Opinion: A new deal for health

Sania Nishtar, candidate in the race for World Health Organization director-general. Photo by: Jakob Polacsek / World Economic Forum / CC BY-NC-ND

Rewind to 2003, as Severe Acute Respiratory Syndrome spreads rapidly across the world and health systems start to collapse. Over a period of four months, the viral respiratory illness spreads widely and swiftly. International trade and travel almost cease in parts of west Asia, markets slump and economies are crippled. Fast forward to the recent Ebola and Zika epidemics: The same pattern emerges, albeit at a smaller scale.

It’s incredible to consider that although these diseases affected tens of thousands of lives, humankind was relatively lucky. The SARS virus characteristics meant that containment was possible, despite significant shortcomings in health systems and preparedness around the world. If the virus had been more infectious, things could have quickly resembled the Spanish flu pandemic of 1918, which killed tens of millions.

In today’s world of intercontinental travel, a global pandemic could kill hundreds of millions, throw the world into another great recession and result in dire economic and social consequences for the planet and human race.

Pandemics, however, are not the only threat to public health. Antimicrobial resistance, noncommunicable diseases, widening inequalities in health and the dramatic effects of climate change are also threatening to wipe out the development gains of the last century.

Now more than ever, the World Health Organization must effectively exercise stewardship to protect the world from these threats. It must also drive action toward the vision of health for all, which has been validated in the Sustainable Development Goals. The question is: How can the WHO, as the world’s only universal membership multilateral agency and the world’s lead health agency, drive such action, given that the vision for health — universal attainment of the highest possible level of health and well-being — is a shared responsibility, especially in view of the fragmented nature of global, regional and even some national systems.  

From my perspective, in order to deliver, first and foremost, the WHO must function to the highest possible standard of efficiency, transparency and accountability, free from patronism and undue influence. Following the West African Ebola crisis, a reform process started to address these long-standing challenges in the organization, as well as to tackle structural performance issues. This reform is in its nascent stages and must be accelerated.

This is no easy task, as the challenges are endemic not only within the WHO but also within the United Nations more broadly, and pose major roadblocks to effecting change. Let me give a critical example from my experience during the election process for Director-General.

A common practice has been for candidates to make “deals for votes” — this can include promising senior management positions or promising “agenda favors.” While “understandable” from the perspective of promoting the interests of a particular nation state, this approach does not make sense for an agency focused on global public goods. Deals constrain the ability to appoint the right people with the appropriate skills for the job. They also affect the WHO’s ability to take impartial decisions, speak truth to power, or be an honest, evidence-driven voice as a global guardian of health.

During the campaign, there has been a great deal of focus on the “political role” of the Director-General. It is important that the next leader has a proven track record of leadership on hard issues to overcome collusive practices and the systemic barriers, which constrain delivery on goals. Political and diplomatic skills are undoubtedly essential capabilities for effective leadership of the WHO, but the world simply does not have the time or resources for “politics as usual” over the next five years.

Furthermore, the leader must have integrity to inspire trust for resource mobilization, and an ability to be impartial and evidence-based in complex situations, which is needed to navigate the WHO out of polarizing situations. A commitment to transparency and integrity are also critical to playing these political roles effectively and restoring the WHO’s reputation. The Director-General will only be able to deliver on the vision of a new WHO with clean hands coming out of the election process.

So yes — I am playing “bad politics” by making no deals, because if I’m elected by member states, I believe that “bad politics” will bode well for “good governance.” My philosophy and practice are to be the change that I want to see.

I have therefore decided that I will make senior management appointments based on merit and through a transparent recruitment process, with due consideration to gender and geographic diversity, which are also key to good global governance. I was the first candidate to declare that I would publish my campaign finances, and I have provided fully costed expenses and the source of the funding. I have also kept election expenses to a minimum. My campaign is supported by my government and a small network of volunteers. I have not hired public relations agencies, political strategy companies, or advertising firms.

I am humbled by the many member states around the world that appreciate my hard stance on transparency and good governance. These countries have stepped out of a singular view of “national interest” and support me regardless of political or regional considerations.

My vision for a new WHO focuses on the need for the organization to reclaim its primacy and regain the world’s trust as its lead health agency. I stand on my record as a builder and reformer, and someone who has demonstrated commitment to transparency and accountability. I will accelerate meaningful reform of the organization.

I will focus the WHO on its core mandates and will usher in a new leadership paradigm, in which the WHO leads by building partnerships — both inside and outside of the health sector — and acts as a force multiplier by playing its exclusive roles.

To truly contribute to the SDGs and fulfill its mandate, the WHO will need to better articulate what it does and does not do as an agency. It needs a dedicated external relations function to articulate its role, its successes, capacities and limitations and forge partnerships, recognizing the need to work with all stakeholders without vilification, but with transparency and accountability.

It needs a new and professional resource mobilization strategy, backed by appropriate advocacy and a focus on results and accountability. It needs to break silos and truly promote a life-course approach and multi-sectoral response. It needs to respond to member states’ needs, rather than promote Geneva-based top-down solutions. This features prominently in my vision.

Throughout my career as a doctor, in civil society, government and with international agencies, I have lived by the mantra that if you start with a strong foundation, you’ll get the right outcomes in the long-term. For the WHO this means going back to basics, starting with the norms and standard setting function, effective emergency preparedness and response, and rebuilding the foundation.  

The situation of the WHO is grave. The time for niceties is over. We are one disease outbreak away from an unimaginable catastrophe that could be worse than the Spanish flu outbreak of 1918. This means I am even willing to commit to one term in office, if that is what is required to accelerate reform within the WHO and eliminate the influence of detrimental political practices.  

By supporting my candidacy, member states will be casting their vote for reform, transparency and accountability, and an earnest desire for change. United, we will solve the health challenges of today and tomorrow, and restore the WHO we all need.

This op-ed is one in a series from all three WHO candidates. You can read our full coverage and analysis on the election of the next WHO director-general in May 2017.

Devex does not endorse any particular candidate.

About the author

  • Uiy

    Sania Nishtar

    Sania Nishtar is the founder and president of Heartfile, co-chair of the WHO Commission on Ending Childhood Obesity and former federal minister of the government of Pakistan. She is a candidate in the race for WHO director-general.