Miklós Szócska sees risk sharing as a vital tool in preparing for global pandemics and boosting the resources of the World Health Organization.
The Hungarian candidate for the WHO director-general race has used the concept before. During his time as health minister, Szócska introduced a public health product tax on food and beverages with high salt and sugar contents. The initiative generated funds that helped finance the salaries of doctors and nurses, lowering rates of health worker emigration.
A similar idea can be applied for the WHO, he tells Devex, with the money raised going to a global risk sharing fund that would build the health systems of countries where there’s poor to nonexistent health services.
Szócska spoke with Devex ahead of the DG race on why the global community should try to share responsibilities and risks more, what changes and improvements he plans to implement at the U.N. health aid agency if he becomes director-general, and how he plans to execute on promises of reform. Our conversation has been lightly edited for length and clarity.
What’s your main platform and the primary message for your candidacy?
A stronger WHO that sympathizes — [that is] what we are looking for. We understand that this work can become so uncertain, and the risks become so high [with] these pandemic outbreaks. And because of burden of disease, burden of noncommunicable diseases, is ruining society so much, I think it’s time to do it a little differently. [It’s time to] try to share the risks, because [if] there’s a pandemic outbreak, this is very costly. I think if you just share the risks of pandemic outbreaks, and if you could start to share the risks of universal health coverage and building the foundations in countries where there is no existing health services, then we could change a lot. And we can save a lot and make the world better.
What are your specific strategies or ideas for how to share the risks for pandemics and strengthen WHO?
We have certain ideas. This is very easy: You can put a small levy on food and drinks that contain too much sugar, too much transfat, or too much salt, and there are people who consume just like that, and if you can put a levy on that, we can collect the money that is necessary for the basic community primary health services. We have to develop systems that cover all. So number one is that we should generate resources — we should institutionally generate resources. We cannot build institutions on simple donorships, so we have to create resources institutionally, that’s number one.
Whoever wins among six candidates for the director-generalship of the World Health Organization will have a consequential impact on the future of agency and of global public health itself. Candidates are promising leadership and bold change. But any reform will have to contest with a WHO's fraught budget, demanding member states and a stultifying bureaucracy. Devex takes an exclusive look at the stakes behind the vote.
On the other hand, the work needs a global health leader. WHO should be an agile agency against pandemic outbreaks. WHO cannot do everything, so WHO should work in partnerships with many agencies. But we should have an agility — proactive activity against outbreaks. We should monitor, try to prevent outbreaks, and act fast when there are outbreaks.
WHO should manage for performance. There has to be an agile project management methodology to talk about the performance, to talk about the results that they want to achieve regularly. And for every project constantly, [we need] quick feedback. We should not wait for the letters to cross, but [rather] we have to have a close communication line to see what is stalling the project, what is blocking us to achieve the results that we planned. We should work more directly, we should manage the global portfolio of very complex projects in a more agile manner and [have] much more direct communication. We have to coordinate our activities.
Usually these sorts of taxes are implemented by individual countries. How would you boost resources at the WHO, which is very dependent on member states’ funding?
Unfortunately, WHO is more dependent on donor funding. Eighty percent of funding of WHO comes from donors, and the member state funding is 20 percent. Number one is that we have to stabilize funding, and we have to increase the stable funding for WHO. I think that will come only with performance.
When I mentioned sharing the risks, the institutional resource generation for its sharing, will be a long [process] to establish — will be a long political process. But there are countries where 1 cent on each glass of sugary beverages would not make people poor. That 1 cent on a glass of sugary beverage should go to a global risk-sharing fund. Those who eat unhealthy, or not necessarily healthy food and drink, could contribute to global risk sharing. Those countries who can afford this, and those citizens who can afford this, should understand that sharing the risks is cheaper than the global economic rundown because of a pandemic outbreak, where the international traffic is lost, or tens of thousands of people die. In this global world … you cannot stop pandemics. In countries that have basic health services — community nursing, basic public health services, basic surveillance — those countries could manage these outbreaks much better than the countries where there’s no public administration of public health, basic public health, or community health services. So they should create a global fund.
You have talked about working in closer cooperation with regional and country offices. How do you plan to move ahead with this idea, given the bureaucracies in place?
In my understanding of the WHO general director’s position, is that it is not the top bureaucrat. In my understanding, [it] is that WHO should be a health leader, so there’s an active political advocacy for health. The WHO director-general is also a CEO. To manage performance, and to be the a health global political advocate, the director general will need time.
So I think the bureaucracy should be rationalized, and in my understanding, one difficulty in WHO is that [it is] very difficult to bring the member states to agreement. If you proactively coordinate and consult, then the member states who regularly meet once a year on a committee meeting, they’ll know the issues, [and] then they [will] have time to share their opinions on them. [In that case,] they just make an easier consensus. I think there has to be a proactive consensus-making [among] the member states. There has to be time for doing political advocacy for health and performance management.
One more thing. The WHO has extreme expertise, so it’s rich in resources, knowledge. It can also be a knowledge depository. In environments where people are very much … [organized] by bureaucratic procedures, those organizations block creativity. I will use any effort to try and organize … liberalization from them.
You mentioned WHO’s expertise and how it can be a knowledge repository. We also have other institutions doing similar work, like the World Bank, which has increased its focus on health under the leadership of Dr. Jim Yong Kim. How would you address questions about the relevance of WHO?
WHO should not be a development agency. The resources available for WHO are not relevant for that. But we should renew the partnerships. We should make sure that all these international agencies and global partners are building on WHO as an institution and WHO resources.
Read Q&A’s with other candidates:
One very important thing: many times it happens that large development agencies have ready-made solutions like privatization of health care or privatization of health insurance or centralization of health care or centralization of health insurance, depending on the agency you work with. But WHO is an impartial, independent organization that can judge interventions by evidence. That role should be strengthened and we should collaborate with these large agencies to have more relevant interventions.
The other thing is that there should be local ownership, because many times these development projects are externally forced into communities, and they are not ready for the given development, and they do not want the agencies to administer it. So many times the development is wasted. WHO should strengthen its change-management capacities and it has to act in that manner. So no idea is carried without an implementation strategy, and no idea is carried without local ownership.
What do local ownership and change management mean in practice? Would it entail boosting the number of staff at WHO?
The time for preparing for the candidacy was not necessarily enough to understand every detail of WHO as an organization. One of the tasks I was assigning to my staff is that there has to be an administrative and thematic review of the organization. That should go together with the installing of performance management, project portfolio management structure.
We have to understand what do people do in the organization. Even the most efficient organizations can have resources that could be mobilized for action. That’s one of the core principles [I’m pushing]. We should mobilize WHO resources for action. And then we can talk about this stuff.
Based on your understanding of how the organization works, do you see anything at WHO that requires an immediate and drastic change?
Every region is different. I [will use the] European example, because I know European operations better. Two things I will emphasize besides what I’ve said so far: there are duplications in the organization. So there are two groups in the organization that are working on the same topic. One is progressive, and the other is not so progressive. But the not so progressive can interfere in a way that they are blocking the action of the progressive group of experts. This duplication should finish. These duplications that are paralyzing the progressive action of some parts of the organization should be finished, immediately.
The other is the crisis communication. It is a practice in national politics that the health leader is responsible for all the determinants of health. Health is responsible for poverty and for the consequences of poor education. And WHO is also in that position that the citizens of the world and politicians of the world and the development community of the world, they are expecting WHO to perform well while the resources are very low.
So there is this scapegoating of the healthcare sector that, “why can’t you solve the health problems?” Hospitals can heal people, but they cannot prevent disease. With crisis communication, you not only have to make sure that the citizens of the earth receive proper information of pandemics, and pandemic outbreaks, but we should try to manage expectations.
We will not be able to change the work overnight. So it is duplications and improvement of crisis communications — these are the two things that [we] have to address very fast.
What’s your leadership style?
I’m rocking the boat simply by immediately radiating the importance of teamwork and project type organization and performance management. But I’m absolutely democratic, and I expect people to be responsible and be autonomous, and I expect them to be loyal to the cause of the organization.
I know that change cannot happen overnight, and whenever we are expecting people to invest emotional energy in doing things differently than they did before, I know that creates uncertainty. I’m there to help them, and I’m there to give them information, and I’m willing to wait for the moment when I can intervene. But I will work on the momentum for change. It is not that you go in the organization with a machete and do things like that. You have to build the momentum for change. Wherever I went [before], I was there for change.