ABSTRACT
This chapter reviews WHO's evolving strategy and the main elements of the action and influence of the eight Directors-General of the organization. A major issue for all WHO Directors-General has been the balance between the fight against diseases, a vertical approach, and the primary health care concept adopted in 1978 focusing on basic comprehensive health care, a horizontal approach, now updated as Universal Health Coverage, a part of the Sustainable Development Goals. Another fundamental issue is that of the balance between the normative role of WHO and its technical and operational functions. An important advance in WHO's normative work is the adoption in 2003 of the Framework Convention on Tobacco Control by the World Health Assembly (WHA). WHO's several financial crises and member States' challenges to its effectiveness and credibility have triggered a reform programme which may restore its legitimacy.
