PHA-Exchange> WHO DG candidate's views

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Equal Opportunities to Health For All.
Dr Pascoal Mocumbi's Vision for WHO
Maputo, 14th October 2002

 1. Guiding Principles
1.1. Advocacy for Health
Today, Health is one of the most important issues on the global development
Agenda. It has become an issue for Heads of State and Finance Ministers, for
multilateral financing and development agencies and global organizations of
all kinds -NGOs, universities, corporations and foundations, thanks, in
large part, to WHO's leadership and advocacy. WHO has gathered the evidence
and communicated the message that the Health of a nation's people is
critical to its economic and social development. WHO has also furthered the
understanding of opinion leaders outside the Health Sector that diseases
know no boundaries and that the Health of any single nation can be affected
by a health problem that arises in any other.
Achieving this level of global awareness has been difficult and we must
celebrate it. Yet the global disease burden remains high, with millions
continuing to die from curable and/or preventable diseases, because of
poverty and weak Health Systems. Ill health is also a major contributor to
poverty. The vicious cycle of poverty and ill health continues to deprive
people of their dignity and subjects them to unnecessary pain and suffering.
To break this vicious cycle, the global community must intervene to achieve
broad and powerful improvements in World Health and sustainable economic
development. As part of this effort, we at WHO, must deepen our awareness of
the links between poverty and ill health. It is now urgent that we translate
this awareness into action so that we can achieve our long-stated goal of
Health for All. This is the main focus of my vision and will be one of my
top priorities as WHO's first leader elected in the 21st century.
The image of WHO should continue to be promoted and its visibility should be
enhanced so that it can better serve as an advocate for World Health. We
must, however, assure that our image is built on a strong foundation of
expertise and capability. Only thus can we play our role at global and
national level of keeping Health at the top of the Development Agenda.
1.2. Investment and Partnerships
WHO was created to serve as the source of global Health expertise and
leadership within the UN System. In this role, it serves member countries
and other organizations that concern themselves with Health or whose actions
have Health consequences. To play this role effectively in a complex world,
WHO must, in every initiative, seek appropriate alliances and mobilize
partners for sustained action.
We must continue to set standards and define performance objectives, so that
we can measure our progress and hold ourselves and our partners accountable
for reducing inequalities in Health. In this respect, I will emphasize the
importance of effectively investing in Health and of financing Health
Systems at appropriate levels. I will also strongly promote optimal use of
available resources for Health. I believe that this is the way forward, if
the Millennium Development Goals, the Okinawa 2000 Summit Goals and the
Goals of the Johannesburg Summit Action Plan for the improvement of world
Health are to be achieved.
I will also ensure that WHO will join forces with ALL other partners
(international and multilateral organizations, financing and development
agencies, governments, public and private institutions, NGOs, the scientific
community, training and research institutions and others) to work to combat
poverty and hunger, thus improving the Health of the world's people.
There is no doubt that investment in Health is crucial for development. What
is needed now is for us to act on this knowledge. Governments and financing
institutions should begin to demonstrate their commitment by changing their
approach to economic and development policy at country level. The health of
people should also be at the center of the world trade debates.
WHO has a long experience of successful cooperation with NGOs, particularly,
at HQ level. This partnership should be reinforced and extended to other
levels of the Organization, especially, to the country level. Together, WHO
and NGOs should define common goals and mechanisms to empower communities in
the promotion of their own Health.
1.3. Commitment to Countries
As we take action on Health at the global level, our effectiveness will also
depend on the degree to which WHO is seen as an organization with a
knowledgeable voice on Health issues for all the countries of the world, and
one that can, when called upon, mobilize broad based action to support
country efforts to address their own health priorities. As health minister,
foreign minister and, now prime minister, of a developing country that has
put the Health of its people at the center of its development agenda and
maintained that commitment through a civil war, natural disasters and the
challenges of economic restructuring, I know first hand the importance of
effective partnerships in such a long term effort.
I am convinced that WHO work at the country level is a critical element to
enhance the visibility and effectiveness that the Organization needs to
carry out its global mission. While we are not, directly, an implementing
agency, we must play a role in supporting country efforts to develop their
implementation capacity.
I shall therefore develop efforts to strengthen WHO Country Representations,
particularly in those countries with greatest need of technical support.
This process should include dialogue and partnership with Governments,
Regional Directors, WHO staff, other UN Agencies and other cooperating
partners in Health, including NGOs. In so doing, we must build on the
positive experiences of other UN and multilateral agencies and NGO's and
learn from their successes and failures.
1.4. A Rights Perspective
While health is critical to the development of nations and societies, it is
also critical to an individual's ability to participate in and contribute to
society, whether it is as a worker, a voter, a member of a community or a
member of a family that can provide for its members and raise the next
generation of citizens. Women are critical members of any society and, in
too many, their resources and expertise are lost because of a failure to
give them equal access to society's resources or include them equally in the
decision making process. This situation must change and I am committed to
ensuring that WHO plays its part to see that it does.
The international community has long accepted the idea that governments
carry the ultimate responsibility to ensure the conditions in which their
people can achieve their full potential for Health. A right to equal
opportunities for health has also been articulated in international
instruments to which many countries have subscribed. I believe it is
critical for WHO to participate in bringing back into the spotlight the
issue of Health as a Human Right and the role of ethics and bioethics in
informing our Health policy making at global and national level. To move
ahead on this agenda, I will work closely with allied organizations of the
UN system and ALL other partners to build consensus on a "Charter on the
Rights to Health".

2. A Framework for Action
2.1. Health for All and Primary Health Care for the 21st Century
I believe that  the "Health For All" (HFA) strategy and the Primary Health
Care (PHC) approach should be revitalized and revisited as needed to reflect
the challenges of this new century. While few countries have achieved the
goals articulated in these strategies, much progress has been made and their
value as a framework for action has been widely accepted. WHO must work with
Member States to take stock of the evidence of successes and failures in
this 25-year journey of implementation, during which many countries have
undergone a demographic and epidemiological transition. Important goals
embodied in the "Health For All" (HFA) strategy such as Universal Coverage
and Equity in access to Health care have, unfortunately, not been achieved
and new efforts in this direction have to be deployed.
This review process must reflect what we have learned about the broader
determinants of Health, including social, economic, cultural, gender,
behavioural, demographic and environmental factors. More specifically, we
must consider the roles of education, nutrition, economic status, the nature
of work, racism and community cohesiveness in determining Health Status.
Within Health Systems, we should look anew at how to develop an integrated
approach to Health care delivery and referral systems. Of utmost importance
will be to revisit the role of WHO and its organizational structures
vis-a-vis the HFA strategy and PHC approach.
In my own experience, the HFA strategy and the PHC approach have the
potential to empower communities. When coupled with the synergies produced
by intersectoral cooperation, they can bring about a new dynamism to promote
and advance Health Development in all nations in the world, both rich and
poor.
In this context, I commit myself to organize a Global Forum for consultation
involving ALL partners to create a shared vision of a HFA strategy and the
PHC approach for the 21st century.

2.2. Evidence for Action: Health Research
I believe that action for Health Development must be based on scientific
evidence to create a neutral ground for international cooperation among
Member States, and to allow informed debate within WHO and on health
priorities within countries. In my long managerial experience, I have always
strived to start with evidence and work to generate consensus when possible
or to identify a way forward that is compatible with divergent interests. If
elected to lead WHO, I firmly commit myself to continue to do so. By
creating neutral ground, Health can act as a bridge for peace in conflict
and Health development can play an important role to consolidate World
Peace.
I will pay special attention to Health research that informs policy to guide
the development of Health Systems and provides important information for
implementation on the ground. Health research cannot neglect the health
problems of the poor and needs to pay greater attention to the broader
determinants of Health. WHO should ensure that Health research is
intensified in the areas of genetic disorders, chronic and degenerative
diseases and traditional medicine.
WHO has a good record in promoting and mobilizing expert knowledge, skills
and resources to tackle various health and biomedical problems both directly
by its own staff and through partnerships with collaborating centers and
experts worldwide. It is also in a position to identify best practices by
countries in a variety of areas. Throughout the years, WHO has been a
scientific reference and depository of scientific knowledge in different
fields of Health. This wealth of information and knowledge should be made
easily available and be widely disseminated. I make a strong commitment to
analyze constraints to this dissemination and devise new improved ways to
work in partnerships with academic and research institutions and the private
sector to ensure that this precious scientific information is easily
available to those who need it, anywhere in the world.
WHO must also commit itself to the development of capacity in countries who
lack it to conduct research and collect and analyze important Health data
that can be used as evidence to improve the Health of their people.
Partnerships with Member Countries enjoying scientific strength will be an
important vehicle for such efforts.

2.3. Human Resources for Action
A critical issue for most Health systems in the world relates to human
resources for Health. Without balanced, motivated and qualified health
teams, Health objectives can be put at risk. WHO has been playing a critical
role in promoting and facilitating development of human resources for Health
in Member States, particularly in the developing world. I believe that this
effort should be sustained and expanded.

3. Addressing Priority Health Problems
3.1. Principal Health Challenges
The world still faces enormous health challenges. Many affect all
countries - HIV/AIDS, TB, mental health problems, intentional and
unintentional injuries and the increasing burden of chronic and
non-communicable disease. Making health systems more effective and fairer is
a challenge for all governments.
To take one example, HIV/AIDS has changed the pattern of life in many
countries, with serious implications for developmental strategies. It is of
paramount urgency to tackle this universal scourge. We need to ensure that
the agreed commitments from the special session of UN General Assembly on
HIV/AIDS are met. Much has been achieved within the UNAIDS framework,
particularly in advocacy and building awareness regarding the gravity of the
situation. As the UN specialized agency on Health matters, WHO will continue
to work with UNAIDS to ensure effective advocacy for adequate investment of
global resources to tackle HIV/AIDS. Together, we must guarantee that proper
support is provided to countries to design and implement their action
programs on HIV/AIDS.
Other diseases are less geographically widespread, but no less serious.
Malaria, Schistosomiasis, Leprosy, Dengue, Chagas' Disease and many
communicable diseases still continue to constitute major health problems to
considerable sectors of humanity, particularly in low-income countries, as
do high maternal and peri-natal mortality. Often, these diseases are
associated with poverty and lack of access to promotive and preventive
measures, pharmaceuticals and appropriate health care. Renewed efforts are
needed to help countries face and overcome these challenges to Health.
The Essential Drugs Policy adopted by the WHA in 1978 and the Action Program
on Essential Drugs created the following year, are important tools for
addressing these challenges. Progress has been made, but more work needs to
be done. We must sit together with ALL concerned parties (UN and
multilateral agencies, Governments, Development and financing institutions,
the pharmaceutical industry, the scientific community, NGO's and other
public and private interested parties) to review the experience of the past
25 years, recent international agreements and the Doha Declaration,
respecting each others concerns and reaching a better understanding, so as
to generate a new impetus and create conditions for further innovation and
success.
WHO must provide a clear picture to the world of the nature of these
challenges and the evidence for interventions that work; it should help to
mobilize the resources to address them globally, in regions and in
countries. Sometimes, it will have both the expertise and resources to work
directly with Member States to implement necessary programs. At other times,
work will be done with partners or by stimulating the action of other
organizations better suited to play a role in preventing a disease or
promoting and protecting health. We also face finite resources and our
priority setting must involve dialogue with Member States and interested
parties about the nature of the problems, the feasibility and effectiveness
of action and who can take it. But, in whatever strategy chosen, WHO is
responsible for assuring that progress is made towards our goal of Health
For All.

3.2. Preventable Diseases: A Burden to Humanity
The disease burden in the world is still high despite improvements in life
expectancy and in the infant mortality rate in the last 50 years.
Disparities in the distribution of the disease burden across social strata
and regions are glaring. For a number of diseases, mainly communicable, we
now have the knowledge and technological means to prevent them, but they
still heavily contribute to the total burden of disease. We cannot be
indifferent to this situation and miss the opportunities for change. I
commit myself to develop a dynamic special initiative, with the involvement
of interested partners, to make measurable progress in reducing the
incidence and prevalence of priority preventable diseases. We must select
those diseases that represent a high burden, but can be prevented or
eradicated by known technologies. If these technologies have not yet been
applied or are not yet affordable, we must work with the right groups of
stakeholders, committed to this initiative, to develop innovative and bold
approaches to achieve our goals.

3.3. Meeting Women's Priority Health Needs
There is no doubt that the health of women, especially the most vulnerable
and disadvantaged, is an area of great concern. Despite the rapid
technological advances that have been made and the knowledge on women's
health that is now available, women continue to suffer from preventable
morbidity and mortality. While there have been improvements, especially in
terms of the physical quality of health indicators, the health status of
women remains precarious and in some instances, is even worsening.
There is evidence of the unacceptable inequities that exist in women's
health, the limited choices that are made available to women and finally,
the lack of accountability for their health. We must take bold steps to
rectify this situation and make available health care programmes that
address their specific needs, using a life span perspective as well as a
holistic approach.

3.4. Behavioural Change and Health Promotion
Scientific evidence is accumulating regarding the crucial role of
behavioural change (in relation to nutrition, sexual behaviour, control of
tobacco and alcohol use, prevention of drug abuse and promotion of physical
exercise, just to mention a few) for human health improvement. Therefore, I
will bring Health Promotion to the forefront of WHO's overall approach to
health problem solving and ensure that due attention is paid to it as part
of all of our initiatives. WHO shall strengthen its capacity to provide
appropriate technical support to Member States in this area.

3.5. Environmental Issues as Determinants of Human Health.
For the last 25 years, the importance of the environment as an essential
determinant of Human Health has become increasingly obvious. After the Rio
Conference in 1992, a WHO special commission collected the evidence
available at the time. The recent Johannesburg Summit reemphasized the
interconnection among Environment, Sustainable Development and Human Health.
Therefore, I state my commitment to renew our efforts to tackle this crucial
priority for Human Health.

3.6. Ageing: A Challenge for Health Systems
In the last three decades, there has been a growing acknowledgement of the
importance of ageing as a challenge for Health Systems. The problem, which
was initially restricted to the developed industrialized countries, has now
become of concern to an increasing number of countries and will very soon
become a global concern. WHO has taken initiatives to help countries focus
on this critical issue and these efforts must be expanded, involving other
partners, with WHO playing a leading role.

3.7. Natural and Man Made Disasters as Barriers to Health.
Famines, droughts, floods, mass movements of population and situations of
conflict and war, as well as the threat of terrorism, are examples of
potential health disasters as well as political and developmental disasters.
By improved monitoring of worsening health conditions WHO and governments
can give early warning of impending disasters. WHO will need to become more
active in raising awareness of the health impacts of these events and assure
that appropriate health action is included in international strategies to
prevent and respond to these threats. There is considerable expertise
throughout the world that WHO can help bring to bear on the planning by
international agencies and nations to prepare for such events.
In response to disasters, WHO should develop greater capacity for rapid
intervention with a minimum of bureaucratic delays. WHO is also in a unique
position to affirm the value of human life and Health across the lines of
conflict.

4. Managing for Results
4.1 WHO Staff
At the core of WHO's ability to play its role as the source of global Health
expertise is the excellence of its professional and support staff. It must
attract the best and brightest from around the world and create the
organizational environment and culture in which they can fully contribute
their expertise and very diverse experience to the complex problems that
must be solved. They must be able to work effectively across traditional
organizational boundaries both within WHO and with critical external
partners in Health. These fine women and men must also have the opportunity
to grow within our organization -- grow in knowledge, experience, and have a
clear and transparent path to career advancement. One of my highest
priorities will be to ensure that WHO staff are recognized, supported and
respected for their quality and for their commitment to our important work.
Staff recruitment procedures and methods will be analyzed, in order to
guarantee high technical and scientific standards, without any need to
question the established principle of geographic quotas. Competent
individuals are available from all around the world and WHO must, therefore,
strengthen its ability to identify staff and expert advisors from well-known
and less well-known pools of talent.
It is critical that we ensure an equal representation of women at all staff
levels and among our external advisors.
Very special attention will be given to the appropriate selection and
training of WHO Country Representatives.
I will also pay special attention to staff development activities and new
staff development opportunities will be created.
WHO, has, in the recent past, undergone a considerable restructuring
process. Time is necessary to consolidate these changes and to stabilize the
new working relationships brought about by the restructuring process. The
main thrust of my management and leadership will be characterized by the
adoption of modern, democratic and results oriented managerial methods,
based on evidence. In so doing, I will always seek dialogue with interested
parties in the decision making process. I will pay particular attention to
listening to the staff and will take in consideration their views and
suggestions.
High priority will be given to the improvement of the managerial and
organizational mechanisms within WHO. Especially, I will consider ways and
means to reduce bureaucracy, transaction costs and potential efficiency
losses between Headquarters, Regions and Country level.

4.2. Our Regional Structure
WHO can only be effective as a global organization and for our Member
States, if the staff in Brazzaville, Cairo, Copenhagen, Geneva, Harare,
Manila, New Delhi, Washington DC and in WHO Country Representations see
themselves as part of a single Organization whose goal is World Health. This
goal can only be achieved if individuals, organizations and governments
around the world work effectively with WHO to develop strategies suited to
their own regional and country environments. WHO's structure must reflect
this interdependence within our own Organization, and the Regional Directors
will be part of my core executive team.

4.3. Networks of Expertise
One key to our future success will be our continued ability to bring
together the best experts in a given field from around the world to
deliberate and set standards that countries and other multilateral
organizations can use to guide their work. This is our normative function
and it is fundamental to our role. This ability to tap the best expertise
through our Collaborating Centers, our Member States, our partners and the
individual and organizational networks of our staff worldwide must be
maintained and strengthened.
As countries join international initiatives to address critical health
challenges, we must use our expert networks, partnerships with other
agencies, NGO's, corporations and relationships with governments to support
them. Action plans must include the creation of sustainable capacity to
enable countries to continue their progress in the implementation of these
initiatives.
Working together, we will find the best ways of providing tailor-made
technical cooperation to achieve sustainable national Health policy goals
and to draw on the experience of individual countries to build a wealth of
Health knowledge that can benefit the rest of the world. Through our
standard setting and normative work, and our access to worldwide networks of
experts, we can ensure the quality and effectiveness of global actions for
Health. With these powerful tools, we can equally inspire further commitment
to a renewed WHO to face the challenges of the 21st century.

TOGETHER, WE CAN MAKE THIS VISION A REALITY