Opinion: The election that matters for the health of the world

A health extension worker counselling a mother on best nutrition practices. Photo by: Nesbitt /  UNICEF Ethiopia / CC BY-NC-ND

Pandemics, resistant bacteria and other infectious disease pose some of the greatest threats to national borders, people and economies. The risks are global, so our resilience and preparedness not only depend on our own country’s health systems, but on the least common denominator of health systems around the world. This is why a physician in Manhattan was diagnosed with Ebola contracted in West Africa; a woman in Reno died of a resistant bacteria from India; and thousands in the United States contracted Zika, a virus that spread from Brazil across the Americas.

Perhaps the most ideal mechanism to address global preparedness and response to such public health threats is through the World Health Organization, the United Nations agency with a 194-country membership charged with safeguarding the health of the world’s population.

The WHO’s Executive Board just announced the three finalists in the running for director-general: David Nabarro, Sania Nishtar and Tedros Adhanom Ghebreyesus. While news about this critical upcoming election may be overshadowed by media coverage of executive actions and bombasting, it offers one of the greatest levers to impact the health of the world’s population and is as headline-deserving a topic as any.

In the current context of what the WHO needs the most, Tedros Adhanom Ghebreyesus, former health and foreign affairs minister of Ethiopia, is the most qualified for the role. Over the past 30 years, he has led health systems in his home country of Ethiopia and chaired the board of the Global Fund to fight AIDS, Tuberculosis and Malaria, one of the largest coffers for global health financing.

Tedros’ suitability for director-general rests is his irrefutable ability to create and build efficient and sustainable health systems, the linchpin of health care delivery. Under his leadership, Ethiopia has made such dramatic improvements in public health outcomes that it is often heralded as a model for health care delivery in low- and middle-income countries. During his tenure, Ethiopia trained and deployed nearly 40,000 health extension workers — mostly women — to the most remote and hardest-to-reach parts of the country to provide basic health care services. Evidence suggests that his interventions have led to precipitous declines in rates of infant mortality to levels that even countries with far more resources have not been able to achieve.

While Ethiopia had previously grappled with one of the greatest doctor shortages in the world, under Tedros’ leadership, the country opened 13 new medical schools, dramatically increasing the number of graduating doctors in the country. When there were concerns or critiques about how this may lead to decrease in quality of medical education, Tedros created new partnership models to pair the new Ethiopian schools with leading U.S. and European institutions for faculty career development, curriculum enhancements, and capacity building for locally relevant research.

Both of us have seen firsthand at the University of Michigan how such partnerships are creating high-quality, highly motivated medical doctors and researchers in Ethiopia.

Of course there is also a political element to the role of director-general. Tedros has witnessed firsthand that the real challenge for the WHO — and for mproving health of populations around the world — is not a lack of new ideas and innovative concepts. It will need serious commitment of resources — both in terms of financial and political capital, and also strong implementation. With more than 80 percent of its money coming from voluntary contributions earmarked for specific programs, the WHO has little fungibility or budgetary flexibility to act on emergent health issues.

Tedros has been the health minister of a resource-poor country where, quite often, multiple aid agencies work with their own specific — and sometimes conflicting — goals, implemented through fragmented delivery architecture. In Ethiopia, Tedros was able to convince government and private financiers that the overall system benefits when they let the country government act as a single point of control and coordination. Of all the candidates, he would be the most capable at negotiating enhanced core contributions from member states. His pragmatic and implementation-oriented managerial style and his political experience stand the best chance of convincing WHO member states to increase contributions to create a well-functioning WHO.

Over time, the WHO has burdened its scarce technical and resource capacity in managing a whole gamut of activities, extending it into areas that would probably belong in the mandate of other global and regional agencies. Tedros knows how to focus an organization on its core and central function. His counterparts in developing countries, especially in sub-Saharan Africa, have also made him realize that it will be extremely important to balance international rule setting and normative policy while also allowing space for countries to determine their own policy around pressing health issues. Striking such a balance requires someone who is an insider to the club of developing country health ministers.

This election may well represent a watershed moment in the architecture of global health governance. The WHO urgently needs a leader to repair its deficit in finances and credibility.  Fractured and under-resourced health systems are in need of fortification to not only project those within their own borders but also to build resilience against the rise of transnational threats to public health. Tedros is the candidate to do both, and it would be in all of our best interest to elect him.

Stay tuned for more opinion pieces on the three director-general candidates and the role of the WHO under new leadership in May 2017, and read Devex’s exclusive look at the stakes behind the vote.

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About the authors

  • Yadav

    Prashant Yadav

    Prashant Yadav is a senior fellow at the William Davidson Institute at the University of Michigan and a visiting scholar at the Harvard Medical School.
  • Akash%2520goel

    Akash Goel

    Akash Goel is a physician and journalist. He is a World Economic Forum Global Shaper.