Perhaps it was the most awaited event at the 68th World Health Assembly — World Health Organization Director-General Margaret Chan’s speech.
WHO’s leadership committed to reform her organization to what “the world needs [and] expects” from the global health body. The decisions were guided by the resolution the executive board adopted in January, and by the interim recommendations made by the expert panel charged to review WHO’s initial response to the Ebola crisis.
WHO has acknowledged the need to change some of its own systems and boost its own emergency capacity following the challenges it faced in mobilizing a more robust response to the Ebola outbreak in West Africa. How might these reforms look in practice? An exclusive interview with Dr. Bruce Aylward, WHO's overall lead in the Ebola response.
“I have heard what the world expects from WHO. I have heard calls for clear lines of command and control, for streamlined administrative procedures that support speedy action, for effective coordination with others, and for stronger community engagement and better communications,” she said in her speech Monday, May 18.
In response, Chan announced “fundamental changes” to WHO’s work, starting with the creation of a single program for health emergencies.
Under this program, Chan will combine the organization’s resources on outbreaks and emergencies from headquarters down to country level. The idea is to speed up the organization’s response to emergencies, be flexible and produce “rapid impact.”
The program will be directly under Chan, and she personally pledged accountability for its work. Performance benchmarks will be put in place to ensure actions are taken within the shortest time period — within 24 to 72 hours, not months.
The new program will also coordinate the work of the global health emergency workforce, which the executive board has requested the WHO leadership to pursue as part of the resolution adopted in January.
This workforce will comprise medical professionals and experts from the Global Outbreak Alert and Response Network, the Global Health Cluster, foreign medical teams and “others” that Chan did not specify. Within WHO meanwhile, the director-general committed to strengthen the skills of her emergency staff, boost the number of logisticians, medical anthropologists and risk communications experts within the organization, and ensure the agency has a roster of experienced and competent emergency coordinators who can be deployed immediately to lead field operations.
She noted the program will have its own business rules and operational platforms, and that she is developing procedures that would streamline the organization’s administrative and managerial work, as well as those concerning logistics, procurement and staff recruitment.
The ‘5 percent’ increase
Resources needed to move the reforms forward are expected to come from the organization’s $4.38 billion proposed budget for 2016-2017, which reflects an 8 percent increase from the approved budget for the current biennium period.
Chan is proposing a 5 percent increase in member states’ assessed contributions to ensure the full financing of the budget.
“Without this, the proportion of the program budget financed from assessed contributions would fall to levels that could compromise our ability to manage the work of WHO strategically across all program areas and offices,” Chan argued in the proposed budget plan, dated April 30.
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The request does not include salary increases. It also shows a 3.4 percent decrease in budget allocation for the communicable diseases category, which WHO says “reflects a strategic shift toward upstream policy and technical work” in the program areas of tuberculosis and vaccine-preventable diseases.
Chan also announced the establishment of the long-awaited $100 million contingency fund, which will draw financing from “flexible voluntary contributions.”
“The Ebola outbreak shook this organization to its core,” Chan said in her speech. “I do not ever want to see this organization faced with a situation it is not prepared, staffed, funded or administratively set up to manage.”
“I urge you to make this happen. I will do my part,” she added, pledging to complete all her announced changes by the end of the year.
A strengthened IHR
Chan also made reference to strengthening the International Health Regulations and its implementation — an issue the expert panel also raised in its interim assessment, and for which it recommended the introduction of sanctions to member states that fail to comply with the IHR.
The panel tasked to review the World Health Organization's initial response to the Ebola outbreak released its interim report ahead of the 68th World Health Assembly, which kicks off next week. We highlight the recommendations and remaining questions.
“The IHR are not performing with the effectiveness envisioned for this legal instrument that aids preparedness and promotes an orderly rules-based response,” the director-general said. “Changes are needed here as well.”
But while Chan acknowledged the panel’s recommendations for the organization to explore independent evaluation of member states’ core surveillance and response capacities in health emergencies, which are required under IHR, she stopped short of announcing concrete actions on how she plans to make this happen.
What part of Margaret Chan’s speech grabbed your attention? Let us know by leaving a comment below.
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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