/ 8 June 2018

Tedros aims to turn the WHO around

Clear mandate: Tedros Ghebreyesus
Clear mandate: Tedros Ghebreyesus

News analysis:

Mercedes Sayagues in Geneva

It’s been a year since the World Health Organisation (WHO) appointed its first African boss, when Ethiopia’s Tedros Adhanom Ghebreyesus replaced Margaret Chan.

Tedros has a clear mandate: transform the WHO into a performing organisation after its dismal failure to control the Ebola outbreak in West Africa in 2014-2015, which killed 11 000 people, and the Zika virus in Brazil in 2015.

And as if on cue, just three weeks before Tedros hosted his first world health assembly in Geneva, the Democratic Republic of Congo (DRC) experienced a new outbreak of Ebola. This time the WHO reacted quickly and efficiently. “I am proud of our response,” said Tedros in his opening speech, thanking his staff and nongovernmental organisation partners such as Doctors Without Borders (MSF) and the Red Cross.

READ MORE: Ebola vaccine put to the test in DRC

This signals change. In 2014, the WHO’s regional office for Africa ignored the MSF’s warning about the Ebola pandemic for weeks.

“The fortress mentality at WHO is gone, partnerships are in,” said Richard Horton, the editor of the medical journal The Lancet. “Tedros is not afraid to share or concede power to achieve results.”

It wasn’t a smooth start for the Ethiopian doctor: last November, he made a major gaffe by appointing Zimbabwe’s president at the time, Robert Mugabe, as the WHO ambassador for noncommunicable diseases. The backlash — from human rights activists, donors and WHO staff members — against the man who had plunged his country into economic and social misery forced Tedros to rescind his decision after three days. Insiders say the appointment was intended as a reward for Mugabe, chairperson of the African Union in 2016, for delivering the African vote for Tedros.

Much wiser was the election of Zimbabwe’s minister of health, David Parirenyatwa, as president of this year’s World Health Assembly, the 71st iteration of the annual event. The son of Zimbabwe’s first black doctor, Parirenyatwa did his best to keep the country’s health system afloat in spite of Mugabe’s policies.

Along the Geneva corridors there’s a positive buzz. The number of women in leadership positions has more than doubled in Tedros’s first year, to 64%, and “zero tolerance” of sexual harassment is advertised by the WHO’s offices.

“The new open-door policy filters down to all levels,” said Asiya Odugleh-Kolev, a community health specialist. “In my 17 years at WHO, I have never been through such an intense process of rethinking our work.”

One problem is shrinking funding, underpinned by a general loss of confidence in the WHO, and the rise of new global health actors such as the Global Fund. Just 20% of the WHO budget is untied core funding, whereas 80% is tied to donors’ specific pet projects or causes, which may not be the WHO’s priorities.

READ MORE: WHO’s new boss is just the right medicine

Said Rwanda’s President Paul Kagame: “Countries must pay their contributions punctually, and in return demand value for money and accountability.”

Christopher J Elias is president for global development at the Bill and Melinda Gates Foundation, the largest nonstate contributor to the WHO. “Three years ago we were hearing harsh criticism of WHO, especially in Africa, but I have seen steady and incremental gains in performance and in rebuilding confidence,” he said.

Elias mentioned the WHO’s recent rapid response to polio in Lake Chad countries, the pneumonic plague in Madagascar and Ebola in the DRC, adding that “drug companies are now more confident that drug donations, which are big in Africa, are being used properly”.

“The more WHO delivers, the more support it will get,” said Daniel Graymore, senior representative of UK Aid in Geneva. It is the second- largest state donor to the WHO.

For the next five years, the priority is universal access to health care (UHC) as a driver for equity and a tool to strengthen health systems. “We will not settle for a world in which there is a 33-year difference in life expectancy between some countries,” said Tedros.

Asked how he would nudge governments towards this goal, Tedros replied: “WHO will engage consistently with countries, producing policy briefs packed with evidence, IMF-style.”

Matshidiso Moeti, the WHO’s regional director for Africa since 2015, said: “The first step for UHC is to assess the capacity of national health systems. Then we must find allies, including the private sector, help ministers of health and parliamentarians make a better case for UHC, and engage in a coherent dialogue with ministers of finance.”

On May 26, as about 4 000 delegates packed their bags, the question was: Is Tedros really capable of radically transforming a 70-year-old organisation?

“My view is wait and see,” said Gerda Verburg, co-ordinator of the Scaling Up Nutrition Movement. “We heard the good things WHO will do. Let’s see how they get it done.”