How much change? New WHO Director-General plans first moves

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24 August 2017

by Ben Duncan, Senior Advisor, Health & Wellbeing

He is the first WHO Director-General to be African, the first not to be a medical doctor (though he does have a PhD) and the first to be a prolific Tweeter. Nonetheless, other than for WHO’s social media team, the arrival of Dr Tedros Adhanom Ghebreyesus at the World Health Organization (WHO) on 1 July has not yet led to major change. But is this just the calm before the storm? This autumn the new WHO Director-General will announce the senior leadership team he wants to help him implement his mandate. This will be the first signal of whether the Dr Tedros era will be one of revolution or evolution at WHO.

“Too white, too technical and too bureaucratic”. That would be a crude way to summarise criticisms sometimes levelled at WHO HQ in Geneva. Though much of the criticism is unfair, it is difficult to deny that Europeans and North Americans are somewhat over-represented in senior positions compared to Africans (looked at it terms of their percentage of the overall world population). Of the nine senior leaders who work with the Director-General only one, Deputy Director-General Dr Anarfi Asamoa-Baah, is an African. Of the remaining eight (7 Assistant Director-Generals and an Executive Director), four are Europeans and two are Australians. It’s therefore likely that Dr Tedros will take steps to increase recruitment of talent from Africa and other underrepresented world regions. The question is, how fast will this happen and how will it be balanced against other priorities

Speaking to WHO staff on 3 July Dr Tedros has told them:

Talent is global, but opportunity is not. We will continue to conduct open recruitment, based on merit. However, we will ensure merit is seen from global or geographic and gender perspectives and the recruitment is done fairly and on an even playing field.”

But, Dr Tedros also acknowledged the importance of stability and continuity and that there is a certain amount of “reform fatigue” among WHO staff. One of his first actions as Director-General was to ask the current senior leadership team at WHO to stay in place into the autumn. The initial indications, then, are that Dr Tedros will proceed with some caution in personnel changes at WHO.

That said, Dr Tedros’s reform agenda for WHO goes beyond diversity. During his campaign to become Director-General, and subsequently he has pledged to reform WHO’s Byzantine finances. In his speech to WHO staff on 3 July Dr Tedros noted that WHO currently managed over 3,000 separate grants from donors. This is hugely inefficient and needs to be reformed. Moreover, Dr Tedros wants to improve the way WHO works with donors old and new and how it demonstrates the impact of funds received.

As a former Foreign Minister of Ethiopia, Dr Tedros is more than happy to step into the world of high politics and diplomacy. He has made achieving universal health coverage his top priority for WHO. In a commentary article published in the medical journal The Lancet on 17 July (All roads lead to universal health coverage) he stated “Universal health coverage is ultimately a political choice. It is the responsibility of every country and national government to pursue it." WHO will develop a system for benchmarking Member States’ attainment in reaching the goal of universal health coverage, which they are committed to under UN Sustainable Development Coverage 3.8 Judging by Dr Tedros’s performance so far (notably at the G20 meeting in Hamburg in July), he will be quite willing to undertake high level advocacy with Prime Ministers and Presidents to get countries to improve their performance. In contrast, few of his predecessors as Director-General have been comfortable doing this.

In conclusion, the Dr Tedros era at WHO may demand new skills and approaches from WHO staff. There may be some personnel changes to achieve this, but we don’t know how many. We will know more about “how much change…” this autumn when Dr Tedros announces his new senior leadership team.

Highlights of Dr Tedros’s first 50 days at WHO

1 July Dr Tedros takes office as WHO Director-General

3 July Dr Tedros addresses WHO staff at its headquarters in Geneva

7-8 July Attends G20 Summit in Hamburg, Germany (read his speech to G20 leaders)

12 July Address to UN Security Council, New York, about situation in Yemen

17 July To coincide with publication of WHO estimate of the cost of attaining the 16 health targets in the UN’s Sustainable Development Goals, Dr Tedros publishes a Commentary “All roads lead to universal health coverage” in The Lancet. He also addresses a High-level Political Forum in New York about “Universal health coverage: a political choice

18 July Speaks at launch of progress report on Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health in New York

19 July Launches WHO Report on Global Tobacco Epidemic with businessman, philanthropist and former New York mayor Michael Bloomberg in New York (read Dr Tedros’s speech)

23-26 July Visits Yemen to see WHO and UN work to respond to Cholera outbreak there and highlight need for international funding. Issues joint statement with leaders of UNICEF and World Food Programme (WFP), who have also travelled to Yemen,

27 July Visits United Arab Emirates. UAE pledges US $10 million for response to Cholera outbreak in Yemen

4 August Address to Member State Ambassadors in Geneva about his joint visit with UNICEF and WFP to Yemen

18-19 August Attends and speaks at Belt and Road Forum for Health Cooperation: Towards a Health Silk Road hosted by China in Beijing (speech on 18 August, speech on 19 August)

Photo credit: WHO

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