If Sania Nishtar wins the race to become director-general of the World Health Organization, she will be the first leader in the organization’s history to come from a developing country. But it would hardly be Nishtar’s first time trailblazing. As Pakistan’s first female cardiologist, she has emerged as a leader of public health both at home and abroad.
Nishtar has founded her own NGO, successfully worked with her own government to advance health reforms, and sat on a number of leadership positions in several international health panels and advisory groups. She ran in 2015 for the position of U.N. high commissioner for refugees and thereafter led the U.N. Secretary General’s Independent Accountability Panel for the Global Strategy for Women’s, Children’s and Adolescents’ Health.
Across her multiple posts, Nishtar has earned a reputation for pushing transparency — an area she is emphasizing again in her candidacy for the WHO, releasing a 10-point manifesto of priorities for the organization she hopes to head. Back home, Nishtar is known as the architect of the Handover Papers, which summarizes the work she undertook during her time as federal minister under Pakistan’s caretaker government before the 2013 elections as well as recommendations for reform to her successor.
Pakistan’s candidate takes a firm stance on conflicts of interest. She stepped down from her position as chair of the U.N. panel after accepting her nomination as the WHO director-general and pledged to make her campaign financing public. She tells Devex how she plans to bring this same accountability to the recruitment and selection of persons of key influence at the organization.
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.
In this Q&A, Nishtar discusses why she places particular emphasis on transparency in her candidacy, how she plans to address questions of the WHO’s relevance and offers a glimpse of how she plans to address the organization’s financial constraints. Our conversation has been lightly edited for length and clarity.
You’ve made 10 pledges as part of your candidacy as director general of the World Health Organization. Is there any one in particular of your pledges you feel the urgent need to tackle immediately, if you are elected to the position?
Two of the pledges are about the overarching conduct in office. So leadership correction, transparency and accountability. Four of them are programmatic in nature, and four are about the institutional reorganization.
So they are not mutually exclusive, and there’s a need to work on all of them together. However, if you want to single out one thing, I would like to single out transparency and accountability.
How do you find the current structure of WHO in terms of transparency and accountability?
I think the current administration is making steps to embrace transparency. There’s already a lot of information out there on their website. So there is progress on that area already, and I’d like to build on that. I’d like to make transparency quite meaningful.
Why the emphasis on transparency?
Because it’s a public agency, and transparency is not just about making information public. When you are recruiting, you have to be very transparent on the process: Who made the reference? What languages was it advertised in? What time period is given? You really have to be committed to transparency.
Does that also include the selection process for the DG?
Of course. That is where it starts. And if you read my pledges, the first pledge that I made was to make my electoral campaign financing public. Because people will need to know that you have no hidden influence during your term in office.
You rightly mentioned about the process starting with the election of the DG, but the process also has to cascade to how the deputies are going to be selected and how the assistant DGs are going to be selected.
If candidates are not going to be transparent in this stage, there is a risk that they may promise favors, and countries then have the compulsion to vote because they’re receiving favors from the next DG rather than [voting] on merit.
So what I’m trying to indicate is that the culture and the mindset and the institutionalization of transparency has to cut across the whole of the organization because it’s a public agency. It is accountable not only to member states, but also to the people.
There are a lot of questions today about WHO’s relevance amid the presence of other global health players. And at the same time, there has been a lot of criticism of WHO over the past year regarding its emergency response capabilities. WHO is also struggling with its financing. Do you have a strategy to address these issues?
WHO is the world’s lead health agency; it is not meant to do everything. But there are things that only WHO can do. WHO is the world’s only universal membership multilateral agency in health. And it has some mandates which are not tangible, for instance the setting of norms and standards. It’s exclusively WHO’s doing. The overall coordination of global actors, and leadership through coordination is WHO’s exclusive mandate. The response to cross-border issues, which includes operational readiness in emergencies, [and] response to threats such as AMR. On efforts around disease eradication, WHO is meant to be the lead agency for knowledge management.
Now, that does not mean that WHO does everything on its own, but it means it exercises moral authority — has the moral authority to be the leader. Which is why if you look at my vision, there are three things that resonate very loud in that vision:
1. That I will restore trust. 2. That WHO should focus on its exclusive mandate. 3. And the third thing that rings loud in my vision is partnerships.
If [another] agency is better at doing something, or it has a comparative advantage, WHO should let that agency do that.
Is there anything WHO is doing right now that may be better done by another institution?
I don’t want to go into the nitty-gritty details, but the World Bank, for example, clearly has an advantage on financing. WHO can certainly find a way of [parceling] out work. For instance, the World Bank is setting up the Emergency Pandemic Financing Facility. WHO should broker a partnership, for instance, in setting up a fund to catalyze development of vaccines and drugs, and new antibiotics to tackle antibiotic resistance and to produce drugs for neglected diseases.
WHO should not try to reproduce that. It should just partner with them [the World Bank] and it should tell them that, OK, our comparative advantage is in policy and normative standard setting. This is what we do — you do what you’re good at. Because you know the mission is to bring better health to people, to strengthen systems, and to increase capacity. And if you can do it through partnerships, why don’t you? I mean, you can come to a pastry shop and eat a pastry. Why do you want to have a pastry shop of your own doing?
In the domain of emergencies, there are so many potential partnerships. For instance, there are so many bilateral initiatives. We’ve already talked about the pandemic facility. The U.S. government has the U.S. global health security agenda helping 51 countries. Then of course in the countries, unless you partner with humanitarian agencies, with disaster management agencies, there is [the U.N. Office for the Coordination of Humanitarian Affairs.] UNOCHA is much better positioned to help in infectious outbreaks at large scale. Why does WHO have to have to recreate those capacities?
I think it’s a question of a mindset. That you know a leader has to think, OK, this is what needs to be done to achieve my objectives … and how can we partner with them to achieve the objectives we want to achieve?
Do you have anything in mind to address WHO’s financing problem?
Tomorrow night, I’m going to put out my manifesto to the public domain. As part of that, I’m mentioning that I will broker a consensus between the member states on a balance between the assessed and voluntary contributions.
In the detailed document, I’ll talk about the need for a better balance between the assessed and voluntary contributions, and my intent to engage member states with a view to achieving that.
Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.
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