PHM-Exch> WHO Regional Offices .... Lancet's Editor view

[Claudio Schuftan]

From: Jo Kreysler <jokreysler at hotmail.com>

Lancet 9 November, 2013

Offline by Richard Horton

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962290-4/fulltext

text also below



Comment
1544
www.thelancet.com
Vol 382 November 9, 2013
Richard Horton
Offline: A renaissance in WHO’s regions
The Regional Offices of WHO—there are six of them: in
Copenhagen, Manila, New Delhi, Brazzaville, Cairo, and
Washington, DC—are easy targets for criticism. Here is
what sceptics often say. The Regional Offi
ces of WHOare bureaucratic fi efdoms of power-loving Regional
Directors (RDs), who have mostly been elected through
outright bribery. Regional Offices obstruct, rather than
facilitate, the advance of health in countries. They
compete with Geneva and rival the Director-General of
WHO for influence and resources. Since RDs are elected
and not appointed, they feel they have the right to ignore
Geneva and indulge their own interests, which often
centre on personal enrichment and winning re-election.
RDs are unaccountable to countries (indeed, to anyone).
Ultimately, the only sure fact about WHO’s Regional
Offices is that they dilute the overall eff
 ectiveness of the agency, leaving it vulnerable to attack by those hostile
to multilateral institutions. While Regional Offices fiddle,these sceptics
argue, WHO burns. Although this view
may have been true 20 years ago, it is certainly not true
today—at least, not in all WHO regions.
*
Instead, the global health community should welcome
a renaissance of regional leadership in WHO. Take the
Regional Office for the Eastern Mediterranean (EMRO),
led by Ala Alwan since 2012. He arrived in Cairo with a
huge credit line. As an Assistant Director-General (ADG)
at WHO’s Geneva Headquarters, he delivered the 2011
Political Declaration on the Prevention and Control of
Non-Communicable Diseases, a towering achievement in
the agency’s history, securing a key part of the post-2015
agenda for health. With this victory, he came to EMRO
with a mandate for reform. Dr Alwan quickly set about
devising a new strategy for his 22-country region. He
integrated global priorities (MDGs, NCDs, health-system
strengthening), areas that he helped to shape in Geneva,
with more regional concerns (emergency preparedness,
emerging infectious diseases) that he also knew well,
having been a former Minister of Health in Iraq. He
started recruiting talent from across the agency, and he
looked outside to countries to attract the best of a new
generation of health leaders. He has moved quickly. At his
Regional Committee meeting, held in Oman last week,
his agenda was focused and specific, unlike the sprawling
chaos that characterises the World Health Assembly.
Ministers were left in no doubt about the priorities they
were expected to act upon, including the alarming return
of polio to Syria, which poses an epidemic threat to the
entire region. As one of EMRO’s senior advisors told me
last week, “Ala Alwan is making a difference, even though
the changes take too long according to his own liking”.
That is exactly what WHO needs—people with a sense of
urgency and zero tolerance to delay.
*
What of other WHO regions? Carissa Etienne is bringing
a similar strategic discipline to the Pan American Health
Organisation (PAHO), where she became RD earlier this
year. Her priority is to deliver universal health coverage.
She is well qualified to do so. She too was an ADG (for
Health Systems and Services) in Geneva before being
elected to PAHO. She has already, together with the
Rockefeller Foundation and other partners, established a
scientific network to review the lessons of health reforms
in her region and what they mean for universal health
coverage in the future. Ala Alwan and Carissa Etienne
represent a new generation of leadership in WHO’s
regions. Elsewhere, the story is more patchy. Zsuzsanna
Jakab is widely admired as a good and kind administrator
of the WHO Regional Office for Europe. She has given
welcome priority to inequalities in her region. One
colleague describes her, positively, as a “safe pair of hands”.
These skills are all excellent. But should WHO not expect
more? In the Regional Office for the Western Pacific,
Shin Young-soo continues (from 2014) with a second
term as RD. In South-East Asia, Poonam Singh, currently
Deputy RD, will assume leadership from February 1, 2014.
Both must learn the lessons of their two colleagues in
EMRO and PAHO. But the most troubled region of WHO
is the Regional Office for Africa. The two terms served by
Luis Sambo have not been a success. WHO in Africa has
been utterly marginalised by almost every other global
health institution. African countries need to look carefully
for a new leader of their region (whom they will elect next
year). It is a crucial moment for Africa. Can WHO’s regional
renaissance continue? Africa will decide.
Richard Horton
richard.horton at lancet.com
Richard Horton
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