Priorities for the next WHO director-general

The next director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, will have his work cut out for him when he takes the helm. Even before the election, government, business and civil society leaders were weighing in on what the priorities of the next director-general should be.

From restoring faith in WHO, to updating and upgrading systems, to improving transparency and coordination between local offices and headquarters, the recommendations can help form a roadmap, not just for Tedros’ first 100 days but for his critical first year in office and beyond.

He has a daunting task of establishing a vision for the agency, getting buy-in and then focusing on improving management and operations, while publicly measuring the results. Many people will be watching his early actions, notably who he chooses to hire and how he lays out his vision.

“We know the next health emergency is a matter of not if, but when, and when it happens the world will turn to the WHO for guidance and for leadership. We need to be sure it’s up to the task,” said Tom Price, the United States secretary of health and human services, at an event held Tuesday prior to the vote.

The U.S. strongly supports WHO, he added, but the next director-general will need to manage political sensitivities between regional and country offices and work to ensure that public health decisions are science-based and insulated from politics. The next director-general will also need to make WHO more “effective, accountable and transparent” both in how resources are spent and about results.

All this change is necessary in part because while WHO is still important, it needs to look quite different to what it did when it was founded 70 years ago.

“Its inability to stay up with the times and changes made it less effective,” said Ashish Jha, the director of the Harvard University Global Health Institute, at the event.

Early actions

While some of the reforms and changes needed will take time, there are things that the next director-general should do early on in his tenure to pave the road for success.

Step one for Tedros should be an exercise in listening — taking the time to hear and learn from staff, partners and other stakeholders, said John Flannery, the president and chief executive officer of GE Healthcare. There is often a temptation to “come out of the gate strong” he said, but he cautioned that it may be wise to move at a deliberate pace.  

Another recommendation, from Loyce Pace, the president and executive director of the Global Health Council, is that Tedros launch a public relations campaign that would acknowledge past shortcomings, serve as a bit of a mea culpa for the organization, and help educate people about why WHO is important. That reputational work can help get external and internal buy-in that can help the director-general achieve further objectives, including raising funds, down the road, she said.

Jha suggested that Tedros first look internally and tackle some critical reforms — creating a much more transparent system, implementing human resources reform and creating an independent accountability mechanism beyond the executive board, something akin to an inspector general.

Tedros should also take early action on gender equality, by taking personal leadership over gender equality initiatives and in early hiring efforts, Claire Somerville, executive director of the Gender Centre at the Graduate Institute of International and Development Studies in Geneva, wrote Devex in an email.

A strategic vision

While the first 100 days may be important, it is the first year that is critical, said Mark Dybul, the executive director of the Global Fund to fight AIDS, Tuberculosis and Malaria.

Tedros will need to determine WHO’s mission in the years ahead and what its role and scope can and should be. In order to do that, he must evaluate the agency’s strengths and determine its priorities.

“We passed a policy last year on the WHO's framework of engagement with nonstate actors, to that end governing bodies and the secretariat need to think about what WHO’s comparative advantages are and how it can become more focused on the needs of member states and not try to do more than it should or can,” Price said. “WHO must become focused on its core mission.”

Tedros has an opportunity also to help the global health community shift its way of thinking from one that is siloed by disease or other priority to a more multisectoral, cross-cutting view of health, that focuses on prevention, systems and innovation in finance, technology and new ways of working, said Jan Beagle, the deputy executive director of UNAIDS.

Tedros will need to not only determine his vision for the organization in the first year but he must then both message the internal and external transformation, and work quickly to operationalize it, he said. He may need some quick wins, but it it will be critical that he focuses on the mission and articulates a clear strategy and agenda, Dybul said.

“You cannot do change management without that,” he said.

Dybul urged him to give staff a “bigger mission, a vision to rally around,” which most working in health are looking for.

Operations and accountability

Once Tedros has the strategic plan and vision, he will have to get staff in place and also ensure that the organization has the implementation capabilities to deliver on its goals — which may mean a need to improve core infrastructure, training and clinical capacity in various countries, Flannery said.

Who Tedros hires will be watched closely, as the type and caliber of people who work at the agency are critical to its success. Several people urged that the hiring be open, transparent and driven by the skills of the individuals rather than politics. Who he chooses will say a lot about how he’ll lead, Dybul said.

Moreover, without the right people, who are both competent and motivated, any of his reform efforts would collapse, Flannery said.

Price had some specific recommendations on the human resources challenges, including ensuring that WHO takes advantage of the latest technology, attracts the most qualified people and provides flexibility for different types of engagements at the agency.

“A short term contract at WHO should not become a guarantee of lifetime employment there. That does not create the WHO that we all need,” Price said.

Looking at hiring practices and reforming human resources may also mean that the agency needs to lay off some of its employees, if they don’t fit with priorities, or to make way for others who have the skill sets the agency needs.

Tedros will also need to ensure that people are “freed up to do what they were hired to do” and not constrained by bureaucracy and diverted into other projects, Beagle said.

A key part of operations reform will be setting up a robust accountability framework, in whatever form it takes. Given the agency’s need to rebuild its reputation and some of the criticisms that Tedros faced during the election, including allegations that he covered up epidemics while he was health minister in Ethiopia, he will need to focus on transparency and accountability. Part of those efforts will need to ensure that there are good measurement mechanisms so progress can be effectively tracked.

Given the changing dynamics in global health — from where funding is coming from to who is engaged — this next director-general will also have to think strategically about how to partner, and where others, for example from the private sector, might be able to improve human resources management, procurement or supply chain issues at WHO.

Finding the money

Tedros will also be responsible for helping WHO, which has repeatedly fallen short in fundraising campaigns, to find the funds necessary to continue its work and achieve global health goals.

Improving transparency and effectiveness at WHO might help bring in more financing, or ensure more flexible financing that isn’t earmarked to specific issues. But if donors are concerned about how their money will be spent, they will continue to allocate funding to specific causes, which may handcuff WHO, Jha said.

“There is money out there if you use it well. There is no money out there if you don’t use it well,” Dybul said.

Relying on traditional donors is certainly not enough, especially as global health funding is moving and needs to continue to move from grants to loans, with a greater focus on increasing domestic financing and bringinging in the financial sector, Dybul said.

Flannery also urged the next director-general to look at the “huge reservoir” of money in the private sector, and find ways to creates structures or frameworks that would allow companies and financial institutions to invest.

As he looks to attract finances, Tedros should also be sure that he doesn’t overlook less “sexy” issues, including norms and reforms, which may be harder to raise funds for and make the case for investing in those areas as well, Pace said.

Devex is reporting live from the World Health Assembly in Geneva. Follow @devex and our reporters @AdvaSal and @JennyLeiRavelo ‏and subscribe to the Development Newswire for our coverage of #WHA70.