9 May 2017 – Mukesh Kapila
Medical science has never been so productive and yet health inequalities have never been wider – more of the same is not an option
Does it matter who heads the World Health Organization (WHO)?
Yes, say West Africans badly let down by WHO’s feeble response to the Ebola epidemic. Yes, say Darfuris, whose suffering was disingenuously downplayed by WHO as too-sensitive. It matters to the thousands predicted to die from the health consequences of climate change.
It concerns the millions of refugees locked out of normal programmes. It concerns all who cannot access effective healthcare, make reproductive health choices, or get life-saving medications such as insulin. Most of all, it matters to you and I because, in our interconnected world, our personal health chances are shaped by policies and choices made globally.
The list of global health challenges goes on and on. Lifestyle conditions like cancer, heart disease, diabetes and chronic respiratory diseases, along with mental health, take an increasing toll. Meanwhile, old infections re-emerge and new bugs spread alarm. And we should all be concerned that resistance to life-saving antibiotics is burgeoning.
The irony is that never has medical science been so productive and yet health inequalities so wide. That is why continuing to do more of the same is not an option. While extra funding is always welcome, much more necessary is a revolution in mind-sets and attitudes. This means organisational innovation to drive universal health coverage, foster collaboration, strengthen national health capacities, and forge partnerships that respect health as a fundamental human right. Hence, the centrality of WHO.
While WHO has many successes under its belt, it is heavily criticised for its costly, many-layered, self-serving bureaucracy unresponsive to real country needs. World-class health expertise has been fleeing the numerous cubicles of its huge Geneva office. Even its traditional authority to set the norms and standards for things that impact on human health is challenged by centres of excellence elsewhere. Its suspicion of civil society has alienated the groups most vital to service delivery. Its archaic governance cannot or will not hold the organisation accountable. Member states have financially starved WHO because they don’t trust it, or have bypassed it by creating other international organisations that do higher-quality health work.
However, WHO is still a quintessential public good whose reform has become an expansive industry. Many experts and commissions have offered sensible prescriptions. But a reluctant organisation will not take the full cure, making marginal adjustments only to keep limping along.
Who will become WHO’s next director general? 194 countries, meeting as the World Health Assembly in Geneva in late May, will decide from Tedros Adhanom Ghebreyesus of Ethiopia, David Nabarro of the United Kingdom and Sania Nishtar of Pakistan. All are well-qualified. More important are the differences that reveal their personal fitness for the top job. Who will transform WHO and not just navigate it better?
The main determinants of population health are social and political, and the health struggle is too important to be left to technical experts. WHO has thousands of those already. They do not need another super-technician to lead them but a seasoned politician with a domestic and international track record in bringing stakeholders together. WHO must belong to all nations: it should not be in-hock to the few who fund it most. Only then will WHO regain trust and rebuild the inclusive partnerships essential to finance its mission. Good health is not delivered in committee rooms or by parachuting down the ivory towers of Geneva and New York. It comes from accountable frontline leadership of the daily nitty-gritty of healthcare delivery. Only a candidate who has made a real difference nationally is credible in the top job internationally.
That requires a DG with a clear experience-based unifying vision to save an organisation drowning under the weight of many competing technical agendas. All are important but in trying to go everywhere, WHO risks ending up nowhere. Its demoralised staff desperately need to be inspired and not bullied: they plead for a boss who has demonstrated listening abilities and humility in previous roles.
The DG must not just think outside the box but act outside it too. This requires not the safe re-arranging of bureaucratic furniture yet again but the ability to innovate WHO’s business model and organisational set-up. Fresh independent minds and hands are needed and not those already far too vested in the existing system.
A trustworthy director general is a sine qua non. They must have strong moral values, and demonstrated the courage of having lived them without fear or favour. The DG is required to stand up to vested interests and confront tough dilemmas consistently. They must know the fine dividing line between pragmatic expediency and cowardice.
The electors of the DG should be wary of anyone who promises quick technical fixes to ‘make WHO great again’. It is the personal character of the new leader that will ultimately determine whether the organisation can renew its moral and practical purpose and give us the WHO we need.
First published in The Guardian