Dr Tedros of Ethiopia elected as new WHO DG
Published in SUNS #8470 dated 29 May 2017

Geneva, 24 May (Kanaga Raja) -- Member States of the World Health Organisation (WHO) on Tuesday elected Dr Tedros Adhanom Ghebreyesus of Ethiopia as its new Director-General, the first from the African continent to hold this position.

Dr Tedros's five-year term of office begins on 1 July 2017. He succeeds Dr Margaret Chan who held the office since 1 January 2007.

There were three candidates vying for the position - Dr Tedros, Dr David Nabarro of the United Kingdom and Dr Sania Nishtar of Pakistan.

Three rounds of voting took place with Dr Nishtar being eliminated in the first round after garnering 38 votes. Dr Tedros finally defeated Dr Nabarro after receiving 133 votes to 50.

According to a WHO news release, prior to his election as WHO's next Director-General, Dr Tedros served as Minister of Foreign Affairs, Ethiopia from 2012-2016 and as Minister of Health, Ethiopia from 2005-2012.

He also served as chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria; as chair of the Roll Back Malaria (RBM) Partnership Board; and as co-chair of the Board of the Partnership for Maternal, Newborn and Child Health.

According to the news release, as Ethiopian Minister of Health, Dr Tedros led a comprehensive reform effort of the country's health system, including the expansion of the country's health infrastructure, creating 3,500 health centres and 16,000 health posts; expanded the health workforce by 38,000 health extension workers; and initiated financing mechanisms to expand health insurance coverage.

As Minister of Foreign Affairs, he led the effort to negotiate the Addis Ababa Action Agenda, in which 193 countries committed to the financing necessary to achieve the Sustainable Development Goals.

At a media briefing on Wednesday, Dr Tedros, highlighting his travels all over the world, said that the message that was coming very clearly was of people identifying health as a rights issue.

"Wherever you go, that's true," he said, adding that what the world promised in 1948 - health for all - when the WHO was instituted is true today. But still half of the population does not have access to universal health coverage.

"I think it's time to walk our talk and the whole world is asking for that - health as a rights issue, an end in itself. And also health as a means to development."

"All roads should lead to universal health coverage, and it should be the centre of gravity of our movement," Dr Tedros underlined.

He said that when addressing universal health coverage, it means addressing the financial barrier, addressing the challenge being faced with regards to access to drugs and the barriers to accessing quality of care and diagnosis.

Universal health coverage should be at the centre to address these barriers, he said.

Dr Tedros noted that some countries want to use private (sector services) to achieve universal health coverage, while others use public services only - they don't want to use private services, saying that they don't want to commercialise it.

And yet others use a mix of private and public services. Some countries use the general tax while others use insurance, and yet others use a mix.

"There is no one way or one means of achieving universal health coverage. You see based on the country situation, different ways of achieving universal health coverage. We have to respect that. We don't need to impose on the ways, but at least we need to have a consensus and agree health as a rights issue [by] whatever means you use to achieve that goal."

There are many ways of achieving it, "but we have to agree that health is a rights issue [and] an end in itself. And universal health coverage should be at the centre and it has to be tailored to the needs of the countries," he said.

The other thing that come out clearly during his visits and engagement is the emergency response. There is a new programme but "the issue now is we have to implement it with a sense of urgency."

"But when we implement the emergency response programme with a sense of urgency, it has to be geared towards implementing the International Health Regulations in full," he said, adding that at the end of the day, this has to be the bottom line.

Dr Tedros also highlighted the importance of WHO reform, saying that the reform efforts that had already started by the outgoing leadership should continue. "Also if there are new areas we need to consider, we should."

But one thing that is clear in the reform is that "re-engineering the process is important. And the re-engineered processes, assembling them into systems and then maybe identifying new programmes is important."

And then identifying structures that can support the process and system is also important, he said.

But more importantly, is the alignment in the vision. "Do we have the same understanding? Do we belong to the same vision? And based on the vision, do we have similar priorities?"

At the end of the day it is the mindset that is very important, he said.

"Without the right mindset, whatever processes or programmes you introduce, it doesn't work. It won't. So do we belong to the same vision and do we have the right mindset to address the challenges we're facing," he asked, adding that this is key.

He highlighted the issue of human resources as being central in the reform process. "Do we have motivated staff? What does the leadership do to really inspire and motivate the staff?"

Dr Tedros said that the outcome of the voting was very clear and having the confidence of the majority of the member states gives him legitimacy to really implement the vision that he had outlined.

Asked about the fact that the proposed budget released by the Trump administration on Tuesday had called for deep cuts to funding for some global health agencies as well as in other areas and what effect this would have on funding for the WHO, and whether he would be having talks with the new administration, Dr Tedros said it is really important to move fast in addressing the budget issue.

"When we talk about the budget issue, most of the time we raise the WHO budget only, but that's not the right way of thinking about financing the global health agenda," he said, adding that he always prefers to think about the "bigger envelope" in financing the global health agenda.

He pointed out that it can come through the World Bank, Global Fund, GAVI or others but that should be given more priority. Then under that you can have the finance for WHO, he said, adding that he will help the World Bank, the Global Fund and GAVI to raise funding.

He added that this will be channelled to the countries and "which I believe should be significantly increased."

Dr Tedros also pointed to the need to expand the donor base. He noted that financing is dependent on only the traditional donors. When there is some challenge from the traditional donors, then the shock is serious.

He noted that the fund-raising unit in the WHO is really small, both in terms of the numbers and skill-sets in the unit. "We need to strengthen the capacity of the fund-raising unit in WHO both in terms of numbers of people involved there and also their skills."

He said that he has always seen contribution from the US, which always has a bipartisan position.

He has worked with both Republicans and Democrats and "if we can communicate with them the right way and know how to effectively communicate, I think we can also address that. So, I don't take it as a closed issue and I will continue to engage and use that bipartisan position that I have already experienced while working as Minister of Health in my own country, but also when I was chairing the Global Fund."

Asked about the fact that the proposed cuts to USAID is 32% while that for global health is 17% and dramatic cuts of 20-30% for NIH and other scientific research institutes and whether the notion of basic assessments can be revisited at WHO, Dr Tedros said that if the 32% or 17% cut is said that goes to multilateral organisations, when it comes, a surprise like this is not right.

He said that he is a strong believer that there should be an exit strategy - meaning gradual exit that avoids any shocks because when there is a cut in finance like this, the most affected are the poor.

Most of the money goes to those who need the services and terminating it like that has its ramifications. "And I hope this will be understood before finalising the proposal."

On assessed contributions, he said that the issue is how we regain the confidence of member states and partners in WHO.

He said that assessed contributions should not just be discussed at the World Health Assembly stage and that discussions should start at the regional and sub-regional political organisations.

Asked about the issue of universal health coverage and what his strategy would be vis-a-vis the pharmaceutical companies, Dr Tedros said that one of the barriers is access to drugs, a very important component of universal health coverage, and has to be addressed.

It is not just engagement with the pharmaceutical companies that will bring a solution, there is need for a very comprehensive approach to it.

He noted the recommendations of the UN Secretary-General's High Level Panel report on access to medicines last September. "We can start from there," he said.

"Of course, WHO's role in that assessment was not really strong. WHO's presence should be really felt. And we have to start from the recommendations outlined there and there are some important recommendations in that document."

He said that it should be a comprehensive approach including the engagement of pharmaceutical companies, but at the end of the day, "I think access to drugs should be a very important component of addressing universal health coverage."

Asked if it is appropriate that WHO spends more on travel costs (for example, WHO staff travelling in business class) every year than on major disease programmes such as on AIDS, malaria and tuberculosis, Dr Tedros said that in any organisation, reducing the overhead costs as much as possible is important, so that the savings can be used for programmes.

When it comes to travel costs, it has to be seen in relation to the programme, because any travel expenses or other costs, as long as they can be justified due to the programme, it's fine, he said, adding that if it's not justifiable, it has to be addressed.

Dr Tedros was asked about the fact that most of the countries which are currently having neo-liberal economic policies are neglecting health on a large scale and due to this their health budgets are going down and access to primary health care is dramatically reduced. Dr Tedros has suggested that the WHO should not intervene or interfere in this because he wants this to be left to the member state.

Does he not recognise that there is a responsibility as the head of the WHO to intervene in this debate to say that public health investments have to keep up with the disease burden that is growing in these countries?

Dr Tedros said that if we are going to ask commitment from countries, the commitment should be to the goal. "That's what I have observed by the way throughout the world."

"As long as we agree on the goal, any government agrees on achieving universal health coverage, the means could be private, public or a mix."

There are countries that have a very robust private (sector service) and have achieved a better outcome in terms of universal health coverage.

"So that's why WHO should really advocate for the outcome rather than the means because there are many ways of really achieving universal health coverage."

According to Dr Tedros, the central point is the outcome. "If we agree on the outcome, then the WHO should really advocate."

On public health investment and public health issues, he said the government should actually be responsible for (this). Everything cannot be in private hands.

WHO should really advocate for some of the public health areas or interventions to be entirely done by the government itself, he said. "So we have to differentiate the two so we can do both." +