PHA-Exchange> WHO chief announces surprise move to stand down (The Lancet: 31 August 2002)

[UNNIKRISHNAN P V (Dr)]

WHO chief announces surprise move to stand down 

The Lancet: 31 August 2002

WHO Director-General Gro Harlem Brundtland dropped a bombshell on Aug 23 by announcing that she will not stand for re-election when her 5-year term expires next July. The former Norwegian prime minister said she had informed the chairman of the Executive Board-- Burma's deputy health minister Kyaw Myint--that she would "not be a candidate for nomination" when the board makes its choice in January. 

"My decision to complete my work as Director-General at the end of my current term reflects the fact that I have had leading positions in political and public office for nearly 30 years, and would be 69 at the end of a second term", she stated. 

The news shook the UN community in Geneva out of its summer slumber and set WHO corridors abuzz. The US diplomatic mission to the UN lauded Brundtland for bringing "new strategic direction". The British Medical Association (BMA) lamented her departure as premature. "Identifying the problems was the first achievement, implementing them is the second thing, and you need more than 4 or 5 years to achieve that", said BMA spokesman Nigel Duncan. 

Brundtland associates said she wanted to spend more time with her three children and nine grandchildren in Norway, and has become weary with the travel. She is currently in southern Africa to discuss the humanitarian crisis and for the World Summit on Sustainable Development. She then attends meetings in Jakarta, Copenhagen, Washington, Cairo, and Brazzaville. 

Some WHO officials speculated that their boss was tired of being criticised and was bogged down by reforms. These were intended to make WHO more efficient and open but have led to low morale and constant changes in senior management, disparagingly called the "Harlem Shuffle" by insiders. 

Brundtland took office in July, 1998, when the agency was at an all-time low. She replaced Japan's Hiroshi Nakajima, who was widely criticised for poor management and lack of direction. She vowed to place health on the international development agenda, to find new partners to reduce the reliance on governments, and to make WHO more responsive. 

"WHO is solidly on track to fulfil the many demands being placed on it", said Brundtland in her resignation notice. "The critical role of health in development has gained wide acceptance. The world has turned its attention to our priorities", she declared. 

There is widespread agreement that Brundtland successfully combined her political savvy from her 10 years as prime minister with her zeal as a clinician to catapult health up the international agenda. This was not least through her Commission on Macroeconomics and Health, which reinforced the view that health is a prerequisite for, rather than the result of, development. 

But away from the declarations at summits and in policy documents, WHO struggled to improve its infamously ineffective country representation and aid national health systems. 

Brundtland ushered in new initiatives such as Roll Back Malaria and pioneered partnerships, such the Global Alliance for Vaccines and Immunization, with private organisations such as the Gates Foundation. 

This opened up new sources of funding, but weakened WHO's grip. "There are other powerful partners in health these days, from the Gates Foundation which has injected welcome resources into the health sector, to the pharmaceutical companies who are making donations of drugs--all of whom are influencing international policy", commented Gill Walt, professor of international health policy at the London School of Hygiene and Tropical Medicine. 

Brundtland's embrace of the drug industry has proved most controversial. Health activists charge that WHO has sold its soul to big business and has hidden in the shadow of non-governmental organisations (NGOs) such as Médecins Sans Frontières on access to essential medicines. Brundtland allies counter that WHO's quiet negotiations with pharmaceutical companies have done as much to slash the price of antiretrovirals as the more confrontational tactics of NGOs. 

Above all, Brundtland looks set to be remembered for her crusade against smoking. The Framework Convention on Tobacco Control --scheduled for completion next August just after she leaves office--will likely be weaker than she wanted, but will be the first international treaty against a product which currently kills 4 million people a year. 

"She has done a tremendous job on tobacco. She single-handedly put tobacco control back on the agenda", said Amanda Sandford, research manager at ASH. "That will be a lasting legacy to Brundtland." 

Behind-the-scenes jockeying to take up the reins has already begun. Governments have until November to submit nominees. The 32-member Executive Board decides next January and this is, in theory, endorsed by the full World Health Assembly in May. 

With the exception of Nakajima's 10-year tenure, Europeans have traditionally held the post. Brundtland's closest challenger in 1998 was Sir George Alleyne of Barbados. Next year, developing countries may feel that it is their turn. 
Clare Kapp 

++++++++++++++++Forwarded by:

Dr. Unnikrishnan PV
Co-ordinator: Emergencies & Humanitarian Action, OXFAM INDIA
E-mail: unnikru at yahoo.com 
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