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The next head of WHO could be an African and for a good reason

The next head of WHO could be an African and for a good reason

Fetsum Berhane


The year-long process to elect a new Director-general for the World Health Organization has officially began for the leadership transition will occur on 1 July 2017. The Director-General is WHO’s chief technical and administrative officer and oversees policy for WHO’s international health work.

The process technically started in April when the organization's issuance of a call for nominations from member states. The election has no formal geographical requirement but many delegates push for an informal geographical rotation to give chance to unrepresented regions. The incumbent director general, Margaret Chan, is from China. She was chosen in 2006 after the sudden death of Lee Jong-Wook of Korea, who had served since 2003. Hence, the Asia region have had the office for about 14 years.

Before a democratic reform taken by the WHO, the head of the organization was selected by a 34 member Executive Board. For a first time in its history, the entire 194 members of the World Health Assembly will elect from the three final candidates at May 2017.

In the age of new outbreaks, mass migration and other health challenges in addition to stressed funds, the top job at the world's highest public health agency has gotten less attractive and a lot harder. Nonetheless, several candidates emerged to run for head of the United Nations agency.

So far three candidates are known to be in the race, Tedros Adhanom, Ethiopia’s Minister of Foreign Affairs (and former Health Minister), Sania Nishtar, Pakistan's former minister of Education and Training, Sciences and Technology and Philippe Douste-Blazy, France's former minister of Health.

 In continuation of its recent trend, Africa presented a united front and endorsed the candidacy of Ethiopia's former minister of health Tedros Adhanom in the decision made at the January 2016 Summit of AU Heads of State and Government in Addis Ababa, Ethiopia. Abdelmalek Boudiaf, Algeria's Minister of Health and coordinator of the African Group at the WHO said that Tedros's candidacy is "legitimate" and his possible election "would only be fair for Africa". Chairperson of the African Union Commission Nkosazana Dlamini-Zuma also attended the conference in support to Africa's candidate for WHO director-general position.

The nomination of Africa’s candidate, Dr. Tedros Adhanom, is deeply tied with Ethiopia’s achievement on many of the health goals of the Millennium Development Goals (MDG’s) during his tenure.

In the last decade, the number of new HIV/AIDS infections declined, death from malaria has declined to zero percent and it has been six years since Ethiopia experienced a malaria epidemic. Ethiopia constructed 15,000 health posts, more than 3000 primary health centers and about 300 primary hospitals across the country which greatly improved equitability of and access to health services. There had also been promising results in terms of preventing tuberculosis.

One notable success was the globally acclaimed Ethiopia’s Health Extension program which trained and deployed tens of thousands of health extension workers into every rural village across the country. The number of midwives trained in the last three years is also expected to reach more than 13,000 by the end of 2016. This community based health initiative has been widely acclaimed and often cited as a successful local innovation for countries who face financial limitations to achieve their health goals.

The biggest achievement is probably that, according to WHO's 2014 World Health Statistics Report, Ethiopia has accomplished the goal of reducing under-five mortality by 67% compared to the 1991 rate. The UN Inter Agency Group’s mortality assessment in 2013 states that the average annual reduction rate of under-five mortality, which was about 2% from 1990 to 2000, jumped to 5% in the last decade, resulting in a decline from 204 per 1000 children in 1990 to 64 per 1000 children in 2013/14.

The Public Expenditure Review of the World Bank published this month also stated that Ethiopia is one of the few countries in Sub Saharan Africa that achieved a significant reduction in under-five mortality with limited increase in expenditure per-capita. “Using allocation efficiency approach”, the report found, “improvements in health outcomes relative to increase in public health expenditure shows that in the case of Ethiopia, for the same level of increase in expenditure, reduction in under-five mortality can range between 20-110 deaths per 1,000 live births. The analysis shows that Ethiopia reduced under-five mortality by about 80 deaths per 1,000 live births with an increase of US$5 in health expenditure per-capita. No other country has achieved a larger reduction for the same level of increase in expenditure”. This prudent management can only be an asset for the WHO whose funds are stretched than ever.

Taking Ethiopia’s achievements in the sector consideration, the likelihood of an African becoming the next Director-General of the WHO is more possible than ever. 

After the submission deadline and the unveiling of the list of candidates in September 2016, the secretariat will launch a password-protected web forum open to all Member States and candidates and information about the candidates will be posted there for candidates who request it. The Executive Board’s short-list of five candidates will pass through interviews, presentation, and Q&A with Board members and then the list will be cut down by secret ballot to three candidates, who will be forwarded to the World Health Assembly.

A new feature introduced this time is a “candidates’ forum,” for WHO member states, on which the candidates present themselves in person. It will be held be held around November for a maximum of three days. The event will be web-cast, but is only open only to governments and there will be no direct way for non-governmental entities to participate.

The WHO, which is headquartered in Geneva, has these official criterion for the election of its Director-general which will earn nearly US$ 240,000 per year: experience in public health and in international health, leadership skills and demonstrable competence in organizational management and sensitivity to cultural, social and political differences. After the Executive Board of the WHO shortlists three candidates in January 2017, the incumbent Director-general will work with all three until May 2017 for smoother the transition.

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