1 July 2017 – Mukesh Kapila

Dr Tedros should steer clear of vertical disease programmes pushed by donors, be prepared for his authority to be questioned, and tighten the purse strings

The first ever African director general of the World Health Organisation assumes office on Saturday. The election of Dr Tedros Adhanom Ghebreyesus, or as he is popularly known, Tedros, by an overwhelming majority of this year’s World Health Assembly is rightly hailed as historic. This was the first time that each of WHO’s 194 member states got a direct say in selecting the world’s top health leader. The public got involved too through many open debates and social media also influenced the final outcome.

Tedros has impressive credentials. As Ethiopia’s health minister, he presided over a massive expansion of healthcare with impressive health gains by his poor nation. And as his country’s foreign minister, his political and diplomatic abilities influenced extra financing for the UN’s sustainable development goals. He played critical mediation roles in Somalia and South Sudan: useful experience for reconciling states’ diverse positions on health issues. Forging partnerships is his particular strength: he chaired boards at the Global Fund and UNAids, and pushed numerous international health initiatives, from malaria and TB to maternal and child health.

His election signals a changed global mood. An Ebola-panicked world got fed up with the same old technocratic prescriptions that have failed only too often. Faced with many more borderless health threats including climate change and, with increasing discontent fuelled by widening global health inequalities, they voted for change.

But will Tedros be the change the troubled global health body needs? He has declared health to be a basic human right and said: “All roads lead to universal health coverage. Because UHC means leaving no one behind”. If he wants to have a real impact though, the following should be on his to do list:

Promote home-grown national solutions
WHO’s principal priority should be to help countries build their own sustainable human and infrastructural capacities to deliver UHC in their own contexts. This means valuing home-grown national solutions – just as Tedros did in Ethiopia – and not being driven by the one-size-fit-all models or vertical disease programmes pushed by donors. This is also the best insurance for preventing or controlling the next pandemic. Meanwhile, Tedros should resist being set up to fail as the world’s health policeman by paranoid rich countries. In the aftermath of Ebola and Zika, they may be tempted to push WHO to pressurise poor countries to enforce the International Health Regulations without also fully investing in their capacities to do so.

Remember WHO does not have a monopoly on health wisdom
Delivering change will require a revisioning of WHO’s long-presumed position as the centre of the global health ecosystem. Today we have many well-resourced international bodies and national institutions with highly-qualified experts. Thus, WHO does not have a monopoly on health wisdom and its norm-setting and convening authority is questioned. It’s high time that the humbleness that has endeared Tedros to many people rubs off on the organisation.

Hire diverse talent
Tedros needs a radically different business model for WHO, and for international health cooperation. He can start by enabling WHO to regain the trust and ownership of all its member states. The global public good that is the World Health Organisation cannot remain in hock to half a dozen rich countries who pay most of its bills and occupy most of its senior positions. So, an early test for him is if he can construct a senior team of diverse talents from all around the world.

But don’t get bogged down in internal reform
Tedros can’t afford to waste his five-year tenure on simply rearranging institutional furniture. All his recent predecessors as director general have huffed and puffed but ultimately failed to reform WHO. An effective and efficient organisation is just a means towards an end. So, Tedros only has to do enough to make WHO fit for the purpose of delivering his vision.

Look beyond traditional thought leaders
At the same time, he needs fresh ways to tackle intractable issues. He should reach out beyond the self-validating orthodoxy of the elite thinktanks and medical journals, most of whom are in the global north. Tedros is much appreciated for his accessibility and he will find it mind-broadening to encourage new voices in all continents to question existing paradigms.

Accept WHO has to live with its means
Another early test for Tedros is financial. WHO is broke with budget gaps in priority areas and excessive reliance on ad hoc voluntary funding. But he should resist setting out with a begging bowl and instead reform the budgetary architecture and agree a new compact for consistent and predictable funding. As he starts in Geneva and discovers what it is like to live in the fourth most expensive city in the world, he must ask whether everything that is done at headquarters needs to come from there. He will also, no doubt, approach member states for a hike in core contributions. He should only do this when he has delivered something first. Even if he succeeds, WHO must learn to live within its means. Sacrifices must be made to stop the organisation drowning under the weight of numerous competing technical agendas, especially when other agencies do them better.

Encouragingly, he has already recognised that a greater responsibility than saving WHO is championing adequate resources for a wider partnership of global health actors, and to inject more resources into countries themselves.

Already dubbed the “People’s DG”, Tedros’ pledge of togetherness for a healthier world has generated much goodwill and excitement. He has fired-up the hopes and imaginations of people worldwide. He must not let them down. Acting boldly and quickly according to his own moral values will be the best guarantee of that.

First published in The Guardian