Past and present WHO officials and top national politicians are among those who have put their names forward for a job that will prove central to shaping efforts to reduce premature deaths around the world.

The WHO, with a budget for 2006-07 of $3.3bn (€2.6bn, £1.8bn) and 8,500 staff, will play an important role in efforts to achieve the United Nations millennium development goals, which aim to cut child mortality, improve maternal health and reverse the growth in the world's leading infectious diseases.

The election, coupled with the selection of a new executive director for the UN-backed Global Fund to fight Aids, TB and malaria, comes at an important time for global health, after the pledge by the Group of Eight leaders to push for as close as possible to universal access to Aids treatment for those who need it by 2010.

It also coincides with a debate on the need for change in the operation of the WHO and more broadly across the entire UN system, and as the race advances to replace Kofi Annan as secretary-general.

Details of the candidates are to be circulated by October 5. The 34 countries on the WHO's executive board will meet on November 6-8 to short-list about half a dozen for presentations and interview.

In a process that has been criticised for its secrecy, they will vote by ballot until a simple majority emerges for one candidate, who is formally then proposed to a full meeting of the 192-country World Health Assembly on November 9. The process will be highly political, with candidates proposed by Burma and Syria, and five from Europe. China and France have both backed a candidate, breaking an informal understanding by some that members of the UN Security Council should not stand.

Some argue it is time for Africa to lead the WHO, particularly given the continent's enormous health challenges and following the departure of Mr Annan, a Ghanaian, as head of the UN. Two past director-generals have been from Asia, and nominees this time from China and Japan risk splitting votes in the region.

The elections were triggered by the unexpected death in office in May of Dr Lee Jong-wook from South Korea, who was credited with implementing important policies including efforts to scale up HIV treatment around the world.
However, he often avoided conflict, notably with the US over issues including intellectual property protection and with China over the status of Taiwan. He also sparked internal animosity with his style in restructuring the agency and decentralising staff from the Geneva headquarters, triggering a strike late last year.

Many critics argue that the WHO's structure, with much of the budget and many nominations determined by its regions, needs to be reformed but that the director-general would need widespread country support to bring about change.

Kamran Abbasi, the editor of the journal of the Royal Society of Medicine in London, said: "The central issue is how much happens at the centre. There is a need for decentralisation backed up by resources."

He also said there was a need to shift from the WHO's focus on communicable diseases to non-communicable ones such as diabetes, which are increasingly important in the developing as well as the developed world. "The WHO was set up to fight communicable disease but this should be a dynamic organisation, not entrenched in a 1940s view."

Prof Christopher Murray from Harvard University said the WHO had a clear advantage in setting standards but there was debate on the suitability of its staffing and resources to translate and implement such guidelines in individual countries.

He also called for a strengthening of the WHO's role in epidemic surveillance, and developing evidence-based policies to strengthen health systems. "There is a lot of rhetoric in this area but little progress. However, everyone involved in scale-up of programmes recognises that how systems are organised, how staff are trained and paid, how they are regulated and managed are absolutely critical."

By Andrew Jack in London, Frances Williams in Geneva and Tom Mitchell in Hong Kong
Copyright The Financial Times Limited 2006 / Published: September 7 2006 03:00