The election of Gro Harlem Brundtland as director-general of the World Health Organisation will provide it with a new lease of life and open doors to world leaders.

The nomination of former Norwegian prime minister Gro Harlem Brundtland to the post of director-general of the World Health Organisation has been greeted with relief by many who feared for the future of the 50-year-old agency.

Dr Brundtland, elected after four rounds of secret ballot by WHO's executive board, still has to have her nomination ratified by the full World Health Assembly when it meets in May, but a rejection at that stage would be unprecedented.

Five candidates had been nominated for the post. They were George Alleyne, director of WHO's American region since 1994; Uton Muchtar Rafei, director of WHO's South East Asia region since 1994; and Ebrahim Samba, WHO director of Africa since 1995. The fifth candidate was Nafis Sadik, executive director of the United Nations Population Fund since 1987.

A sixth candidate, Fernando Antezana, who became WHO's deputy director- general last year, was forced to withdraw following allegations that he had lied about his qualifications.

Dr Brundtland, the first woman ever to head WHO, secured 18 votes - one more than the minimum 17 required. Dr Alleyne came second with 10 votes, and Dr Uton Muchtar Rafei third with four votes.

Dr Brundtland has already announced her intention to strengthen WHO's role and put health first on the international agenda.

'The health dimension has not had enough attention from the leaders of the world,' she said, in her first post-election comments. 'We have to change that.'

But her job will be tough. First, she has to reclaim the credibility the organisation has lost over the past 10 years under the leadership of Japan's Hiroshi Nakajima. Morale within WHO during his two terms in office has slumped.

Allegations that Dr Nakajima's Japanese supporters had sought to buy votes dogged his last re-election campaign in 1993. Concerns have also been raised over awarding contracts, destroying sensitive records and rewriting reports.

Dr Nakajima had been accused of mismanagement, a lack of leadership, of failing to articulate a clear global vision of health and of failing to develop coherent responses to the world's major health problems.

WHO plunged further into disarray and disrepute when the National Audit Office withdrew as its external auditor after NAO comptroller and auditor- general Sir John Bourne refused to tolerate any longer the 'increasingly contentious attitude' of the WHO secretariat, which, he said, showed a lack of co-operation and trust, making his job impossible.

There is little evidence that the situation has improved since then, but observers now believe that Dr Brundtland, a former public health physician and three times Norway's prime minister, is a seasoned politician with the expertise and credibility to turn the organisation around.

Health secretary Frank Dobson believes she has 'the necessary experience, vision and qualifications' to take on the demanding post. 'In particular, her extensive international experience and her commitment to development issues will help ensure that WHO remains an international leader in promoting better health as we move into the 21st century,' says Mr Dobson. 'Dr Brundtland's proven leadership and managerial abilities will help WHO ensure its resources are properly focused on targets which reflect the world's most important health issues.'

Donald Reid, director of the Association for Public Health, is 'delighted' with Dr Brundtland's nomination.

'I hope she will be able to strengthen the organisation's commitment to public health, and make WHO a beacon for public health which stands out above the constant concerns of global politics,' says Mr Reid. 'She is our best hope of getting things done and is well respected in the public health field.'

Lord Hunt, co-chair of APH and co-chair of the newly established all- party group on primary care and public health, hopes Dr Brundtland's appointment will be 'the beginning of a new chapter' in WHO's work. WHO should be a dynamic, international agency, but recent political infighting has got in the way of much of its good work, he says.

'Dr Brundtland has a very good reputation, which will restore credibility to the organisation. Her profile will open doors that have been closed to WHO in the past - she will be listened to by world leaders,' he adds. 'From a public health point of view, her appointment is brilliant.'

The World Medical Association, which represents 8 million doctors worldwide - including Russia and China, which have just joined - has already said, on the strength of Dr Brundtland's appointment, that it wants to work with WHO on 'various collaborative ventures'. Representatives from WMA met all the candidates in Geneva before the interviews.

'The difficulties WHO has experienced over the past 10 years have hampered its activities,' says a spokesman.

'It will now be able to move forward. Dr Brundtland's appointment has given WHO a new lease of life.'