First 100 days - Priorities for the Next DG

Less than a month ago, the world elected its new health diplomat – Dr. Tedros, known by his first name, as the next director general (DG) of World Health Organization (WHO).

This election set new precedence in many ways:

• for the first time the vote to choose the next DG was expanded to all 194 member states making the process transparent and open;

• for the first time the new DG elect is from an African country and;

• for the first time new DG is not a medical doctor.

As much as these election reforms create hope for a better tomorrow, there is no doubt that Dr. Tedros as the new DG faces urgent and long-term global health challenges ranging from outbreaks of infectious diseases like Ebola to a critical food crisis in countries affected by conflict. As Dr. Tedros will assume office on 1st July, 2017, he will also need to prioritize focus areas that range from structural changes within the organization to battling financial crises in the given political and economic landscape. The first 100 days for Dr. Tedros will be critical and will be closely monitored to assess the performance by different stakeholders including member states, academia, not for profit organizations, private sector and non-state actors.

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During the World Health Assembly, Global Health Council and MSH organized a side event to discuss what the future priorities for the next DG should be. The panelists of the session included Dr. Ashish Jha, Director Harvard Global Health Institute; Loyce Pace, President Global Health Council; Jennifer Healy, Counsel Dentons US LLP; John Flannery, President & CEO GE Healthcare; Mark Dybul, Executive Director The Global Fund to Fight AIDS, Tuberculosis and Malaria; and Jan Beagle, Deputy Executive Director UNAIDS. The keynote speaker for the even was the United States Secretary of Health and Human Services, Tom Price. This panel generated many interesting discussions regarding the priorities and focus areas for the next DG.

Secretary Price acknowledged that the next health emergency was not a question of if but when and in case it happened the world would look up to WHO for leadership and guidance. Considering WHO as a lead health agency for the world, he laid down key areas of focus for the next DG that would prepare WHO for addressing future challenges. These included:

1. Evidence based decision making

2. Effective, transparent and accountable systems for how funds and resources are allocated and used

3. Attract highest qualified people including technical staff

4. Human resource policies for staffing that ensures that short term contracts do not become life-long contracts

5. Expectations and demands associated with positions

6. Fight to eradicate polio

7. Non-communicable diseases and infectious diseases.

Secretary Price also emphasized the need for WHO to act as a global convening body and coordinator to address world’s health issues. WHO should be the driver for innovation and try to implement Framework for Engagement with Non-State Actors (FENSA) to gain competitive advantage. Consultations with member states should be sought to understand their needs and act accordingly.

What would be policy priorities for the next DG in short term and long term?

Dr. Ashish Jha iterated that WHO is essential in today’s times and is very much needed. Therefore, it is much more important for WHO to be effective in its programming and breakout of its effectiveness and funding cycle. Policy changes create opportunities for reform so the next DG should focus reflecting on its internal structures to promote HR reform, accountability reform and transparency where access to information is available to all stakeholders.

Loyce Pace said that WHO needs to acknowledge that it suffers from an image problem. It is important for the next DG to talk about shortcomings in order to learn from past mistakes and identify opportunities to create new relationships.

John Flannery said that new DG needs to listen as well as have a strategic focus. For this new DG needs to take stakeholder’s reflections and insights into consideration to identify what needs to be changed. It would be crucial for new DG to build commitments as well as competencies and foster engagement especially among the youth.

Jan Beagle laid down the key focus areas for new DG to be: 1) prevention that adopts social determinants of health approach, 2) innovation – use of technology internally and externally and incorporating new ways of connecting with people and 3) gender equality and empowerment of people.

Mark Dybul emphasized on operationalizing vision and setting clear mission that transforms the message and brings accountability framework in WHO’s organizational structure. This structure would determine how teams get in place, focus on quality and setting high standards of merit. WHO needs to develop multi-sectoral rapid response teams in order to manage emergencies and develop new partnerships.

What should WHO mission be and how to scope it?

Dr. Jha said that main part of determining WHO’s strategy is to look at two key questions: 1) what is it that WHO doesn’t do and 2) what are the things that only WHO can do? Through this process the new DG can identify areas of priorities, build holistic system and identify areas where to invest funds.

Going forward, it would be essential for Dr. Tedros to realize that “no size fits all” and there is critical need to adopt country specific policies and targets. WHO can benefit by partnering with international organizations to bring legitimacy, independence and expertise within the organization and its programming. These partnerships have the potential to strengthen the capacity of local community actors and mobilize resources to enhance their capacities to tackle emergencies.

Apart from HR reforms and policy changes, the new DG would also need to streamline its financing and funding sources. 75% of WHO’s funds are earmarked which leaves little cushion for the next DG. It would be important for Dr. Tedros to determine how to package health care financing that reinforces confidence in WHO’s capacity as well as sets performance targets. Mark Dybul said that it is very important how money is used. He also added that it is time to engage the financial sector as relying on traditional donors may not be enough.

John Flannery mentioned that WHO would need to develop a provider framework that draws lessons from global best practices and attracts greater investments from the private sector.

Building trust would require next DG to work with non-state actors and greater stakeholders by drawing gender lens and building engagement with youth, adolescents, and LGBTIQ groups.

What should be performance metrics for next DG and how to institutionalize change?

Building partnerships and bridging the gap between health systems and local communities is critical for WHO. Working towards resilient health systems would require the next generation of health experts to be nurtured and developed and as next DG, Dr. Tedros should prioritize harnessing partnerships with academic institutions. This also requires non-state actors to engage with universities, go beyond geographical boundaries and get to know organizations working towards shared goals. FENSA framework could lay down the process of how these partnerships can be developed and fostered and how to measure the progress.

Another way to hold the next DG accountable is by developing good HR models that are based on best practices. Who is hired as well as the caliber of people working in the organization would be critical to organizational success. Mark Dybul emphasized whom Dr. Tedros hires will determine a lot about how he leads.

Rebuilding confidence in WHO’s effectiveness to combat challenges would require focus on developing transparency and accountability mechanisms within the organization. Ways to monitor next DG’s performance includes progress on 60-40 pledge, access to healthcare through country by country score, ensure diversity and hold people accountable, and developing new models of care and standards.

Women in Global Health in its Call to Action published in The Lancet earlier this year launched key priority focus to measure next DG’s progress on gender equality and women’s empowerment by promoting gender equality in leadership positions of WHO; engaging men and women in meaningful ways within technical programmes of WHO; and adopting evidence based practices that use gender disaggregated data and promoting gender parity and equality in health governance across WHO and in Member States.