to previous studies (Gagnon and Labonte 2013;Aluttis et al. 2015), our findings suggest that learning processes related to EB terms [F1] are common in cases of global health strategies in the literature. ...
Full-text available
National policy on global health (NPGH) arenas are multisectoral governing arrangements for cooperation between health, development, and foreign affairs sectors in government policy for global health governance. To explore the relationship between national and global processes for governing global health, this paper asks: in what forms of interaction between NPGH arenas and global health governance are learning and networking processes present? In a multiple case study of Norwegian and Swiss NPGH arenas, we collected data on intersectoral policy processes from semi-structured interviews with 33 informants in 2014-2015. Adapting Real-Dato’s framework, we analyzed each case separately, producing monographs for comparing NPGH arenas. Analyzing both NPGH arenas for relational structures linking external resources to internal policy arena processes, we found five zones of interactions - including institutions, transgovernmental clubs, and connective forms. These interactions circulate ideas and soften arenas’ boundaries. We argue that NPGH is characteristic of transnational governance of global health.
... Chorev, 2012;Lee, 2009;Siddiqi, 1995); yet, there is very little literature that describes the event (cf. Eckl, 2017) or analyses its meaning within and for the global health community. ...
Full-text available
The World Health Assembly is the WHO’s supreme decision-making body and consists of representatives from the 194 WHO Member States who take formal decisions on the WHO’s policies, workplan and budget. The event is also attended by representatives of non-governmental organisations, the private sector, the press and even members of the public. Based on participant observation at six World Health Assemblies, in-depth interviews with 53 delegates to the WHA, and an analysis of WHA Official Records, this article examines the ritualistic aspects of WHA negotiations. We argue that analysing the WHA as a ritual provides an insight into power and legitimacy within global health. Not only are certain understandings of health issues and courses of actions decided by the Assembly, but also the very boundaries of global health community are set. The rules of the ritual place limits on different categories of actors, while both formal and informal rules of behaviour further serve to include or exclude actors from the rituals. Success in negotiation is measured by through the inclusion of certain ideas, norms and values in the wording of resolutions and is achieved through the repetition of language in speeches and by adhering to the rules of behaviour.
Scholars have demonstrated that deliberation between political actors in states as well as in International Organizations (IOs) matters because it can impact the quality and legitimacy of outcomes. Yet, we do not know much about how deliberation between political actors can be triggered in practice. Drawing on insights from the deliberative turn that has taken place in Comparative Politics as well as insights from International Relations, this paper inquires how different IO institutional features effect the extent of diplomatic deliberation. Unique and novel survey data shows that there is variation between and within IOs. In some IOs, such as the UNFCCC or CoE, diplomats engage in extensive deliberations, while they do so considerably less in others, such as the UNWTO or IWC. Our paper provides novel insights into the inner working of IOs. In general, diplomatic debates are most pronounced in large IOs with high level delegates that often opt for negotiating behind closed doors. In addition, specific institutional design elements matter in the different stages of an IO policy-cycle, such as procedural rules fostering interaction between diplomats in the negotiation stage or a limited policy scope in the voting stage.
Full-text available
In the study of international organizations (IOs), time and space have mostly been approached as contextual, even implicit and unrelated, factors. Instead this special issue considers them as co‐constitutive of multilateralism and investigates three main questions: (i) How are IOs influenced by time and space? (ii) How are time and space experienced within IOs? (iii) How do IOs influence time and space around them? This introductory article compiles the contributions’ findings and points to a cyclical process: IOs are influenced by the spatiotemporal conditions of their enactment, leading to a diversity of practices and experiences within these organizations which in turn impact time and space, both in the way they are conceptualized and in their concrete embodiment. The special issue has proven the merit of taking time and space seriously in the study of IOs. This article concludes with a series of (non‐exhaustive) research avenues to continue this promising analytical and empirical endeavor, including discussions on the relationship between IO performance and time and space, and the impact of the COVID‐19 pandemic. This special issue applies an original lens to an overlooked aspect of IO research, bringing (temporary) findings, but also suggesting multiple avenues for research.
Full-text available
Full-text available
Since 1945 at least five United Nations organisations have become substantially involved in international health activities. This has led to considerable confusion among policy makers, scholars, and UN staff over distinct and appropriate mandates. Interviews with staff an a historical analysis have shown that while formal mandates have been complementary, effective mandates have led to an unclear delineation of activities. The process of translating formal into effective mandates have been influenced by the decentralised nature of the UN, lack of a master plan for its activities, the considerable growth in the policy agenda and the shift towards a multisectoral approach to health. The identification of each organisation's comparative advantage, at both the global and country levels, is one way of understanding what each organisation does best and perhaps should be doing. There is a need for improved mechanisms to define effective mandates, taking into account comparative advantages, if the mandates of UN organisations are appropriate to meet future challenges in international health.
What factors influence IO faithfulness to mandates assigned by member states? Although recent literature treats IOs agents as autonomous actors in global politics, most work continues to treat the bureaucracy of an international organization as a unitary actor. I argue that the unitary actor assumption limits our ability to assess how internal factors such as fragmentation influence agent faithfulness. When we conceive of IO bureaucracies as collective agents — those including more than one bureaucratic actor and subject to internal fragmentation — IO faithfulness can be more fully explained. Specifically, fragmentation limits faithfulness by inhibiting the effectiveness of principals’ control mechanisms (i.e. oversight and agent screening and sanctioning). These arguments are illustrated using a case study of the World Health Organization and its efforts to improve health systems between 1982 and 2008.
In this companion volume John van Maanen's Tales of the Field, three scholars reveal how the ethnographer turns direct experience and observation into written fieldnotes upon which an ethnography is based. Drawing on years of teaching and field research experience, the authors develop a series of guidelines, suggestions, and practical advice about how to write useful fieldnotes in a variety of settings, both cultural and institutional. Using actual unfinished, "working" notes as examples, they illustrate options for composing, reviewing, and working fieldnotes into finished texts. They discuss different organizational and descriptive strategies, including evocation of sensory detail, synthesis of complete scenes, the value of partial versus omniscient perspectives, and of first person versus third person accounts. Of particular interest is the author's discussion of notetaking as a mindset. They show how transforming direct observations into vivid descriptions results not simply from good memory but more crucially from learning to envision scenes as written. A good ethnographer, they demonstrate, must learn to remember dialogue and movement like an actor, to see colors and shapes like a painter, and to sense moods and rhythms like a poet. The authors also emphasize the ethnographer's core interest in presenting the perceptions and meanings which the people studied attach to their own actions. They demonstrate the subtle ways that writers can make the voices of people heard in the texts they produce. Finally, they analyze the "processing" of fieldnotes—the practice of coding notes to identify themes and methods for selecting and weaving together fieldnote excerpts to write a polished ethnography. This book, however, is more than a "how-to" manual. The authors examine writing fieldnotes as an interactive and interpretive process in which the researcher's own commitments and relationships with those in the field inevitably shape the character and content of those fieldnotes. They explore the conscious and unconscious writing choices that produce fieldnote accounts. And they show how the character and content of these fieldnotes inevitably influence the arguments and analyses the ethnographer can make in the final ethnographic tale. This book shows that note-taking is a craft that can be taught. Along with Tales of the Field and George Marcus and Michael Fisher's Anthropology as Cultural Criticism, Writing Ethnographic Fieldnotes is an essential tool for students and social scientists alike.
  • Health Governance
  • Volume Xi
World Health Organization: Past, present and future Governance for health in a changing world: Special issue
  • Devi Sridhar
  • Lawrence O Gostin
  • D J Hunter
  • T Schrecker
  • R Alderslade
Devi Sridhar and Lawrence O. Gostin, " World Health Organization: Past, present and future ", Public Health 128, no.2 (2014): 117-118; D.J. Hunter, T. Schrecker and R. Alderslade, " Governance for health in a changing world: Special issue ", Public Health 129, no. 7 (2015): 831-832.
Studies of work Ethnomethodology and ethnography
  • Jörg Bergmann
  • Robert M Emerson
  • Kendra Coulter
Jörg Bergmann, " Studies of work ", in Handbuch Berufsbildungsforschung, edited by Felix Rauner (Bielefeld: W. Bertelsmann, 2006), 639-646, Melvin Pollner and Robert M. Emerson, " Ethnomethodology and ethnography", in Handbook of Ethnography, edited by Paul Atkinson, Amanda Coffey, Sara Delamont, John Lofland and Lyn Lofland (London: Sage, 2001), 118-13, and Kendra Coulter and William R. Schumann eds., Governing Cultures: Anthropological Perspectives on Political Labor, Power, and Government (Basingstoke: Palgrave, 2012).