[Ip-health] Devex: For his first 100 days, WHO's new DG Tedros gets a nod of approval. But can he sustain it?

Thiru Balasubramaniam thiru at keionline.org
Sun Oct 15 06:38:22 PDT 2017


https://www.devex.com/news/for-his-first-100-days-who-s-new-dg-tedros-gets-a-nod-of-approval-but-can-he-sustain-it-91127

<SNIP>

A discussion of the U.N. High Level Panel Report on Access to Medicines —
which the source said specifically asks the question on how to solve the
policy incoherence between trade, health, and the SDGs, a deeply complex,
tension-filled discussion for sure — failed to progress at the last World
Health Assembly, due to strong opposition from some rich powerful countries
with large pharmaceutical industries. But advocates expected more from WHO,
and were disappointed, having felt they didn’t get the necessary support
from the institution that’s supposed to be “the moral authority on health.”

They are hoping Tedros will be more proactive in taking on the issue at the
next executive board meeting, at the next World Health Assembly. And they
hope he will fully implement some of the resolutions WHO has been mandated
to do, such as the WHO Global Strategy and Plan of Action on Public Health,
Innovation and Intellectual Property, which the source said WHO has not
fully implemented to date, despite it having been passed in 2008. An
independent review of the strategy and action plan, released early this
year, identifies several countries’ lack of awareness and engagement on the
plan’s implementation.

But in implementing the strategy, WHO should consider the current contexts.
Tedros should also apply the same political lens he has applied to health
in general when discussing the issues of affordable medicines in political
fora, the source said.

“Most of these mandates are about increasing access to medicines to the
poorest countries of the world, and that’s extremely important. But if you
look at where people don’t have access to medicines right now, they are
everywhere [including] in middle- and high-income countries,” the source
said. “There’s nobody safe from the issue of lack of access to medicines
and vaccines.”--
For his first 100 days, WHO's new DG Tedros gets a nod of approval. But can
he sustain it?

By Jenny Lei Ravelo @JennyLeiRavelo 13 October 2017

 www.devex.com/news/91127


MANILA — When World Health Organization Director-General Tedros Adhanom
Ghebreyesus announced his leadership team last week, it was hard to imagine
him garnering anything less than a positive thumbs up for his first 100
days in office.

The team has all the makings for a positive review: it represents all WHO
regions and more than 60 percent are women. The selection, many argue, show
how it’s possible to achieve diversity without sacrificing talent.

At a time of increasingly greater demand for gender equality at the
leadership levels of U.N. agencies and development organizations, Tedros’
move struck a strong chord among many advocates who, until the announcement
was made, were cautiously optimistic of the WHO director-general delivering
on his promise of gender equal leadership. It also seemed to symbolize a
largely positive reception for Tedros’ first three months on the job that
have seen him trot the globe advocating effectively for WHO, reach out to
staff internally and plot an ambitious road ahead — although questions
remain on just how much he can deliver.

Unlike the much publicized election campaign for the WHO director-general
position, the process of picking the senior leadership team was largely
confidential. The only name that surfaced before the announcement was that
of Dr. Soumya Swaminathan, who would become his deputy director-general for
programs.

The picks followed backlash to an August brainstorming session between
Tedros and World Bank President Jim Yong Kim, when a photo of the meeting
posted on Twitter revealed zero women at the discussion table among more
than a dozen men. Although Tedros was quick to address the issue on social
media, it raised concerns over what the senior team at WHO would look like.


Oh dear. Where are the women in the highest echelons of #globalhealth
leadership? #womeninGHhttps://
twitter.com/JimYongKim/status/901089089998532608 …

6:55 AM - Aug 26, 2017


Tedros Adhanom
✔@DrTedros
You are right. It's embarrassing, we need to do our best to change this
https://twitter.com/piaengstrand/status/901381232281481220 …

11:54 AM - Aug 26, 2017

But all that talk vanished as soon as names of his leadership team were
published. Almost everyone Devex spoke to right after the announcement had
congratulatory remarks for the global health leader.

“It’s a great senior line up [and] a break from the past. We are delighted
that Tedros heard the message of the [Women in Global Health] movement and
shares our understanding of the importance of women’s leadership for
delivering better global health,” said Ann Keeling, policy fellow for Women
in Global Health, adding, “Tedros deserves a pat on the back on this one!”

Katja Iversen, CEO of Women Deliver, said Tedros has set the bar high for
gender parity and diversity, one that she hopes will be taken up across all
levels of WHO and inspire other organizations.

The announcement was followed by another similarly high-profile and
well-received appointment: The WHO aid chief has recruited Dr. Sania
Nishtar, whom he ran against for the director-general position, to chair a
high-level commission on noncommunicable diseases that WHO will be
establishing ahead of the third U.N. high-level meeting on NCDs in 2018.

At the 68th regional meeting of the WHO Western Pacific office on Thursday,
he also appointed Elizabeth Iro, secretary of health of the Cook Islands,
as WHO’s first chief nursing officer. Iro will be part of Tedros’ senior
leadership team.

The appointment of the senior leadership team is one that the global health
community had been anticipating, but it’s not the only item on the aid
community’s list. Tedros has made a number of promises during his campaign
for the director-general position, and the aid community, along with his
staff, have been watching closely, charting the progress or lack thereof on
each item.

Tedros’ early ‘accomplishments,’ according to his advisors

Everybody agrees it’s too early to make judgment on what the WHO
director-general has accomplished to date. Tedros took over the
organization in July, about a month after his election at the World Health
Assembly. But be it his 100 days in office, or first year, Tedros is
doubtless fully aware eyes are on him and the changes he is expected to put
in place in WHO’s work and functioning.

“I am proud of everything we have accomplished together in the past 3
months,” he told WHO staff and member state delegations on Thursday, when
he highlighted the global momentum for universal health coverage and health
security.

“But the clock is ticking. We have just 13 years to keep the promises we
made to the world’s people,” he said.

His senior advisers believe Tedros can count three major accomplishments to
date. First is the completion of his leadership team. The second is his
high-level diplomacy work, which has allowed him to refresh the discussions
around resource mobilization for WHO and global health at large.

“He feels extremely strongly that WHO is the only member state-owned
agency, and that he shouldn’t really be putting out a bucket to beg money,”
said Tedros’ senior advisor Dr. Senait Fisseha. “The financial resource
mobilization needs to change from a financial monologue to a financial
dialogue where member states have to take responsibility to raise the
resources for the WHO.”

Third is the roll out of a new strategy contained in the draft concept note
for WHO’s 13th general program of work. In it, he talks about major shifts
in the way WHO should go about its business, from a focus on results to WHO
adding a function of becoming operational in certain contexts.

The process traditionally takes up two years, and budget negotiations often
start long before the framework is finalized, said Fisseha.

But Tedros is fast tracking the process to have the program of work ready
for discussion by the executive board, presumably as early as during a
special session in November. Feedback from regional committees and informal
online consultations for the program of work is set to close Oct. 13, and
WHO targets to publish the draft 13th General Program of Work on its
website by Nov. 1. If all goes well, the board could consider the draft in
January and submit it for final consideration and approval at the World
Health Assembly in May 2018.

With this timeline, Tedros could have an early kickstart in mobilizing
resources for WHO’s programs and potentially align the budget to approved
priorities.

In the old process, “the budget request comes before the strategic
framework, so he’s really changing and that’s a fundamental change. He’s
truly bringing a whole new way of working at the WHO that’s efficient and
that everybody’s been asking for,” Fisseha said.

The draft concept note for the 13th Program of Work includes:

• Focus on results not just outcomes

• Align its work with the Sustainable Development Goals

• Implement clear programmatic priorities in line with the organization’s
budget

• Become more operational

• Place emphasis in meeting countries’ needs

• Provide political leadership across the global health spectrum

The changes contained in the draft concept note aren’t exactly surprising.
Anyone who has closely paid attention and followed Tedros’ many speeches
before WHO member states and in high-level political fora should by now be
familiar with the direction he wants to bring his organization along. But
some of the priorities raise critically important questions, such as what
does it mean when the document says WHO will “become operational?”

“I think where I would want to really have more clarities or be clear on
[is] where WHO’s role ends and begins,” said Loyce Pace, president and
executive director of the Global Health Council, a membership organization
providing support and connecting different stakeholders around global
health issues.

“I think what he tries to do is outline where that would happen and why,
particularly with countries most in need and especially in emergency
situations,” Pace said. “But there’s a bandwidth question for me with
regards to WHO’s operational capacity, and whether or not that subset of
settings extends or contracts depending on certain contexts, certain
crisis, on the level of resources of these countries [because] that can
change over time.”

The aid community’s own checklist

Members of the global health community have their own checklists for the
director-general. Among these is whether Tedros is able to listen, as he
promised, to their recommendations; whether he’s being strategic in the use
of his time and WHO’s finite capacities and resources; and how he is
engaging the wider global health community in his leadership journey.

Those advocating for gender parity at senior leadership within WHO would be
the first to acknowledge that Tedros is indeed listening, although they
certainly hope Tedros would consider their other suggestions, as well.
Women in Global Health, for example, has also asked Tedros and his team to
appoint a senior gender champion that directly reports to him and for WHO
to adopt a policy that ensures gender balance across its events, panels, or
roundtable discussions, or that, “at the very least, set that as an
organizational cultural standard to strive toward,” Women in Global Health
Executive Director Roopa Dhatt told Devex.

Some members of civil society meanwhile felt encouraged with Tedros’
decision to engage with them, particularly on such an important topic as
WHO’s future program of work.

In September, on the sidelines of the U.N. General Assembly, Tedros and his
team arranged for a meeting with several members of civil society, to whom
he introduced a concept note of his draft program of work for WHO for
2019-2023, and invited them to provide feedback — a process he has already
carried out with almost all WHO regional committees. This week, he’s about
to complete the process with the simultaneous regional meetings of WHO’s
Western Pacific and Eastern Mediterranean offices in Australia and
Pakistan, respectively.

“I think their goal was to really just kind of have an open dialogue with
our community and let us know he was available to them, [but] I found that
very encouraging — that him and his office were so open to engaging with
sort of more people in the community, and not only with representatives of
member states,” said Pace.

Pace said she thought the meetings were an indication that Tedros took to
heart the recommendations made by members of the global health community,
including civil society. In May, after the election, GHC drew up a list of
recommendations for the new director-general. Top of the list was for
Tedros to listen so he can better understand where the critical assumptions
and opinions about WHO are coming from, helping him draft a clearer way
forward.

“I think that he is rising to the occasion and what I see is a map for
success and I’m encouraged by what I’m seeing so far,” Pace said. But “of
course we still need to see how the strategy is implemented, how the
leaders perform, and some of these other pieces in the coming months.”

Via SlideShare

Tedros and his promises

A particular hallmark of Tedros’ early days in office is his presence. He
has appeared at almost every important political meeting and global health
conference held in the past three months. Tedros attended the G-20 meeting
in Hamburg, Germany, and the London Family Planning summit in July. He
engaged in discussions with the Chinese government on their Belt and Road
initiative in August. And he participated in key meetings and events during
Global Goals Week in New York, from the U.N. General Assembly to the Global
Citizen Festival, in September.

He spent this week in Islamabad and Brisbane to attend two of WHO’s
regional committee meetings. Next week, he will be in Montevideo, Uruguay,
to attend a major global NCD conference.

His senior advisor and close confidant, Fisseha, attributes this actions to
Tedros’ background as a diplomat, but also in his conviction that health is
not just a technical issue but also political.

“He’s a former foreign minister,” she noted. “He appreciates the importance
of political leadership, and that health is not just a technical issue,
that he needs to engage the heads of states at the highest level.”

She argued that in the short time Tedros has been in office, he was able to
elevate both WHO and universal health coverage at the highest level by
showing up at these political capitals and high-level meetings.

Tedros’ availability and presence in these different settings has gotten
nods in the global health space. People appreciate that he is taking the
time to be present at key political and global health events, as well as
his efforts to understand issues from the ground, such as his trip to
Yemen.

The large amount of travel, however, has raised questions on how he is able
to follow through on early promises to engage more with staff. And with him
moving so much, has he had time to sit down and assess the issues within
his own institution?

Devex reached out to the staff association in Geneva, but only a
spokesperson replied, requesting that interviews go through official
channels. Fisseha, however, believes Tedros has followed on his promises.

“He works round the clock. You see him, when he attends a meeting in D.C.
or New York or G-20, he goes in, he goes for a day or two, and then he
flies out straight from the airport to the [WHO] office [and then] doesn’t
leave until 8 p.m.” she said. “He’s like a locomotive that just doesn’t
slow down. [But] we want him to slow down so he can serve much longer.”

Tedros has implemented his open-door policy to staff every Thursday, and
initiates meetings with staff, including the staff association and
directors at WHO, the senior adviser said.

“He eats in the cafeteria with staff [and] walks with them through the
hallways. He doesn’t use the special entrance designated for the
director-general in the back. He understands WHO’s most valued assets [are]
the staff,” she added.

But Tedros’ presence does not seem to penetrate across the organization
just yet. The perception by some staff is that he travels a lot, and when
he is in Geneva, he’s mostly engaged in meetings with high-level officials.

“In my view, some proactive ‘outreach’ on the part of the
director-general’s office would be helpful as most people are, like myself,
too apprehensive about going up to someone as high up as the DG …
especially after the more top-down organizational culture of the past few
years,” a WHO staffer who spoke on condition of anonymity told Devex.

This does not mean Tedros is not following through on his words. In fact,
some staff confirm to Devex the WHO aid chief’s open door initiative, and
one of them knew of three people who had appointments with him in the past
three months. Their feedback: he’s been “highly receptive” and “friendly.”

“All staff have been welcome to provide him suggestions in a 15 minute
face-to-face appointment,” one staffer, who also spoke on condition of
anonymity, said. “That’s already more interaction with the staff than the
previous DG had in her 10 years.”

This speaks to Tedros’ intentions of having more engagement with staff,
which he has mentioned several times in speeches, but it also demonstrates
that it requires a major cultural change that other high-level officials in
the organization could well follow.

“He’s asking everyone to be the same, to lead by example. He’s now asked
all the ADGs of course to be … [and] the existing teams and directors, and
ADGs [to] please make yourselves available,” Fisseha said.

Tedros has also taken it as his task to resolve internal tensions and
issues between teams, some of which have persisted for years and have
affected the way the organization operates.

Fisseha didn’t elaborate further, although she gave the example of apparent
longstanding issues between WHO and the International Agency for Research
on Cancer when Tedros came on board, which the director-general discussed
with the IARC’s director and teams.

“He said if we have issues, we’re going to sit down and solve it. We need
regular engagement, and not only when issues arise,” Fisseha said. “As he
repeatedly said, unless we’re healthy internally, we cannot be healthy and
functional externally.”

This could have inspired a proposal in the WHO’s program of work concept
note to incentivize cross-departmental collaboration, and disincentivize
approaches done in siloes.

Tedros’ litmus test

Tedros has consistently called universal health coverage his top priority.
He spoke of it earlier during his campaign for the director-general
position, and has been putting it front and center in all of his
engagements, whether in the context of drumming up support and investments
from different political leaders, or in terms of how WHO should organize
itself.

He has noted that the road to UHC will be different in each country, and
that to achieve it will require significant investments in country health
systems — including better information systems and sufficient workforce
equipped with the right training and skills — and finding the means to
sustainably finance each part. Having a strong health system, he said, is
vital to responding to health emergencies. He has also established a WHO
Health Security Council that meets every two weeks to review all health
emergencies communicated to WHO globally and how the organization is
responding to each of them.

But WHO’s performance in health emergencies will not be the only litmus
test on whether the institution succeeded in forging a path toward
universal health coverage in countries. Advocates and policy experts will
be gauging too how Tedros handles discussions on access to affordable
medicines.

To date, some of them think Tedros has not highlighted the issue enough in
his push toward universal health coverage.

“Dr. Tedros has talked about UHC, everywhere. At the UNGA he put universal
health coverage and SDGs at the forefront. What I think is missing, to be
honest with you, is the link between that and the link for affordable
medicines. I don’t think [he has raised the issue] strongly enough,” an
expert on the topic who spoke on condition of anonymity for fear of
endangering their consulting work told Devex.

The source has found Tedros focusing much of his discussions on mobilizing
resources for universal health coverage and “the right to health.”

“And that’s really powerful and really correct,” the expert said. “But I
think I’ve not seen enough [discussion] for example about the existing
policy incoherence between trade frameworks and the right to health and the
SDGs.”

A discussion of the U.N. High Level Panel Report on Access to Medicines —
which the source said specifically asks the question on how to solve the
policy incoherence between trade, health, and the SDGs, a deeply complex,
tension-filled discussion for sure — failed to progress at the last World
Health Assembly, due to strong opposition from some rich powerful countries
with large pharmaceutical industries. But advocates expected more from WHO,
and were disappointed, having felt they didn’t get the necessary support
from the institution that’s supposed to be “the moral authority on health.”

They are hoping Tedros will be more proactive in taking on the issue at the
next executive board meeting, at the next World Health Assembly. And they
hope he will fully implement some of the resolutions WHO has been mandated
to do, such as the WHO Global Strategy and Plan of Action on Public Health,
Innovation and Intellectual Property, which the source said WHO has not
fully implemented to date, despite it having been passed in 2008. An
independent review of the strategy and action plan, released early this
year, identifies several countries’ lack of awareness and engagement on the
plan’s implementation.

But in implementing the strategy, WHO should consider the current contexts.
Tedros should also apply the same political lens he has applied to health
in general when discussing the issues of affordable medicines in political
fora, the source said.

“Most of these mandates are about increasing access to medicines to the
poorest countries of the world, and that’s extremely important. But if you
look at where people don’t have access to medicines right now, they are
everywhere [including] in middle- and high-income countries,” the source
said. “There’s nobody safe from the issue of lack of access to medicines
and vaccines.”

Similarly, Iversen, CEO of Women Deliver, was pleased when Tedros attended
and spoke for women and girls during the London Family Planning Summit in
July. But she hopes Tedros will be more “fierce” in advocating for girls
and women’s health, rights, and well-being, including on matters of sexual
and reproductive health, in his engagements with political leaders and
across the work of WHO.

Tedros should also continue engaging youth and should create a youth
advisory board that could be involved in co-creating policies and programs
in development.

“If given seats at the table, we know that youth and civil society groups
will push the WHO to be more ambitious, innovative, and effective at
meeting the real needs of underserved populations,” she said. “Youth must
not be forgotten from WHO’s priorities. Dr. Tedros will soon face the
challenge of meeting the needs and aspirations of a rapidly growing youth
population.”

While Tedros may have encouraging results in these early days of his
tenure, the road ahead is long and the responsibilities longer. For him to
sustain current optimism in his leadership, he will need to ensure he
delivers on the ambitious roadmap he has initially set out for the
organization — and more.

“History will be our judge,” he said in his Thursday regional committee
speech. “Will our grandchildren admire our achievements? Or will they say
we had a lot of meetings, and wrote a lot of reports, but didn’t achieve
very much?”



-- 
Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org



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