Q&A: Tedros on internal policies, staff engagement, and legacy

MANILA — For the past six months, World Health Organization Director-General Tedros Adhanom Ghebreyesus has been laying the groundwork for how he will run and lead the institution. Now, member states and observers in the global health community are watching closely to see what comes next.

As part of our exclusive interview with the WHO aid chief, Devex sat down with Tedros to learn more of his plans for the organization, how he aims to move forward with his gender parity goals amid a new United Nations policy that could affect succession planning, what his plans are to promoting a more open recruitment process at the organization, and what legacy he intends to leave WHO.

The conversation below has been edited for length and clarity.

In a span of six months, you’ve appointed your senior leadership team, created a council that meets fortnightly to take stock of public health emergencies, started to drive a culture of change within the organization, and more. What else can we expect from WHO under your leadership, apart from the draft 13th general program of work that will be considered at the World Health Assembly in May?

The second thing maybe would be the transformation plan. In order to achieve this very ambitious GPW, we need a transformed WHO. And that’s why we have a new architecture, a new transformation plan, to really change WHO, not only the processes and business model, but even the culture of WHO.

The transformation plan indicates that as soon as the transformation agenda we have outlined is over in a year or two, then that will lead us into installing a strategic unit in WHO, like the brain of WHO, that will help WHO change on a regular basis. If you like, something that will bring continuous improvement in WHO. And what we’re saying now is, “serve and think.” So not only will we serve, but we will regularly scan the environment, see how we’re providing the services based on the need, and then if there are needs for change, we change constantly. So constant improvement or continuous improvement is built into the organization.

WHO has been doing things the same way for many, many years. And this is because there was no built-in change mechanism. There is a one time reform or transformation, then that stops, and it retains something that doesn’t work for the current issues for long, and it lags behind.

The third part is we’re developing a new strategy and investment case. And WHO will be very active in mobilizing resources for the strategic plan, if you like. We cannot really raise enough funding using the existing model. So with the new strategic plan, we need a new model.

Then if I may add one more thing, our focus will be on emergency. We need to keep our world safe. And we’re now building a strong system to prevent, detect early epidemics and manage them. And in 2018, we will be very very aggressive in advocating for universal health coverage and strong health systems, because we can only get a guarantee when we have strong systems actually to prevent epidemics and manage them.

Your commitment to diversity has been lauded by members of the global health community. But I’m curious, how do you continue to push for gender parity and diversity in the midst of a U.N. policy — on extending the retirement age to 65 — which if implemented this year could make it difficult for WHO to do succession planning.

It’s true. It’s going to affect that. But fortunately, the board of WHO decided to at least extend it by one year, meaning for the retirement extension to 65 years old to start in 2019, not in 2018.

So there is a small space that we got to use and help in addressing the gender parity problems that we face. You're right; we need space to address the gender parity issue, and also geographic diversity. We need diversity. You know when you bring people from all corners of the world, they come with their own experiences and wisdom. They add value. And when you represent diversity, that's how you represent the whole world. You can understand their problems too, easily, because these people you bring from all corners of the world will bring cases with them, their experiences with them.

So that's what we are trying to address at WHO, which is not sending comfort in some quarters, but we need women in the leadership. It's a must, and that's what I've been advocating even during the campaign. And the geographic diversity, that's what member states asked for, and we need to do that. That's what I promised to do, and that's exactly what I’m doing. We have already made good progress in the past six months.

While some have praised your efforts on gender parity and geographic diversity, other quarters have questioned the lack of openness and transparency in the recruitment process in your appointments. How did you make these appointments, and do you have plans of providing a more open process in the future?

I have done the appointments the way they have been done before. Nothing different. In the past they used to not be advertised, and so I didn’t, that’s it. But in order to involve more people who have a say, I did something different this year: I involved the regional directors, because they know excellent people; they know more qualified people. I also involved and consulted more people even outside the regional directors, from the international global health community leaders, and they gave their suggestions. So there was a broad consultation, except it was not really advertised on — what do you call it — newspapers or something, which is not the culture. Even in the past that was the same. The reason they were not advertising before was if you advertise it, it takes more than one year to recruit. You know the U.N.'s slow process of recruitment. Can I go on without a team for one year or more?

For the first time I used the same recruitment to get gender parity and diversity. It’s the most diverse; it represents all six regions of WHO, for the first time. This is an achievement, and we have better outcomes. So there is nothing they can complain about.

And the problem, people know it takes one year or so. I will give you an example. For instance, we advertised in November 2016, even before I came, a director position in the emergencies department. We didn’t manage to hire someone until recently. We had to re-advertise in January this year. Imagine, that’s already more than a year. So we have to change that. You can’t have it both ways.

How about regional directors. Will they be elected the same way as in the past?

Regional directors are elected by member states, like me for global.

But once the director-general is elected, they have every right to put together their team. That's what they have been doing in the past. And you know I am the first director-general who was elected by the Assembly, getting more than 130 votes. Previous director-general elections were done at the board level by 34 countries, member states. That’s it.

You know, it was a new process when I was elected. How would anyone expect that previous votes were decided by the board? I have more mandate, 133 countries, and I’m expected to advertise every appointment I have? You can’t. This is one point.

Second, what I'm saying is it takes between one and two years. I would have loved to do it, but how can you work without a team for more than a year? If you want results to kick start immediately and deliver, you need a team. Until we improve the processes in the recruitment, which I will do by the way, we have to follow all processes, meaning, my predecessors appointed directly and nobody questioned that. And I am more legitimate and they cannot question this now.

It's not coming from different quarters by the way. They're just, I don't know, maybe one person or two. That's it. Because they know the process — the old process. My predecessors were appointing. I haven't done anything differently. I actually consulted more, and the regional directors were consulted. I took their recommendations, and they were very happy because we selected the best people. What counts is the team we have, and nobody can comment on their merit, because we took merit as the basis for the selection, then included gender and geography.

One of the concerns raised was linked to your appointment of Dr. Tereza Kasaeva, the new tuberculosis director. What some quarters are curious about is why didn’t you advertise the position early on, when the former director made it known early in the year that he will be stepping down from his position near the end of 2017?

For the TB position, we used exactly the same process as for the rest of the team. There was no need to single her out because we applied the same method. So I don’t know why Politico is raising this issue. If they’re worried about qualification, she’s the most qualified. Her PhD is in TB, she’s a specialist, and she has a medical degree. We use merit as the basis. We brought gender and geography after we checked their merit is really very good.

And by the way, she already started working, and she’s doing well, very well. But even before she was selected, she was selected based on merit. And the same process was applied. So if there was any problem, it cannot be just her only. Why don’t they talk about the deputy director-generals? Why not talk about the assistant director-generals? Why not talk about the other directors? So that’s one.

Secondly, which is really completely unfounded and false is, they said I appointed her after I met Putin. This is false. Completely false, because the appointments were completed around September, and the selection and interviews were actually completed before September. I met Putin only in November. The appointment of Dr. Tereza Kasaeva was delayed because we wanted to announce the top management, the cabinet, first.

The financing to TB came actually after the appointment. I didn’t even hear it directly. There was no negotiation to get money and appoint. They didn’t discuss it with me. I actually heard about their pledge to fund from the department itself later on. So it has no linkage with appointment. It’s a complete fabrication, sad to say.

You may not believe it, but the appointment was done with full integrity.

It doesn’t help, to be honest, to make assumptions and so on. The appointment of one director doesn’t affect the whole organization. Since this director came, she’s doing well. But even if she wasn’t, it wouldn’t matter. One director would not affect the whole organization.

In truth, people didn’t disagree with the team. You heard yesterday [at the executive board] they were saying, it’s the strongest, most diverse … and were commending that. They don’t have any problem with the team, that’s the most important. And even in my team, I know some of them were campaigning against me. But they’re good, so I took them. I didn’t take it personally, because the appointment is for the organization, the appointment is to serve people. So I put them in my team.

Regarding the past six months, how would you describe your experience in leading WHO so far?

I’m leading WHO in a very balanced way, because as I told you, the ship needs to stay afloat. The day-to-day business is going very well. We addressed priority issues, very sensitive issues. We addressed outbreaks of Marburg in Uganda immediately. We moved quickly. That’s what the world wants. Then we had a strategic plan in just few months, and we have discussed in all regional committees these things and had a broad public consultation. And then we have a transformation plan for WHO. We have a new strategy for resource mobilization.

These are the facts: WHO is moving well. We have a new strategic plan. And considering all the outbreaks we had in the last 6 months, we arrested them quickly. We also have women outnumbering men in senior leadership for the first time. I am not boasting, but we’re faring well, and even with new ideas, the organization is moving really well.

What do staff often tell you in your conversations with them?

They give me new ideas. I am a strong believer in listening to the whole staff, meaning you can convert the whole organization into an advisory machinery, because you will get ideas from all over the world. And because we’re all over the world, I get excellent ideas for the organization. Undigested and uncensored ideas. So what I'm getting is exactly that, something that benefits the organization.

I will give you examples.

One staff came and told me, “Tedros we need to build a world health museum in Geneva.” I was really happy. And then another one comes in, because she believes this will not only show the world what the history of medicine is, but that it can be a revenue source also.

And then another person comes in and says, “let's build a WHO foundation. One that will address the resource mobilization issue and so on, and can even run the WHO museum.”

And then another person comes and says, “let’s not be shy; we need to reach out. You know we can mobilize the whole world by using FIFA for instance. Football. So let's partner with FIFA; let’s partner with the international Olympic committee in an aggressive way. Let's reach out to billions, and use soccer and other sports activities for physical activity. Why would we watch? Why would the world watch? Why not just move in to physical activity influenced by soccer, athletics and so on, so the whole world moves? Because if you move you become healthy. One of the things that we suggest for people to keep healthy is to keep moving. You know that. So why can't we use this?”

And another came up with special ways of engaging the staff. And I told you it resonates with what I started. The same, but saying we should mobilize every staff in the organization, and that every staff should have a say on what to do, what to change. This is the way we can engage.

So what I'm getting at is: Since I've started my open hour, I have met now more than 90 people, one-on-one, and they come up with excellent ideas. Very few came with complaints of their own. Very few. But we try to address that too. We try to help them. That’s why I want to listen to them. When they need help they can come and talk to me. And when they come with ideas to help the organization, I just want to listen. And so far I'm really happy to see how strong the organization will be if we can use the talent pool that we have. The organization will really improve because we have huge talent and excellent minds that can help this organization do better.

That, by the way, should be the responsibility of leadership — to release the potential of staff. I'm not here saying I will do everything myself. I can't. I'm just one person. I'm here to release the potential of this organization, all these talented people who can change the face of this organization and serve the people, keep the world safe, promote health and serve the vulnerable. I have seen that, and I'm really encouraged by what I saw.

When you look back to your term years from now, what legacy would you like to leave WHO?

Two things: One is on universal health coverage. I hope by then we will have incredible consensus and progress on health system strengthening, and a focus on primary health care and prevention. This is one.

Second is a strong WHO, especially on emergency preparedness and response. You know the world gets into panic quickly when there is an outbreak, so we really need to do a lot in keeping the world safe and protecting the world from emergencies, outbreaks, epidemics or pandemics.

I think we should invest in these two.

This is the final installment in a three-part series of our exclusive interview with the WHO director-general. Read part one and part two.

Read more Devex coverage on the World Health Organization.