Next in line: WHO director general Dr Tedros Adhanom Ghebreyesus addressing the IAEA Scientific Forum. His successor should be able to
champion the voice of the Global South. Photo: Dean Calma/IAEA
Dr Tedros Adhanom Ghebreyesus, the director general of the World Health Organisation (WHO), is serving his last few months in the post as the Geneva-based organisation enters the job market to fill the role.
It is expected that Ghebreyesus will soon issue a call for proposals, which essentially is a call for nominations.
This is not just another ordinary election; it’s an election to select the next chief of the world’s largest health organisation.
The nomination process is set to attract a lot of interest from several professionals in the field, ranging from ministers responsible for health in their respective countries to individuals serving in other UN agencies, including the WHO itself.
While everyone awaits with great anticipation the revelation of the list of potential candidates that might lead the global health organisation, we argue in this piece that the next candidate should be able to navigate several hurdles in an ever-changing geopolitical climate, as well as lead institutional reforms urgently to ensure global health security.
Brief context of the WHO
The WHO came into existence on 7 April 1948. It is one of the specialised agencies of the UN and boasts 192 member states.
Recently, the US and Argentina have commenced the process of leaving the organisation.
The only UN member state to have never been part of this global health agency is the tiny central European principality of Liechtenstein.
The main objective of the WHO, as stipulated on its website, is “to promote health, keep the world safe, and serve the vulnerable. Our goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well-being”.
However, despite the objectives of the intergovernmental organisation, it has faced numerous challenges, including an overstretched budget and an unconducive and uncertain geopolitical climate.
In terms of leadership, the WHO is led by a director general, who is the chief technical and administrative officer. He is supported by an executive committee, which comprises the executive director of the WHO Health Emergencies Programme, chief scientist, chef de cabinet and three assistant director generals, who each have a distinct role.
Besides the headquarters in Geneva, WHO member states are grouped into six regions, with each region having its own regional office.
WHO and its operations in a polycrisis global order
At the time of its establishment and its first World Health Assembly meeting in 1948, which established diseases such as malaria, TB, maternal and child health and nutrition as its priorities, the organisation had a budget of $5 million at its inception.
It is worth noting that the global order at the time of the founding of the WHO and the present day has fundamentally changed.
In 1948, the world was going through a post-war reconstruction period and increased globalisation.
Recently, the international rules-based order has been fractured and this has had a direct effect on the WHO and its operations. One such example is the US, one of WHO’s largest donors, pulling out of the organisation.
In the present day, the organisation faces several challenges, among them a strained fiscal purse and political bias.
The Covid-19 pandemic and the response from the WHO exposed weaknesses in global health governance. The WHO was accused by various quarters during the Covid-19 pandemic of delayed action, poor communication, vaccine equity failures and governance limitations.
While the criticisms are valid, we argue that some critics of the WHO’s response to the pandemic fail to understand how the organisation carries out its operations and the limitations it faces, set by its own member states. For example, the limited autonomy placed on the WHO secretariat also hamstrings the organisation’s ability to respond rapidly to public health emergencies, epidemics and pandemics.
Traits of an ideal WHO director general
As highlighted above, the purpose of the article is not to pinpoint which specific prospective individual should be chosen but to highlight what character traits the next director general should possess.
The next director general of the WHO should be a female. Out of the eight former director generals in the history of the organisation, only two have been female.
This stands in stark contrast to available data by the National Health Workforce Accounts, which says women comprise 67.2% of the health workforce globally but occupy 25% of senior roles.
Leaving women, who make up most of the healthcare workforce, out of healthcare leadership will lead to worse health outcomes. Women are constantly denied their rightful place in several fields, including medicine and public health. This trajectory needs to end.
In Africa, only one female (Dr Matshidiso Moeti) has been a WHO regional director out of the six males who have occupied the position.
The ideal WHO chief should also possess the necessary skills to navigate the fractured international rules-based order, push for fiscal reform and transparency in the organisation.
The ideal candidate should not only possess a track record in public health or medicine but should also be a strong administrator. This is essential given the fact that the organisation faces mounting political pressure from certain countries to act in a certain manner.
The ideal candidate should also be able to champion the voice of the Global South in the global health governance architecture and notably lead the reforms needed.
Is it fair that Africa carries a disproportionate burden of disease, yet its say and involvement in global health governance remains limited due to various reasons?
The ideal WHO chief needs to champion vaccine equity without any preconditions.
The hoarding of vaccines or vaccine nationalism seen during the Covid-19 pandemic, should never repeat itself.
For many low- to middle-income countries, the WHO plays an important role in ensuring that these countries have scientific and technical support to achieve their goals.
The next director general of the organisation must be able and willing to steer the institution through this turbulent period, where the multilateral order is being stretched to its limit every day.
Patrick Kadima lectures at the University of the Witwatersrand and holds a BA, LLB and interdisciplinary MA specialising in law, economics and social sciences. Dr Nthabiseng Makgana is the chief executive of Chris Hani Baragwanath Hospital and holds an MBChB and an MBA in healthcare management. They write in their personal capacity.