<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><div class="gmail_default" style="font-size:large"><h1 class="gmail-txttitle">How McKinsey and Company Infiltrated the World of Global Public Health</h1>
<p class="gmail-txtauthor">By Julia Belluz and Marine Buissonniere, Vox</p>
<p class="gmail-date">17 December 19</p>
<blockquote><br><strong><em>The Gates Foundation brought billions of dollars to the sector — and a business-friendly ethos consultants could exploit. </em></strong></blockquote><br>
<p><img src="https://readersupportednews.org/images/stories/alphabet/rsn-W.jpg" border="0">hen Dr. Tedros Adhanom Ghebreyesus took the helm of the World Health Organization in July 2017, his first <a target="_blank" href="https://www.who.int/dg/speeches/2017/taking-helm-who/en/">speech</a>
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<b> </b>management consultants, such as McKinsey, one of the world’s most <a target="_blank" href="https://fortune.com/2019/03/08/mckinsey-sneader-interview/">influential and secretive firms</a>. But every attempt had ultimately failed to solve WHO’s most vexing — and decades-old — <a target="_blank" href="https://www.sciencedirect.com/science/article/abs/pii/S0033350613002916">challenges</a>, like the agency’s problematic <a target="_blank" href="https://www.bmj.com/content/353/bmj.i2666">financing structure</a> and related <a target="_blank" href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303399">chronic funding shortfalls</a>.</p>
<p class="gmail-indent">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.”</p>
<p class="gmail-indent">But Tedros appears to have embraced change, of a sort. Halfway through his five-year term, his reform — known as “<a target="_blank" href="https://unfoundation.org/blog/post/aligning-for-impact-the-transformation-of-the-world-health-organization/">the transformation</a>”
— 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. </p>
<p class="gmail-indent">“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.” </p>
<p class="gmail-indent">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 <a target="_blank" href="https://www.gatesfoundation.org/">Bill and Melinda Gates Foundation</a>, one of the most powerful players in global health.</p>
<p class="gmail-indent">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. <a target="_blank" href="https://www.who.int/about/finances-accountability/procurement/ca/en/">WHO has a portal with data</a>
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. </p>
<p class="gmail-indent">For example, the portal shows WHO’s headquarters awarded McKinsey with $4.19 million in contracts between <a target="_blank" href="https://www.who.int/about/finances-accountability/procurement/service-awarded-contracts-2017.pdf?ua=1">2017</a> and <a target="_blank" href="https://www.who.int/about/finances-accountability/procurement/2018-service-awarded-contracts.pdf?ua=1">2018</a> — but not whether those were reform-related. (WHO declined to specify.) </p>
<p class="gmail-indent">Even agency staff — including officials who have reported directly to Tedros — say they’ve been left in the dark. </p>
<p class="gmail-indent">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.” </p>
<p class="gmail-indent"><b>How consultants are shaping global health </b></p>
<p class="gmail-indent">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. </p>
<p class="gmail-indent">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. </p>
<p class="gmail-indent">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. </p>
<p class="gmail-indent">The 80-plus<b> </b>global health leaders and staff,<b> </b>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.</p>
<p class="gmail-indent">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? </p>
<p class="gmail-indent">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. </p>
<p class="gmail-indent">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. </p>
<p class="gmail-indent">“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 <a target="_blank" href="http://www.mukeshkapila.org/about/inbrief.html">global health pioneer</a> who led the UK’s first HIV/AIDS program, and has worked with consultants from multiple firms over the decades.</p>
<p class="gmail-indent">Madhu Pai, who directs McGill University’s global health program, <a target="_blank" href="https://www.globalhealthnow.org/2019-08/10-fixes-global-health-consulting-malpractice">recently wrote</a>
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.” </p>
<p class="gmail-indent">The opaque nature of the consulting business means it’s difficult to know which firms are most influential. While <a target="_blank" href="https://www.dalberg.com/">Dalberg</a>, <a target="_blank" href="https://www.pwc.com/gx/en/services/advisory/consulting.html">PwC</a>, <a target="_blank" href="https://www.accenture.com/us-en/about/consulting-index">Accenture</a>, <a target="_blank" href="https://www.bain.com/">Bain</a>,
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 <a target="_blank" href="https://www.washingtonpost.com/news/on-leadership/wp/2015/12/21/the-head-of-the-gates-foundation-on-combatting-ceo-disease/?utm_term=.a5f0888b6ff9">vowed to, and did, curtail spending</a> on consultants beginning in 2015. </p>
<p class="gmail-indent">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.”</p>
<p class="gmail-indent">“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.”</p>
<p class="gmail-indent">BCG declined to comment. A McKinsey spokesperson said, “We are proud of our work on global public health.” </p>
<p class="gmail-indent">The latter firm has been in the news lately for <a target="_blank" href="https://www.propublica.org/article/how-mckinsey-helped-the-trump-administration-implement-its-immigration-policies">advising the Trump administration to cut spending</a> on food and medical supplies for migrants, <a target="_blank" href="https://www.propublica.org/article/new-york-city-paid-mckinsey-millions-to-stem-jail-violence-instead-violence-soared">manipulating statistics at Rikers Island prison</a>, and declining to disclose the client details of Democratic <a target="_blank" href="https://www.vox.com/policy-and-politics/2019/12/11/21010731/what-we-know-about-pete-buttigieg-mckinsey">presidential candidate and former McKinsey staffer Pete Buttigieg’</a>s work, until the lack of transparency became an issue in the Democratic primary. </p>
<p class="gmail-indent">In global health, critics are also demanding more
transparency from the firms themselves, and from the organizations that <br></p><p class="gmail-indent">keep hiring consultants — beginning with the Gates Foundation. </p>
<p class="gmail-indent">“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.” </p>
<p class="gmail-indent">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<br></p></div><div class="gmail_default" style="font-size:large">for the full article, go to</div><div class="gmail_default" style="font-size:large"><br></div><div class="gmail_default" style="font-size:large"><a href="https://readersupportednews.org/news-section2/318-66/60311-how-mckinsey-and-company-infiltrated-the-world-of-global-public-health">https://readersupportednews.org/news-section2/318-66/60311-how-mckinsey-and-company-infiltrated-the-world-of-global-public-health</a></div><div class="gmail_default" style="font-size:large"><br></div><div class="gmail_default" style="font-size:large">I think the rest is also excellent.</div><div class="gmail_default" style="font-size:large">Claudio<br></div></div>