PHM-Exch> How McKinsey and Company Infiltrated the World of Global Public Health AND WHO

[Claudio Schuftan]

How McKinsey and Company Infiltrated the World of Global Public Health

By Julia Belluz and Marine Buissonniere, Vox

17 December 19


*The Gates Foundation brought billions of dollars to the sector — and a
business-friendly ethos consultants could exploit. *


hen Dr. Tedros Adhanom Ghebreyesus took the helm of the World Health
Organization in July 2017, his first speech
<https://www.who.int/dg/speeches/2017/taking-helm-who/en/> at headquarters
in Geneva landed on a hopeful audience. WHO staff had seen a recent string
of new bosses, each with a plan to reinvigorate and shake up the
organization. The leaders’ reforms often involved bringing in management
consultants, such as McKinsey, one of the world’s most influential and
secretive firms <https://fortune.com/2019/03/08/mckinsey-sneader-interview/>.
But every attempt had ultimately failed to solve WHO’s most vexing — and
decades-old — challenges
<https://www.sciencedirect.com/science/article/abs/pii/S0033350613002916>,
like the agency’s problematic financing structure
<https://www.bmj.com/content/353/bmj.i2666> and related chronic funding
shortfalls
<https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303399>.

Tedros, as he’s known, suggested things would be different this time. He
seemed to sense the staff’s reform fatigue and their leeriness of external
consultants, reassuring his rank and file: “Any enduring change at WHO will
come from the staff outwards. I do not believe in perpetual reform, and I
think WHO staff are reformed out.”

But Tedros appears to have embraced change, of a sort. Halfway through his
five-year term, his reform — known as “the transformation
<https://unfoundation.org/blog/post/aligning-for-impact-the-transformation-of-the-world-health-organization/>”
— is still in progress. And while he has offered WHO staff opportunities to
engage in the process, the agency is also crawling with outside
consultants, current and former WHO staffers told Vox.

“The one thing that WHO staff didn’t want,” said a senior official who was
involved in the reform process, “is a McKinsey type of reform,” using the
well-known firm as a shorthand for what they’ve seen consultants bring to
WHO and other health agencies over the years: “musical chairs,” “cost
cutting,” and “debunked management fads.”

In addition to McKinsey, WHO confirmed they’ve worked with five other
consultancies during the transformation: BCG, Deloitte, Preva Group, Seek
Development, and most recently, Delivery Associates, which has a multi-year
contract worth $3.85 million. The total value of the consultant contracts
is about $12 million, at least a quarter of which has been paid for
directly by the Bill and Melinda Gates Foundation
<https://www.gatesfoundation.org/>, one of the most powerful players in
global health.

Though WHO is a public institution, the details of these engagements, and
Gates’s involvement, aren’t available in the WHO’s budgets or financial
statements. The information that is disclosed on WHO’s website is
incomplete. WHO has a portal with data
<https://www.who.int/about/finances-accountability/procurement/ca/en/> on
contracts the agency processes — but it excludes those paid for directly by
donors like Gates. It’s also missing information on what, exactly,
consultants have been hired to do.

For example, the portal shows WHO’s headquarters awarded McKinsey with
$4.19 million in contracts between 2017
<https://www.who.int/about/finances-accountability/procurement/service-awarded-contracts-2017.pdf?ua=1>
and 2018
<https://www.who.int/about/finances-accountability/procurement/2018-service-awarded-contracts.pdf?ua=1>
— but not whether those were reform-related. (WHO declined to specify.)

Even agency staff — including officials who have reported directly to
Tedros — say they’ve been left in the dark.

One senior official, who worked at WHO when Tedros’s overhaul started, said
the consultants subjected the official to a barrage of questions, on
everything from staff mobility to WHO’s “hierarchies and silos.” The
official said they were never told how the information they shared would
ultimately be used. Another told Vox: “It was like a beehive on the seventh
and eighth floors. There were many people [in] suits. But they don’t talk
to us directly.” A third said, “It’s now been two years [the reform] has
been going on. I have no idea what is happening.”

*How consultants are shaping global health *

Global health, a field dedicated to improving the health and wellbeing of
the poor and most vulnerable, has quietly developed a penchant for highly
paid management consultants and their business world tools.

According to an internal 2016 McKinsey PowerPoint presentation obtained by
Vox, the firm has been involved in the response to the biggest
international disease outbreaks of recent years, from Mers in Saudi Arabia
to Zika in Brazil. During the 2014-2016 Ebola epidemic in West Africa, both
BCG and McKinsey sent staff to West Africa, to advise WHO and the countries
affected.

These firms worked at Gavi, the Vaccine Alliance — a global public–private
partnership focused on expanding access to immunizations in poor countries
— from its earliest days, helping develop their vaccine financing
strategies. Ditto, the Global Fund (another public-private partnership that
invests in treatment and prevention for infectious diseases like HIV/AIDs,
TB, and malaria), UNITAID, the Gates Foundation, the global health
nonprofit Partners in Health, and the WHO.

The 80-plus global health leaders and staff, current and former consultants
at multiple firms, researchers, health care professionals, and NGO workers
we spoke to for this story described the consultants as “pervasive” and
“ubiquitous.” And many have become wary of consultants’ involvement in the
sector.

But how these secretive businesses, which mostly profit from serving
corporate interests, are shaping global public health is an open question —
and one that’s hard to answer. An additional mystery: How much money —
designated by foundations and governments for improving the health of the
poorest — is being spent on them?

These and other uncertainties concern global health workers and analysts,
many of whom would only speak on the condition of anonymity for fear of
compromising their professional prospects.

While some believe management consultants can help institutions become more
effective, others are dubious, particularly after they’ve seen the
consultants’ interventions fail to help — and in some cases even damage —
institutions. And they’ve begun questioning whether precious resources,
especially money designated to helping save and cure the poorest people in
the world, should be flowing to the highest-paid consultants in the world —
who simultaneously advise industries that are exacerbating public health
problems.

“After 30 years of work at many institutions, nothing done by management
consultants comes to my mind as having been brilliant, and a lot has been
inappropriate and wasteful of time and resources,” said Mukesh Kapila, a global
health pioneer <http://www.mukeshkapila.org/about/inbrief.html> who led the
UK’s first HIV/AIDS program, and has worked with consultants from multiple
firms over the decades.

Madhu Pai, who directs McGill University’s global health program, recently
wrote
<https://www.globalhealthnow.org/2019-08/10-fixes-global-health-consulting-malpractice>
of an African colleague who has had to face “‘kids’ with little or no
experience [coming] all the time to ‘advise’ her government on what to do
about health.” Pai now calls this “global health consulting malpractice.”

The opaque nature of the consulting business means it’s difficult to know
which firms are most influential. While Dalberg <https://www.dalberg.com/>,
PwC <https://www.pwc.com/gx/en/services/advisory/consulting.html>, Accenture
<https://www.accenture.com/us-en/about/consulting-index>, Bain
<https://www.bain.com/>, and others came up, McKinsey and BCG seem to have
an outsized impact on the global health sector. One measure of that: The
two firms have consistently been among the top five professional services’
contractors at the Gates Foundation, according to the foundation’s tax
returns, even after the organization vowed to, and did, curtail spending
<https://www.washingtonpost.com/news/on-leadership/wp/2015/12/21/the-head-of-the-gates-foundation-on-combatting-ceo-disease/?utm_term=.a5f0888b6ff9>
on consultants beginning in 2015.

A WHO spokesperson said the agency welcomed the use of consultants. “The
[consulting] companies have supported WHO in areas where we lack in-house
expertise or want to tap the current best-in-class standards,” the person
told Vox. “These are not unreasonable expenditures for an organization of
our size, with a biennial budget of around $6 billion and more than 8,000
staff in almost every country around the world.”

“Since 2017, we have committed $11.509 million to support WHO
transformation efforts,” a Gates Foundation spokesperson said. “WHO sought
these funds to help it implement reforms that had been requested by its
member states.”

BCG declined to comment. A McKinsey spokesperson said, “We are proud of our
work on global public health.”

The latter firm has been in the news lately for advising the Trump
administration to cut spending
<https://www.propublica.org/article/how-mckinsey-helped-the-trump-administration-implement-its-immigration-policies>
on food and medical supplies for migrants, manipulating statistics at
Rikers Island prison
<https://www.propublica.org/article/new-york-city-paid-mckinsey-millions-to-stem-jail-violence-instead-violence-soared>,
and declining to disclose the client details of Democratic presidential
candidate and former McKinsey staffer Pete Buttigieg’
<https://www.vox.com/policy-and-politics/2019/12/11/21010731/what-we-know-about-pete-buttigieg-mckinsey>s
work, until the lack of transparency became an issue in the Democratic
primary.

In global health, critics are also demanding more transparency from the
firms themselves, and from the organizations that

keep hiring consultants — beginning with the Gates Foundation.

“The rise of the Gates Foundation has resulted in more space being created
for management consultancies to solve global health’s problems,” said Devi
Sridhar, chair in global public health at the University of Edinburgh. “The
challenge is trying to follow the money, and figure out the relationships
between funders like Gates, consultancy firms, and the WHO.”

Indeed, the philanthropic juggernaut changed the face of global health. It
also quietly played an instrumental role in launching the field’s
consulting era. CLIPPED HERE
for the full article, go to

https://readersupportednews.org/news-section2/318-66/60311-how-mckinsey-and-company-infiltrated-the-world-of-global-public-health

I think the rest is also excellent.
Claudio
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