<div dir="ltr"><br><div class="gmail_quote"><div dir="ltr"><div><div><div><div><div><div class="gmail_quote">From: <b class="gmail_sendername">Jo Kreysler</b> <span dir="ltr"><<a href="mailto:jokreysler@hotmail.com" target="_blank">jokreysler@hotmail.com</a>></span><br>
<br><div dir="auto"><div><blockquote type="cite"><div><blockquote type="cite"><div><div style="font-size:14pt;font-family:HelveticaNeue,Helvetica Neue,Helvetica,Arial,Lucida Grande,sans-serif"><div>Lancet 9 November, 2013</div>
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Offline by Richard Horton<br><span></span></div><div style="font-style:normal;font-size:18.6667px;background-color:transparent;font-family:HelveticaNeue,Helvetica Neue,Helvetica,Arial,Lucida Grande,sans-serif"><span><br>
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1544 </div><div dir="ltr" style="font-size:12.1333px;font-family:sans-serif"><a href="http://www.thelancet.com" target="_blank">www.thelancet.com</a></div><div dir="ltr" style="font-size:12.1333px;font-family:sans-serif">
Vol 382 November 9, 2013</div><div dir="ltr" style="font-size:8.66667px;font-family:sans-serif">Richard Horton</div>Offline: A renaissance in WHO’s regions <div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
The Regional Offices of WHO—there are six of them: in </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Copenhagen, Manila, New Delhi, Brazzaville, Cairo, and </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Washington, DC—are easy targets for criticism. Here is </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">what sceptics often say. The Regional Offi</div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif"> ces of WHOare bureaucratic fi efdoms of power-loving Regional </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Directors (RDs), who have mostly been elected through </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">outright bribery. Regional Offices obstruct, rather than </div>
<div dir="ltr">facilitate, the advance of health in countries. They </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">compete with Geneva and rival the Director-General of </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
WHO for influence and resources. Since RDs are elected </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">and not appointed, they feel they have the right to ignore </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
Geneva and indulge their own interests, which often </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">centre on personal enrichment and winning re-election. </div><div dir="ltr">RDs are unaccountable to countries (indeed, to anyone). </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Ultimately, the only sure fact about WHO’s Regional </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Offices is that they dilute the overall eff</div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif"> ectiveness of the agency, leaving it vulnerable to attack by those hostile </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">to multilateral institutions. While Regional Offices fiddle,these sceptics argue, WHO burns. Although this view </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">may have been true 20 years ago, it is certainly not true </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">today—at least, not in all WHO regions.</div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">*</div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
Instead, the global health community should welcome </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">a renaissance of regional leadership in WHO. Take the </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
Regional Office for the Eastern Mediterranean (EMRO), </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">led by Ala Alwan since 2012. He arrived in Cairo with a </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
huge credit line. As an Assistant Director-General (ADG) </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">at WHO’s Geneva Headquarters, he delivered the 2011 </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
Political Declaration on the Prevention and Control of </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Non-Communicable Diseases, a towering achievement in </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
the agency’s history, securing a key part of the post-2015 </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">agenda for health. With this victory, he came to EMRO </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
with a mandate for reform. Dr Alwan quickly set about </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">devising a new strategy for his 22-country region. He </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
integrated global priorities (MDGs, NCDs, health-system </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">strengthening), areas that he helped to shape in Geneva, </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
with more regional concerns (emergency preparedness, </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">emerging infectious diseases) that he also knew well, </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
having been a former Minister of Health in Iraq. He </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">started recruiting talent from across the agency, and he </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
looked outside to countries to attract the best of a new </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">generation of health leaders. He has moved quickly. At his </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
Regional Committee meeting, held in Oman last week, </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">his agenda was focused and specific, unlike the sprawling </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
chaos that characterises the World Health Assembly. </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Ministers were left in no doubt about the priorities they </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
were expected to act upon, including the alarming return </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">of polio to Syria, which poses an epidemic threat to the </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
entire region. As one of EMRO’s senior advisors told me </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">last week, “Ala Alwan is making a difference, even though </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
the changes take too long according to his own liking”. </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">That is exactly what WHO needs—people with a sense of </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">
urgency and zero tolerance to delay.</div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">*</div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">What of other WHO regions? Carissa Etienne is bringing </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">a similar strategic discipline to the Pan American Health </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Organisation (PAHO), where she became RD earlier this </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">year. Her priority is to deliver universal health coverage. </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">She is well qualified to do so. She too was an ADG (for </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Health Systems and Services) in Geneva before being </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">elected to PAHO. She has already, together with the </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Rockefeller Foundation and other partners, established a </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">scientific network to review the lessons of health reforms </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">in her region and what they mean for universal health </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">coverage in the future. Ala Alwan and Carissa Etienne </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">represent a new generation of leadership in WHO’s </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">regions. Elsewhere, the story is more patchy. Zsuzsanna </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Jakab is widely admired as a good and kind administrator </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">of the WHO Regional Office for Europe. She has given </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">welcome priority to inequalities in her region. One </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">colleague describes her, positively, as a “safe pair of hands”. </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">These skills are all excellent. But should WHO not expect </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">more? In the Regional Office for the Western Pacific, </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Shin Young-soo continues (from 2014) with a second </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">term as RD. In South-East Asia, Poonam Singh, currently </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Deputy RD, will assume leadership from February 1, 2014. </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Both must learn the lessons of their two colleagues in </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">EMRO and PAHO. But the most troubled region of WHO </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">is the Regional Office for Africa. The two terms served by </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">Luis Sambo have not been a success. WHO in Africa has </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">been utterly marginalised by almost every other global </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">health institution. African countries need to look carefully </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">for a new leader of their region (whom they will elect next </div>
<div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">year). It is a crucial moment for Africa. Can WHO’s regional </div><div dir="ltr" style="font-size:17.3333px;font-family:sans-serif">renaissance continue? Africa will decide.</div>
<div dir="ltr" style="font-size:17.3333px;font-family:serif">Richard Horton</div><div dir="ltr" style="font-size:14.7333px;font-family:sans-serif"><a href="mailto:richard.horton@lancet.com" target="_blank">richard.horton@lancet.com</a></div>
<div dir="ltr" style="font-size:8.66667px;font-family:sans-serif">Richard Horton</div></div></div></div>
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