Meet the candidates for WHO's top job in Africa

The race for the next regional director of the World Health Organization’s Africa office is moving full steam ahead with a month left before the elections. It’s a five-year term, which could evolve into a decade if reappointed. The next leader will replace Dr. Matshidiso Moeti, who has served in the role for the past nine and a half years. African ministers of health will vote by secret ballot on whom to nominate during closed door meetings at the end of August. That nomination will then be submitted to WHO’s executive board in January for final confirmation, and the new regional director will take on the role in February. Four countries have put candidates forward: Niger, Rwanda, Senegal, and Tanzania. Last Monday, candidates presented themselves and their priorities during a candidates forum, where ministers of health questioned them. There was a lot of overlap in what candidates said they would prioritize, such as accelerated access to universal health coverage, helping the continent adapt to the impact of climate change on health systems, improving maternal and child health care, combating communicable and noncommunicable diseases, and preparing for health emergencies. But the candidates also worked to set themselves apart. Senegal’s Dr. Ibrahima Socé Fall Fall started his career as a front-line military doctor in the 1990s. He was deployed with troops during the conflict in the Casamance region in Senegal, which was a foundational experience for him. “I learned the importance of meticulous planning, quick decision-making, and the ability to adapt to rapidly changing situations,” he said, during the forum. He’s currently the director of WHO’s global neglected tropical diseases program and has held a host of other roles within the agency, including assistant director general for emergency response, African regional emergencies director, and country representative for Mali. U.N. Secretary-General Ban Ki-moon appointed Fall as crisis manager of the 2014 West Africa Ebola epidemic and U.N. Secretary-General António Guterres appointed him to lead the Ebola response in North Kivu in the Democratic Republic of Congo in 2019. He also led efforts to halt Guinea worm transmission in Senegal, and managed the largest meningitis outbreak in the Sahel in 1996. He is the only candidate who has been part of the executive management team at both the WHO’s regional office for Africa and the agency’s global level, he said. He spoke of ensuring WHO’s support to countries is tailored to reflect their diversity. “I am committed to make sure that what we are doing is really targeted based on the country specificities,” he said. He also spoke about the need for smooth coordination between the Africa Centres for Disease Control and Prevention and WHO’s Africa office — as the political capital that Africa CDC possesses given its position within the African Union is crucial to advancing the continent’s health goals. His candidacy is endorsed by the AU. Niger’s Dr. Boureima Hama Sambo Sambo is the candidate with the most experience leading WHO country offices. He’s currently WHO representative for DRC and has served as WHO representative in Ethiopia and Gabon, as well as on an interim basis in Rwanda. This included leading WHO’s Ethiopia office during the war in Tigray and the northern part of the country and while the country faced severe drought. He said leading several country offices has given him a deep understanding of the unique health challenges faced by different countries — from infectious disease outbreaks to health care infrastructure limitations. He also served as director of climate and other determinants of health at WHO’s headquarters, and other roles in the WHO Africa regional office. He started his career as chief medical officer in Tera Medical District in Niger. He spoke of promoting African solutions to African problems, the need for south-south cooperation, increased local research efforts, and effective culturally sensitive interventions. This includes the inclusion of traditional medicines, accompanied by adequate regulations, into national health systems, which he said he championed while leading WHO’s office in Gabon. He spoke of using innovative solutions, such as telemedicine, in order for health workers to expand their reach. “WHO must demonstrate organizational agility, be flexibly and predictably financed, and adopt a strong country focus,” he said. Tanzania’s Dr. Faustine Engelbert Ndugulile He’s the candidate with the most domestic political experience. He’s served as a member of the Tanzanian parliament since 2010. He also served as deputy health minister until former President John Magafuli, who was an infamous COVID-19 denier, removed him from the position in May 2020 amid a series of high-ranking public health dismissals as the country drew criticism for its response to the pandemic. Ndugulile had been in the job since 2017. He contradicted government advice, such as using steam therapy to prevent the virus, but no reason was given for his dismissal. Later that year, Magufuli appointed him minister for communication and information technology. It’s his decades of political experience that Ndugulile said sets him apart from other candidates. <blockquote class="twitter-tweet"><p lang="en" dir="ltr">The <a href="https://twitter.com/hashtag/WHOAFRO?src=hash&amp;ref_src=twsrc%5Etfw">#WHOAFRO</a> is in need of a leader who can continue with the transformation agenda and give the final push towards attaining SGDs goals.<br>We need a &quot;transformational leaders&quot; and not a &quot;transactional leaders&quot;.<br>I am fit for purpose for this position, given my background as a… <a href="https://t.co/8LyZFX0s2z">pic.twitter.com/8LyZFX0s2z</a></p>&mdash; Faustine Ndugulile (@DocFaustine) <a href="https://twitter.com/DocFaustine/status/1816036160268914768?ref_src=twsrc%5Etfw">July 24, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script> Via X. “Ministers, I've worn those shoes before. I know the pressures ministers face, and the support they need and expect from the World Health Organization and other stakeholders,” he said during the forum. He added that ramping up political engagement from the continent is crucial in ensuring the population's health. He said that his background as a technocrat will help with that. He said there’s competition among regional health players and that he aims to change that, as he’s a “firm believer in complementarity rather than competition.” He said some stakeholders question WHO’s role but he believes the agency “is still relevant, but we need to be responsive to the needs of member states.” Regional offices are sparsely staffed with technical experts, he said, but he plans to strengthen both country and regional offices. “WHO Afro needs a transformational leader with a vision and track record of driving changes and not a transactional leader who's going to sustain the status quo,” he said. “I’m that transformational leader.” Rwanda’s Dr. Richard Mihigo Mihigo’s formative years in health care took place during the genocide in his country. “In 1994, as a young doctor in a rural hospital, in the southern part of Rwanda, I saw firsthand how primary health care systems, the very foundation of any well functioning national health system, can be destroyed with devastating consequences for the lives and well-being of our population,” he said. He was involved in the rebuilding of the nation’s health systems, including contributing to the launch of the nation’s community health care worker program and health insurance system. <blockquote class="twitter-tweet"><p lang="en" dir="ltr">I was honored to present today my vision and strategic priorities for the election of RD <a href="https://twitter.com/WHOAFRO?ref_src=twsrc%5Etfw">@WHOAFRO</a> to the Ministers of Health during the live forum. Should I be elected, I’m ready to hit the ground running, intensifying efforts and work together towards our common priorities. <a href="https://t.co/4dMvJINOza">pic.twitter.com/4dMvJINOza</a></p>&mdash; Dr Richard Mihigo (@RichardMihigo) <a href="https://twitter.com/RichardMihigo/status/1815371737632043085?ref_src=twsrc%5Etfw">July 22, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script> Via X. He spent 18 years at WHO, which has included in-country work as well as work in the Africa regional office, where he rose to the position of chief of the immunization and vaccine development program. “During the COVID-19 pandemic, I led WHO Afro’s response in this region as the deputy incident manager, coordinating the provision of vital supplies and technical support to our member states,” he said. He joined Gavi, the Vaccine Alliance, in 2022 as global lead and senior director of COVID-19 Vaccine Delivery, Coordination, and Integration. He is now senior director of programmatic and strategic engagement with the African Union and Africa CDC at Gavi. He said there’s a need to shift priorities to focus on WHO responding to the needs of countries. This would include a long-term vision of WHO’s presence decreasing as country capacities are strengthened. He said he would “try and turn upside down this pyramid” where most of the resources are concentrated at regional and headquarter level, and instead increase resources to countries. A withdrawal and glaring gaps There were initially five candidates announced in June, but Côte d'Ivoire withdrew the nomination of N'Da Konan Michel Yao, WHO’s director of strategic health operations, earlier this month. In a LinkedIn post, Yao wrote he respects this “sovereign decision” and hopes for “a peaceful campaign far from lies and attacks and based on smooth judgement about Candidates’ capacity and project.” He previously wrote about fake news related to his candidacy, in regards to another person with a similar name who was accused of trying to smuggle genetic material from the Ebola virus across the Canada-U.S. border. The election has also drawn criticism for its all male lineup. AMREF Health Africa’s Dr. Githinji Gitahi posted on the platform X that he’s aware of women who expressed interest in the job, but that countries didn’t move forward with those nominations. Luchuo Bain, a global health specialist and empirical bioethicist, told Devex that when he watched the candidate's forum there were two things that disappointed him: The absence of female candidates, as well as the candidate’s lack of prioritizing reproductive rights at a time when there is a backlash against these rights globally. "Sexual and reproductive health and rights were grossly ignored," he said.