[Ip-health] Charles Clift - Whither the Good Ship WHO?

Thiru Balasubramaniam thiru at keionline.org
Mon Nov 28 04:19:10 PST 2016


Whither the Good Ship WHO?

Charles Clift, Senior Consulting Fellow, Centre on Global Health Security,
Chatham House

The new more open process to elect the next director-general at the World
Health Organization (WHO) is enlivening what is normally a non-event
conducted behind closed doors. While the WHO and its new leader from 1 July
next year will have many difficult issues to confront, and the WHO is
widely seen as having lost credibility as a result of Ebola crisis, the new
election procedure is proving a much-needed success for the WHO.

Ironically, it came about as a result of a member state working group
established in 2011 because of concerns amongst some member states that
hitherto WHO director-generals had come from only three of the WHO’s six
regions. But while they could have concluded that Buggins’ turn was the
answer, they wisely decided that more democracy was a better solution. And
in addition they introduced a new code of conduct for the election process.

As part of this new process, the six candidates gathered in Geneva on 1-2
November to be interviewed by member states at a forum that was webcast. So
the wider public and nongovernmental stakeholders could view the
proceedings but were not able to ask questions.

Chatham House and its partner, the Global Health Centre in Geneva, decided
to use this opportunity to bring the candidates together at Chatham House
in London on 3 November for a question and answer session which would be
principally for non-state actors interested in the future of the WHO.
Richard Horton, the Lancet’s editor-in-chief, interrogated the candidates
in a panel session where they made short statements and then questions to
the candidates were put from the audience in the hall and via twitter from
the large number viewing the livestream of the event.

The feedback received directly or via twitter was extremely positive. The
three-hour session generated over 1900 tweets and more people watched the
livestream than had watched John Kerry who was at Chatham House the
preceding Monday. The candidates seemed to enjoy it – it was the first time
they had appeared together on a platform – and the atmosphere was friendly
and collaborative rather than competitive. The informal and more
interactive format compared to the preceding Geneva event made it a better
way of elucidating the candidates’ position on the multitude of challenges
that the WHO currently faces. The one disappointment was that Dr Tedros,
the candidate from Ethiopia, had to cancel his appearance at the last
minute as a result of political developments at home.

The co-chair of the event, Suerie Moon, developed an elaborate metaphor for
the WHO which resonated with the candidates. The WHO was a 70-year-old
ocean going liner. The director-general was captain of the liner but in the
fleet were six other ships (the six regional offices) with their own
captains and 150 boats (the country offices). Directing this motley crew
was complex enough but was made more so because the owners of the fleet
(the member states) were often at odds with one another over the direction
it should take and were very reluctant to provide adequate funds for
maintenance of these aging vessels. And yet they kept on loading the fleet
with more and more cargo.

Moreover the fleet was in very choppy waters with numerous health
challenges – dealing with health emergencies, addressing the SDGs, the
health implications of climate change and the aging of the world’s
population – and there were many other boats in the water which were much
more agile and a challenge to the WHO’s authority. The captain of the WHO
ship needed to find a way to navigate these difficult and uncharted waters,
to re-establish WHO’s credibility and authority and clarify its role in
convening and coordinating the many actors in the global health waters.

Many of the questions directed at candidates and their answers – too
numerous to enumerate here – revolved around these marine dilemmas for the
WHO. The views of the candidates inevitably reflected their experiences and
particular interests. Key themes that emerged included:

The need to align the three levels of the WHO. Here there was a role for
accountability compacts between the director-general and the regional
directors and the assistant director-generals, the strengthening of the
Global Policy Group (bringing together HQ and the regional management), and
the development of one vision for the whole organization.

The need to increase sustainable financing – through attracting more donors
and through considering innovative financing mechanisms such as, for
example, sugar taxes. But in order to attract more financing the WHO had to
demonstrate results, which necessitated also more emphasis on measuring
impact. Trust in the WHO had to be restored. At the same time, it was noted
that the mindset in the WHO needed to change – the WHO’s role was not
necessarily to do more itself but to catalyse and coordinate action by
others to achieve shared goals.

In the same vein, partnerships were key for the WHO and several candidates
stressed their experience and expertise in forming partnerships.
Partnership with the private sector was problematic for the WHO in its
standard setting role but some thought cooperation in implementing
programmes was important.

Universal health coverage was much discussed as a means by which all could
get access to health care – ‘let no one be left behind’ was repeated
several times. In that context, the importance of addressing human resource
constraints in national health systems was recognized and the importance of
the WHO in providing advice to governments.

Other subjects raised including the importance of the right to health as a
motivator for improved performance, access to medicines, the role of the
director-general in resolving disputes between member states by being
proactive, and many others. Some but not all of the candidates said they
would reveal their election expenses.

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