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AFRO-NETS> WHO DG candidate's views


  • Subject: AFRO-NETS> WHO DG candidate's views
  • From: Claudio Schuftan <aviva@netnam.vn>
  • Date: Thu, 21 Nov 2002 02:06:30 -0500 (EST)




WHO DG candidate's views
------------------------

Equal Opportunities to Health For All

Dr Pascoal Mocumbi's Vision for WHO
Maputo, 14th October 2002

1. Guiding Principles

1.1. Advocacy for Health

Today, Health is one of the most important issues on the global de-
velopment Agenda. It has become an issue for Heads of State and Fi-
nance Ministers, for multilateral financing and development agencies
and global organizations of all kinds - NGOs, universities, corpora-
tions and foundations, thanks, in large part, to WHO's leadership and
advocacy. WHO has gathered the evidence and communicated the message
that the Health of a nation's people is critical to its economic and
social development. WHO has also furthered the understanding of opin-
ion leaders outside the Health Sector that diseases know no bounda-
ries and that the Health of any single nation can be affected by a
health problem that arises in any other.

Achieving this level of global awareness has been difficult and we
must celebrate it. Yet the global disease burden remains high, with
millions continuing to die from curable and/or preventable diseases,
because of poverty and weak Health Systems. Ill health is also a ma-
jor contributor to poverty. The vicious cycle of poverty and ill
health continues to deprive people of their dignity and subjects them
to unnecessary pain and suffering. To break this vicious cycle, the
global community must intervene to achieve broad and powerful im-
provements in World Health and sustainable economic development. As
part of this effort, we at WHO, must deepen our awareness of the
links between poverty and ill health. It is now urgent that we trans-
late this awareness into action so that we can achieve our long-
stated goal of Health for All. This is the main focus of my vision
and will be one of my top priorities as WHO's first leader elected in
the 21st century.

The image of WHO should continue to be promoted and its visibility
should be enhanced so that it can better serve as an advocate for
World Health. We must, however, assure that our image is built on a
strong foundation of expertise and capability. Only thus can we play
our role at global and national level of keeping Health at the top of
the Development Agenda.

1.2. Investment and Partnerships

WHO was created to serve as the source of global Health expertise and
leadership within the UN System. In this role, it serves member coun-
tries and other organizations that concern themselves with Health or
whose actions have Health consequences. To play this role effectively
in a complex world, WHO must, in every initiative, seek appropriate
alliances and mobilize partners for sustained action.

We must continue to set standards and define performance objectives,
so that we can measure our progress and hold ourselves and our part-
ners accountable for reducing inequalities in Health. In this re-
spect, I will emphasize the importance of effectively investing in
Health and of financing Health Systems at appropriate levels. I will
also strongly promote optimal use of available resources for Health.
I believe that this is the way forward, if the Millennium Development
Goals, the Okinawa 2000 Summit Goals and the Goals of the Johannes-
burg Summit Action Plan for the improvement of world Health are to be
achieved.

I will also ensure that WHO will join forces with ALL other partners
(international and multilateral organizations, financing and develop-
ment agencies, governments, public and private institutions, NGOs,
the scientific community, training and research institutions and oth-
ers) to work to combat poverty and hunger, thus improving the Health
of the world's people. There is no doubt that investment in Health is
crucial for development. What is needed now is for us to act on this
knowledge. Governments and financing institutions should begin to
demonstrate their commitment by changing their approach to economic
and development policy at country level. The health of people should
also be at the center of the world trade debates.

WHO has a long experience of successful cooperation with NGOs, par-
ticularly, at HQ level. This partnership should be reinforced and ex-
tended to other levels of the Organization, especially, to the coun-
try level. Together, WHO and NGOs should define common goals and
mechanisms to empower communities in the promotion of their own
Health.

1.3. Commitment to Countries

As we take action on Health at the global level, our effectiveness
will also depend on the degree to which WHO is seen as an organiza-
tion with a knowledgeable voice on Health issues for all the coun-
tries of the world, and one that can, when called upon, mobilize
broad based action to support country efforts to address their own
health priorities. As health minister, foreign minister and, now
prime minister, of a developing country that has put the Health of
its people at the center of its development agenda and maintained
that commitment through a civil war, natural disasters and the chal-
lenges of economic restructuring, I know first hand the importance of
effective partnerships in such a long term effort.

I am convinced that WHO work at the country level is a critical ele-
ment to enhance the visibility and effectiveness that the Organiza-
tion needs to carry out its global mission. While we are not, di-
rectly, an implementing agency, we must play a role in supporting
country efforts to develop their implementation capacity.

I shall therefore develop efforts to strengthen WHO Country Represen-
tations, particularly in those countries with greatest need of tech-
nical support. This process should include dialogue and partnership
with Governments, Regional Directors, WHO staff, other UN Agencies
and other cooperating partners in Health, including NGOs. In so do-
ing, we must build on the positive experiences of other UN and multi-
lateral agencies and NGO's and learn from their successes and fail-
ures.

1.4. A Rights Perspective

While health is critical to the development of nations and societies,
it is also critical to an individual's ability to participate in and
contribute to society, whether it is as a worker, a voter, a member
of a community or a member of a family that can provide for its mem-
bers and raise the next generation of citizens. Women are critical
members of any society and, in too many, their resources and exper-
tise are lost because of a failure to give them equal access to soci-
ety's resources or include them equally in the decision making proc-
ess. This situation must change and I am committed to ensuring that
WHO plays its part to see that it does.

The international community has long accepted the idea that govern-
ments carry the ultimate responsibility to ensure the conditions in
which their people can achieve their full potential for Health. A
right to equal opportunities for health has also been articulated in
international instruments to which many countries have subscribed. I
believe it is critical for WHO to participate in bringing back into
the spotlight the issue of Health as a Human Right and the role of
ethics and bioethics in informing our Health policy making at global
and national level. To move ahead on this agenda, I will work closely
with allied organizations of the UN system and ALL other partners to
build consensus on a "Charter on the Rights to Health".

2. A Framework for Action

2.1. Health for All and Primary Health Care for the 21st Century

I believe that the "Health For All" (HFA) strategy and the Primary
Health Care (PHC) approach should be revitalized and revisited as
needed to reflect the challenges of this new century. While few coun-
tries have achieved the goals articulated in these strategies, much
progress has been made and their value as a framework for action has
been widely accepted. WHO must work with Member States to take stock
of the evidence of successes and failures in this 25-year journey of
implementation, during which many countries have undergone a demo-
graphic and epidemiological transition. Important goals embodied in
the "Health For All" (HFA) strategy such as Universal Coverage and
Equity in access to Health care have, unfortunately, not been
achieved and new efforts in this direction have to be deployed.

This review process must reflect what we have learned about the
broader determinants of Health, including social, economic, cultural,
gender, behavioural, demographic and environmental factors. More spe-
cifically, we must consider the roles of education, nutrition, eco-
nomic status, the nature of work, racism and community cohesiveness
in determining Health Status. Within Health Systems, we should look
anew at how to develop an integrated approach to Health care delivery
and referral systems. Of utmost importance will be to revisit the
role of WHO and its organizational structures vis-a-vis the HFA
strategy and PHC approach.

In my own experience, the HFA strategy and the PHC approach have the
potential to empower communities. When coupled with the synergies
produced by intersectoral cooperation, they can bring about a new dy-
namism to promote and advance Health Development in all nations in
the world, both rich and poor.

In this context, I commit myself to organize a Global Forum for con-
sultation involving ALL partners to create a shared vision of a HFA
strategy and the PHC approach for the 21st century.

2.2. Evidence for Action: Health Research

I believe that action for Health Development must be based on scien-
tific evidence to create a neutral ground for international coopera-
tion among Member States, and to allow informed debate within WHO and
on health priorities within countries. In my long managerial experi-
ence, I have always strived to start with evidence and work to gener-
ate consensus when possible or to identify a way forward that is com-
patible with divergent interests. If elected to lead WHO, I firmly
commit myself to continue to do so. By creating neutral ground,
Health can act as a bridge for peace in conflict and Health develop-
ment can play an important role to consolidate World Peace.

I will pay special attention to Health research that informs policy
to guide the development of Health Systems and provides important in-
formation for implementation on the ground. Health research cannot
neglect the health problems of the poor and needs to pay greater at-
tention to the broader determinants of Health. WHO should ensure that
Health research is intensified in the areas of genetic disorders,
chronic and degenerative diseases and traditional medicine.

WHO has a good record in promoting and mobilizing expert knowledge,
skills and resources to tackle various health and biomedical problems
both directly by its own staff and through partnerships with collabo-
rating centers and experts worldwide. It is also in a position to
identify best practices by countries in a variety of areas. Through-
out the years, WHO has been a scientific reference and depository of
scientific knowledge in different fields of Health. This wealth of
information and knowledge should be made easily available and be
widely disseminated. I make a strong commitment to analyze con-
straints to this dissemination and devise new improved ways to work
in partnerships with academic and research institutions and the pri-
vate sector to ensure that this precious scientific information is
easily available to those who need it, anywhere in the world.

WHO must also commit itself to the development of capacity in coun-
tries who lack it to conduct research and collect and analyze impor-
tant Health data that can be used as evidence to improve the Health
of their people. Partnerships with Member Countries enjoying scien-
tific strength will be an important vehicle for such efforts.

2.3. Human Resources for Action

A critical issue for most Health systems in the world relates to hu-
man resources for Health. Without balanced, motivated and qualified
health teams, Health objectives can be put at risk. WHO has been
playing a critical role in promoting and facilitating development of
human resources for Health in Member States, particularly in the de-
veloping world. I believe that this effort should be sustained and
expanded.

3. Addressing Priority Health Problems

3.1. Principal Health Challenges

The world still faces enormous health challenges. Many affect all
countries - HIV/AIDS, TB, mental health problems, intentional and un-
intentional injuries and the increasing burden of chronic and non-
communicable disease. Making health systems more effective and fairer
is a challenge for all governments.

To take one example, HIV/AIDS has changed the pattern of life in many
countries, with serious implications for developmental strategies. It
is of paramount urgency to tackle this universal scourge. We need to
ensure that the agreed commitments from the special session of UN
General Assembly on HIV/AIDS are met. Much has been achieved within
the UNAIDS framework, particularly in advocacy and building awareness
regarding the gravity of the situation. As the UN specialized agency
on Health matters, WHO will continue to work with UNAIDS to ensure
effective advocacy for adequate investment of global resources to
tackle HIV/AIDS. Together, we must guarantee that proper support is
provided to countries to design and implement their action programs
on HIV/AIDS.

Other diseases are less geographically widespread, but no less seri-
ous. Malaria, Schistosomiasis, Leprosy, Dengue, Chagas' Disease and
many communicable diseases still continue to constitute major health
problems to considerable sectors of humanity, particularly in low-
income countries, as do high maternal and peri-natal mortality. Of-
ten, these diseases are associated with poverty and lack of access to
promotive and preventive measures, pharmaceuticals and appropriate
health care. Renewed efforts are needed to help countries face and
overcome these challenges to Health. The Essential Drugs Policy
adopted by the WHA in 1978 and the Action Program on Essential Drugs
created the following year, are important tools for addressing these
challenges. Progress has been made, but more work needs to be done.
We must sit together with ALL concerned parties (UN and multilateral
agencies, Governments, Development and financing institutions, the
pharmaceutical industry, the scientific community, NGO's and other
public and private interested parties) to review the experience of
the past 25 years, recent international agreements and the Doha Dec-
laration, respecting each others concerns and reaching a better un-
derstanding, so as to generate a new impetus and create conditions
for further innovation and success.

WHO must provide a clear picture to the world of the nature of these
challenges and the evidence for interventions that work; it should
help to mobilize the resources to address them globally, in regions
and in countries. Sometimes, it will have both the expertise and re-
sources to work directly with Member States to implement necessary
programs. At other times, work will be done with partners or by
stimulating the action of other organizations better suited to play a
role in preventing a disease or promoting and protecting health. We
also face finite resources and our priority setting must involve dia-
logue with Member States and interested parties about the nature of
the problems, the feasibility and effectiveness of action and who can
take it. But, in whatever strategy chosen, WHO is responsible for as-
suring that progress is made towards our goal of Health For All.

3.2. Preventable Diseases: A Burden to Humanity

The disease burden in the world is still high despite improvements in
life expectancy and in the infant mortality rate in the last 50
years. Disparities in the distribution of the disease burden across
social strata and regions are glaring. For a number of diseases,
mainly communicable, we now have the knowledge and technological
means to prevent them, but they still heavily contribute to the total
burden of disease. We cannot be indifferent to this situation and
miss the opportunities for change. I commit myself to develop a dy-
namic special initiative, with the involvement of interested part-
ners, to make measurable progress in reducing the incidence and
prevalence of priority preventable diseases. We must select those
diseases that represent a high burden, but can be prevented or eradi-
cated by known technologies. If these technologies have not yet been
applied or are not yet affordable, we must work with the right groups
of stakeholders, committed to this initiative, to develop innovative
and bold approaches to achieve our goals.

3.3. Meeting Women's Priority Health Needs

There is no doubt that the health of women, especially the most vul-
nerable and disadvantaged, is an area of great concern. Despite the
rapid technological advances that have been made and the knowledge on
women's health that is now available, women continue to suffer from
preventable morbidity and mortality. While there have been improve-
ments, especially in terms of the physical quality of health indica-
tors, the health status of women remains precarious and in some in-
stances, is even worsening. There is evidence of the unacceptable in-
equities that exist in women's health, the limited choices that are
made available to women and finally, the lack of accountability for
their health. We must take bold steps to rectify this situation and
make available health care programmes that address their specific
needs, using a life span perspective as well as a holistic approach.

3.4. Behavioural Change and Health Promotion

Scientific evidence is accumulating regarding the crucial role of be-
havioural change (in relation to nutrition, sexual behaviour, control
of tobacco and alcohol use, prevention of drug abuse and promotion of
physical exercise, just to mention a few) for human health improve-
ment. Therefore, I will bring Health Promotion to the forefront of
WHO's overall approach to health problem solving and ensure that due
attention is paid to it as part of all of our initiatives. WHO shall
strengthen its capacity to provide appropriate technical support to
Member States in this area.

3.5. Environmental Issues as Determinants of Human Health

For the last 25 years, the importance of the environment as an essen-
tial determinant of Human Health has become increasingly obvious. Af-
ter the Rio Conference in 1992, a WHO special commission collected
the evidence available at the time. The recent Johannesburg Summit
reemphasized the interconnection among Environment, Sustainable De-
velopment and Human Health. Therefore, I state my commitment to renew
our efforts to tackle this crucial priority for Human Health.

3.6. Ageing: A Challenge for Health Systems

In the last three decades, there has been a growing acknowledgement
of the importance of ageing as a challenge for Health Systems. The
problem, which was initially restricted to the developed industrial-
ized countries, has now become of concern to an increasing number of
countries and will very soon become a global concern. WHO has taken
initiatives to help countries focus on this critical issue and these
efforts must be expanded, involving other partners, with WHO playing
a leading role.

3.7. Natural and Man Made Disasters as Barriers to Health

Famines, droughts, floods, mass movements of population and situa-
tions of conflict and war, as well as the threat of terrorism, are
examples of potential health disasters as well as political and de-
velopmental disasters. By improved monitoring of worsening health
conditions WHO and governments can give early warning of impending
disasters. WHO will need to become more active in raising awareness
of the health impacts of these events and assure that appropriate
health action is included in international strategies to prevent and
respond to these threats. There is considerable expertise throughout
the world that WHO can help bring to bear on the planning by interna-
tional agencies and nations to prepare for such events.

In response to disasters, WHO should develop greater capacity for
rapid intervention with a minimum of bureaucratic delays. WHO is also
in a unique position to affirm the value of human life and Health
across the lines of conflict.

4. Managing for Results

4.1 WHO Staff

At the core of WHO's ability to play its role as the source of global
Health expertise is the excellence of its professional and support
staff. It must attract the best and brightest from around the world
and create the organizational environment and culture in which they
can fully contribute their expertise and very diverse experience to
the complex problems that must be solved. They must be able to work
effectively across traditional organizational boundaries both within
WHO and with critical external partners in Health. These fine women
and men must also have the opportunity to grow within our organiza-
tion -- grow in knowledge, experience, and have a clear and transpar-
ent path to career advancement.

One of my highest priorities will be to ensure that WHO staff are
recognized, supported and respected for their quality and for their
commitment to our important work. Staff recruitment procedures and
methods will be analyzed, in order to guarantee high technical and
scientific standards, without any need to question the established
principle of geographic quotas. Competent individuals are available
from all around the world and WHO must, therefore, strengthen its
ability to identify staff and expert advisors from well-known and
less well-known pools of talent.

It is critical that we ensure an equal representation of women at all
staff levels and among our external advisors.

Very special attention will be given to the appropriate selection and
training of WHO Country Representatives.

I will also pay special attention to staff development activities and
new staff development opportunities will be created.

WHO, has, in the recent past, undergone a considerable restructuring
process. Time is necessary to consolidate these changes and to stabi-
lize the new working relationships brought about by the restructuring
process. The main thrust of my management and leadership will be
characterized by the adoption of modern, democratic and results ori-
ented managerial methods, based on evidence. In so doing, I will al-
ways seek dialogue with interested parties in the decision making
process. I will pay particular attention to listening to the staff
and will take in consideration their views and suggestions.

High priority will be given to the improvement of the managerial and
organizational mechanisms within WHO. Especially, I will consider
ways and means to reduce bureaucracy, transaction costs and potential
efficiency losses between Headquarters, Regions and Country level.

4.2. Our Regional Structure

WHO can only be effective as a global organization and for our Member
States, if the staff in Brazzaville, Cairo, Copenhagen, Geneva, Ha-
rare, Manila, New Delhi, Washington DC and in WHO Country Representa-
tions see themselves as part of a single Organization whose goal is
World Health. This goal can only be achieved if individuals, organi-
zations and governments around the world work effectively with WHO to
develop strategies suited to their own regional and country environ-
ments. WHO's structure must reflect this interdependence within our
own Organization, and the Regional Directors will be part of my core
executive team.

4.3. Networks of Expertise

One key to our future success will be our continued ability to bring
together the best experts in a given field from around the world to
deliberate and set standards that countries and other multilateral
organizations can use to guide their work. This is our normative
function and it is fundamental to our role. This ability to tap the
best expertise through our Collaborating Centers, our Member States,
our partners and the individual and organizational networks of our
staff worldwide must be maintained and strengthened.

As countries join international initiatives to address critical
health challenges, we must use our expert networks, partnerships with
other agencies, NGO's, corporations and relationships with govern-
ments to support them. Action plans must include the creation of sus-
tainable capacity to enable countries to continue their progress in
the implementation of these initiatives.

Working together, we will find the best ways of providing tailor-made
technical cooperation to achieve sustainable national Health policy
goals and to draw on the experience of individual countries to build
a wealth of Health knowledge that can benefit the rest of the world.
Through our standard setting and normative work, and our access to
worldwide networks of experts, we can ensure the quality and effec-
tiveness of global actions for Health. With these powerful tools, we
can equally inspire further commitment to a renewed WHO to face the
challenges of the 21st century.

TOGETHER, WE CAN MAKE THIS VISION A REALITY

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