In this guest post, Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, unveils his agenda…
Today it is my pleasure and privilege to join and stand before you as the new Director-General of the World Health Organization. Our World Health Organization.
Let me start with the moral centre of our work, with this simple but crucial statement: WHO’s work is about serving people, about serving humanity. It’s about serving people regardless of where they live, be it in developing or developed countries, small islands or big nations, urban or rural settings. It’s about serving people regardless of who they are. Poor or rich, displaced or disabled, elderly or the youth. Most importantly, it’s about fighting to ensure the health of people as a basic human right. Health is a basic human right that you fully understand.
It’s about a child who gets to see adulthood or about a parent who watches their child survive and thrive. It’s about a community living disease-free or an entire country or region that’s better prepared for health emergencies or for climate change.
Without health, people have nothing. Without health, we have nothing as humanity.
That’s why our work here at the World Health Organization is so important. WHO’s work is about helping people to protect and to improve their health. This is our collective vision: a world where everyone can achieve healthy and productive lives no matter who they are or where they live.
My transition, as you know, has been very short, just over four weeks but also very busy. I have been listening intensely and appreciated all the advice I have received from you and others.
Let me outline, for today, three areas that I will focus on:
- Implementing leadership priorities and measuring results
- Delivering results, value for money, efficiency and earning trust
- Reinforcing a talented, motivated and engaged staff
I’ll start with number one: implementing leadership priorities and measuring results.
During the transition, I met with the United Nations Secretary-General António Guterres who emphasized WHO’s opportunity and responsibility to lead on health and the sustainable development goals. As you know, I ran with four clear substantive priorities plus a promise to transform WHO. These priorities came from Member States. I was elected with an overwhelming mandate. I feel obliged by this clear mandate to implement the priorities.
These priorities are:
- Universal health coverage
- Health emergencies
- Women’s, children’s and adolescents’ health
- Health impacts of climate and environmental change
Of this, universal health coverage is at the centre.
I have said many times during the campaign that all roads lead to universal health care. For me, the key question of universal health care is an ethical one. Do we want our fellow citizens to die because they are poor? Universal health coverage, as I said earlier, is a human rights issue. And the responsibility of national governments. It’s not only a technical matter but even more so a political one. Countries should compare their results to their peers and learn from each other.
About four hundred million people have no access, as you know, to even basic health care. Many more have access but will endure financial hardship. During the coming weeks, we will be looking at how best to implement the relevant sustainable development goal, achieving universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
Health emergencies will also be the litmus test for WHO. This topic is also closely related to universal health coverage because our goal is to prevent outbreaks from becoming epidemics at their roots. And this happens at the country level based on strong health systems which robustly implement the International Health Regulations. Universal health coverage and health emergencies are cousins, two sides of the same coin.
We learned important lessons from Ebola. The task is now to make sure these lessons are effectively implemented. The next outbreak can occur tomorrow and WHO needs to be prepared. We have a new programme in health emergencies which is integrated into headquarters and the regions and country offices. I had the chance to observe the recent Ebola response in the Democratic Republic of the Congo and gained confidence that WHO is implementing its reforms. But we need to do more. If you read the report of the Independent Oversight and Advisory Committee prepared for the World Health Assembly, you will see that they think WHO has made progress in implementing reforms but they also think that it’s not fast enough. We mustn’t let this happen. I have met with the leaders of the Health Emergencies Programme and I am committed to making sure the world is prepared for the next epidemic.
Women, children and adolescents are a central focus for universal health coverage and also the most vulnerable and at risk in health emergencies. Did you know that about half of the deaths of women and children are in a humanitarian context? WHO is fully committed to Every Woman Every Child and its areas of focus, including early child development, adolescent health and well-being. Quality, equity and dignity in services as well. Plus, sexual and reproductive health and rights, empowerment of women, girls and communities. And also, of course, humanitarian and fragile settings. While health emergencies hit quickly, climate change is a slow-motion disaster. WHO must play a strategic and decisive role not only in adaptation but also in mitigation.
Finally, for WHO to be effective in supporting countries, we need to have technical expertise in health challenges countries face: communicable diseases including polio, HIV, TB, malaria, hepatitis and neglected tropical diseases and noncommunicable diseases, including cardiovascular diseases, chronic pulmonary diseases, cancer, diabetes, mental health, addictions, accidents and injuries, you name it.
To single out just one vital example, this year, to date, we have had only 6 polio cases in the world. During my tenure, and together, we hope to meet the very last polio victim.
However, countries want holistic offering from universal health care coverage that can be flexible to their needs. These individual areas of expertise are like the players on a football team. Each needs to be strong to win. But without team work, we will not win. Our team needs to work as one. Our team needs a captain. And universal health coverage is the captain of the team.
And the second of what I wanted to say today is on delivering results, value for money, efficiency and earning trust.
I said many times during my campaign that WHO must deliver value for money. This requires first and foremost that we develop a culture of results. We are very fortunate to have the sustainable development goals (SDG). The SDG indicators are the agreed results, framework for the world, especially at the country level.
A key priority for me is to enhance our approach to resource mobilization among donors, old and new. And that has to start by building confidence among partners that WHO will deliver results and impact. I want WHO to be synonymous with results. And that is doable. At the same time, we must recognize that WHO is the world’s platform for global health. It’s the only venue where all governments, along with other stakeholders, come together to discuss and decide fundamental issues in global health. If the platform did not exist, we would need to create it. This global governance function is the infrastructure of global health and the global public good.
WHO has a rightful role and is an undisputed leader in global health. When I met with the UN Secretary-General, he reinforced this role. However, I also want WHO to work with any partner, public or private, who can help improve health. We want to be the partner of choice and this has to go beyond our WHO brand to how we actually work together to improve outcomes for the poor.
I also fully understand from my experience that results happen at the country and local level. So I will be looking for ways to increase our emphasis on country level work in concert with the regions to meet the needs of countries and to optimize our results. We have to strengthen our country offices and need to ensure that Heads of Country Offices are equipped not only with super technical capacity but also with political leadership and resource mobilization skills. In order to ensure our resources and efficiency, we need to have cohesion across all levels of the Organization: country offices, regional offices and headquarters. That’s why I will continue building up on the Global Policy Group in order to have shared vision and accountability at all levels.
We also need to become more efficient in our operations. Let me give you two examples that came to my attention during my interactions with WHO management and other stakeholders after my election. First, I was extremely surprised to learn that there are over 3000 separate grants managed by the World Health Organization. Just think about the transaction costs. This is unacceptable. I faced a similar situation in Ethiopia and developed the one plan, one budget and one report concept. I am cognizant that we cannot go from 3000 grants to one. I understand that. But it does illustrate how we need to radically overhaul and harmonize WHO’s business model and resource mobilization.
My second example from my engagement is, among a lot actually, is the recent uproar over travel costs. I am reviewing the situation thoroughly and will ensure that our resources are used efficiently. We have to be good stewards of our resources. But I think the commitment of all of us will be necessary, but including our partners.
I have already started consultations with Member States, donors and partners on how to harmonize and modernize our resource mobilization. This will be a critical area I will be focusing on and ensure that WHO is adequately and appropriately funded with emphasis on expanding the donor base. From what we discussed so far I see positive developments that will really transform the way we mobilize resources. I hope through concrete actions on results, value for money and efficiency, WHO will earn trust among Member States, partners and donors, old and new, who will want to step up and not only increase their contributions for our collective live-saving work but also become champions of our common cause.
And the third issue I would like to talk about today is reinforcing a talented, motivated and engaged staff. During the transition, I have focused first and foremost on WHO staff. My first meeting was actually with the WHO Staff Association.
If WHO is not healthy internally, then it will not be able to interact effectively externally.
In my acceptance speech in May, I promised staff, I value, I will listen to you. And that’s what I did for the last four weeks. We have an amazing and dedicated staff. I have seen this in the last four weeks. And I believe that staff are our greatest asset more than even ever before. We should take pride in serving humanity.
And as I said earlier, my very first meeting after my election was with the representatives of the WHO Headquarters Staff Association Committee and I will be meeting their counterparts in the regions as well. I told them I will always listen. My answer will not always be “yes” but when it’s “no” I will give my reasons and I will engage them in the decision. But the 10 issues they raised, on many of them, we have the same position. And I was really happy to see that. I also told them that I will act on their concerns and started acting swiftly. And that we have on most of the issues a common position.
During the transition, I met each of the Regional Directors individually and collectively. I also met headquarters Assistant Director-Generals and Directors on several occasions to listen to their great ideas. I also got ideas for change from Heads of WHO Country Offices. I appreciated when those Directors and Heads of Country Offices who consulted with their staff for their ideas they sent to me.
As you all know this was a unique election and the transition was also unique. I listened to staff for their views and opinions. I am so energized by their feedback and input as well as passion, dedication and commitment that I have seen so far.
When I met Directors and Assistant Director-Generals, I told them that I would be accessible and gave them my mobile phone number so they could reach me any time. We have to continue this candid discussion because candour is the best medicine for any organization.
I promise you this dialogue with WHO staff and the Staff Association will continue on a regular basis because we belong to the same team and we need to engage on a regular basis in order to be a winning team. I will continue to listen to and act upon staff concerns and ideas. Any enduring change at WHO will come from the staff outwards.
Let me also emphasize that I do not believe in perpetual reform and I think WHO staff are reformed out. I do believe in continuous improvement, however. Because our greatest asset is people, one core item in continuous improvement is how performance reviews are conducted and what coaching people receive. I would like to tie this much more closely to the results we seek to achieve.
My friends, talent is global, but opportunity is not. We will continue to conduct open recruitment, based on merit. However, we will ensure merit is seen from global or geographic and gender perspectives and the recruitment is done fairly and on an even playing field.
My door will always be open to the staff. In fact, I will set a regular time to meet with staff who wishes to meet with me and I call up on all leaders and managers of WHO at all levels, starting from headquarters to the regions and to the country offices, starting from team leaders to Deputy Director-General to do the same. Listening to our staff is a bottom line and really building our teams.
As a way forward, I would like to tell you that this has been a very holistic election. I have been given a decisive mandate and my vision and priorities for WHO has been endorsed by Member States. I have spent the last four weeks listening and engaging staff and conversing with partners. What we focus on in the next phase is going to be clearly articulating measurable outcomes and swiftly move to implementation with a sense of urgency.
As you can imagine, the very short transition window has not given me enough time to identify the best and appropriate senior leadership team. I hope to complete forming my team in the next few months. That’s why I have asked the existing senior management to stay on their positions for few more months until I appoint my leadership team. As you know, I have asked for recommendations from all levels of the Organization and have received many excellent ideas. I have formed a committee of WHO staff to study these recommendations, composed of Directors, and identify which are the most important ones that would lead to a major paradigm shift in our WHO. I will ensure the full engagement and participation of staff in any change.
Again, let me emphasize that enduring change comes from the bottom up. Only change that’s owned by staff will succeed. As Tom Peters said, change I quote, change is a door that can only be opened from the inside. So in order to fundamentally change WHO, first of all, we all need to individually open our minds for change. Because mind is opened from inside. And two, we all need to collectively work together to open our organizations for change.
My friends, we have a historic opportunity to make transformational improvement in world health. Let’s do it. Let us do it for every woman and child who died when they didn’t have to die. And for every child who failed to reach her full potential. For every victim felled by an outbreak, for every small islander who is faced with the threat of climate change. Let us dedicate ourselves to them. Let us stand together for a healthier world.
Thank you so much. Merci beaucoup.
Dr Tedros Adhanom Ghebreyesus, is the Director-General of the World Health Organization, his tenure officially began on July 3, 2017