AFRO-NETS> Open Letter to African Members of the WHO Executive Board - Appointment of a New DG

[Dare Lola <chestrad@yahoo.com>]

Open Letter to African Members of the WHO Executive Board - Appointment of a New DG
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In 1998, the Executive Board of WHO met and appointed a Director Gen-
eral. At the time of this appointment, WHO was beset with a number of 
challenges. The organization was described as a place 'where ideas go 
to die' and 'the epitome of sclerotic UN bureaucracy' at a time when 
global health was at cross roads. Dr. Gro Harlem Brundtland has done 
so much to reverse this negative global image of WHO and so many new 
initiatives have come out of the once perceived sclerotic organiza-
tion. Once again, it is time for the Executive Board to recommend a 
Director General to the World Health Assembly. 

The terrain of global health has even more actors than it had in 
1998. Africa's ill health, its vicious relationship to poverty and 
poor socio-economic development pose a threat to global health. The 
recently published work of the Commission of Macroeconomics and 
Health [CMH] has provided links to show that health is not only a 
public good, but an economic asset. The idea that the health of every 
nation depends on the health of all others is an epidemiological 
fact. In addition, the terrorist attack of September 11 has height-
ened acceptance that global systems that promote equity and social 
justice are required in the efforts to assure peace and security in a 
rapidly changing world. 

The out-going Director-General in her acceptance speech stated: 

'What is our key mission? I see WHO's role as being the moral voice 
and the technical leader in improving the health of the people of the 
world. Ready and able to give advice on key issues that can unleash 
development and alleviate suffering. I see our purpose to be combat-
ing disease and ill health - promoting sustainable health and equita-
ble health systems in all countries'.

The failure of the public sector in most member states of WHO to de-
liver basic services to its people has occasioned the growth of Pub-
lic-Private-Partnerships [PPPs] to address the unabating scourge of 
disease in Less Developed Countries [LDC], most of whom are in Sub-
Saharan Africa [SSA]. That Africa has achieved limited success in re-
ducing mortality, morbidity and increasing life expectancy is widely 
touted. It is further recognized that that the highest burden of pre-
ventable diseases still challenge the African continent. In addition, 
there is a global focus not only on health improvements but also on 
its relationship to poverty reduction and overall socio-economic de-
velopment of all nations of the world. And as it would appear that 
both poverty and ill health have an African face, the beacon light of 
global health must turn to Africa. 

Dr. Gro Brundtland has been very successful at improving the image 
and relevance of WHO at the global level and has to a large extent 
kept faith with this vision. Her tenure has seen the blossoming of 
many Public-Private-Partnerships for health that have focused on the 
major disease burdens in Africa. Major summits have been held by Af-
rican leaders, with support from global partners to advocate for in-
creased investments in these diseases including the development of 
new drugs and technologies to respond them. PPPs and funds have been 
established for the Roll Back Malaria Initiative [RBM], Global Polio 
Eradication Initiative [GPEI], Global Fund for HIV/AIDS, Tuberculosis 
and Malaria [GFATM], the International Trachoma Initiative [ITI], 
Global Alliance for Vaccines and Immunization [GAVI], the African 
Program for the Control of Onchocerciasis [APOC], Stop TB etc. Part-
nerships have become the in thing and it would appear that for every 
major disease, there is a global alliance or partnership. 

These PPPs have mobilized significant levels of resource. It is esti-
mated that US$ 10 billion dollars are required by the Global Fund an-
nually to combat only 3 diseases (Malaria, Tuberculosis and HIV), US$ 
1.2 billion has been committed by Global Alliance for Vaccines and 
Immunization [GAVI] to immunization and there is a US$ 12 billion 
Monterrey dividend. The resources mobilized by these PPPs exclude 
loans from the Bretton Woods institutions and other development 
Banks, support from the annual budget of the various agencies of the 
United Nations, additional aid provided by bilateral partners, count-
less charitable donations from foundations, charities and other pri-
vate voluntary organizations and the budgetary allocation of African 
governments to health and related sectors. If these sums are added 
and related to the minimum investment of US$ 34 per capita proposed 
by the Commission on Macroeconomics and Health as required to reverse 
the downward spiral of ill health and poverty of Africa's 700 million 
people, it would appear that the annual sum of US$ 23.8 billion dol-
lars required to move Africa forward is currently available. 

However, in spite of the immense amount of resources mobilized by 
these PPPs, disease burdens in Africa remain unchanged. Furthermore, 
there is no coordinated effort, partnership or fund to strengthen 
health and other development systems to deliver the interventions of 
known benefits, and the expanding array of new tools, technologies 
and innovations to African people and households. In a recent analy-
sis by the World Bank, it is reported that if current trends persist, 
no African country will achieve any of the mid decade goals, and in 
fact levels are still continuing on the downward trend 

African governments and their partners require to take stock of these 
investments and their failure to achieve significant impact in Africa 
as they consider the appointment of the new Director-General for the 
institution whose main purpose is 'combating disease and ill health - 
promoting sustainable health and equitable health systems in all 
countries' and charged with the maintenance of standards and norms of 
global health. 

Are financial inflows truly inadequate or are they inequitably allo-
cated? Are resources pledged by global partners but not committed 
timely? How can accountability for these resources be improved and 
made bi-directional, requiring both the partner and beneficiaries to 
make good pledges made? Are committed funds being directed to global 
partnerships and institutions with procedures too cumbersome for Af-
rican systems to access them given the current lack of human re-
sources (numbers, skills and mix) and health infrastructure? Are 
these disease focused global partnerships further draining human re-
source and fragmenting African health and developments systems that 
are known to be weak and fragile? The questions are many, but they 
should be at the fore in the work of the new Director-General, who 
may not be African but must have Africa as a key agenda. 

Sub-Saharan Africa represents the largest pool of health and poverty 
problems in the world. The reversal of the downward spiral of ill 
health and poverty in Africa is the singular challenge of the decade 
and of the new DG of the world's leading health institution, the 
World Health Organization. This new DG requires political skills and 
determination to address the underlying political, economic and so-
cial determinants of the vicious cycle between ill health, poverty 
and poor socio-economic development in Africa. The DG also requires 
leadership skills to coordinate the global health for the benefit of 
Africa with so many actors, stakeholders and indeed leaders.

It is in this regard that we request that the African member States 
of the Executive Board give very careful consideration to their sup-
port for a candidate for this position taking note of the high stake 
Africa has in the choice of a new DG. To assist and guide them in 
this task we request that they consider these questions for the can-
didates as they lobby African countries for their support and vote.

The Questions

How will the new Director General:
1. Not only increase investments in African priority diseases by 
Global PPPs but also make African PPPs e.g. NEPAD effective in re-
versing these dismal trends?

2. Coordinate all of these global PPPs to increase the effectiveness 
of resource mobilized?

3. Assure that global PPPs strengthen African health and development 
systems?

4. Assure that human resource is continually built and retained; and 
that the needed health infrastructure developed?

5. Mobilize resources to generate evidence that will identify path-
ways between strengthened health systems and improved health out-
comes?

6. Operationally link poverty and health initiatives, even at the 
very local levels?

7. Agencies of the United Nations (UN) of WHO is a part of are also 
engaged in various PPPs for health. These have changed the global 
landscape for health and challenges WHO's leadership of health. It 
limits WHO's ability to set standards and norms of care, particularly 
at country level. This has fragmented African health institutions and 
made coordination of service delivery and disease control efforts a 
nightmare. What will the DG do to assure that WHO effectively leads 
and coordinates activities in health, not just on paper but in real-
ity?

8. Is the current structure of WHO still appropriate to provide/give 
advise on key issues that will strengthen African health systems, and 
improve their performance? Or will the institution merely assess, 
score, rank and judge the performance of the health systems of its 
member states? 

9. What about inter-sectoral coordination? How will the DG assist Af-
rican governments to effectively integrate health and its related ac-
tions across all sectors, making it relevant to African political and 
economic integration?

10. Regional and Country Offices of the World Health Organization 
need urgent attention as they are the interface between global ac-
tivities and African governments. The multiplicity of players in the 
health sector mean that they are often unable to lead health sector 
reform and systems development and are ineffective in coordinating 
service delivery. The mandate of WHO to work only with, or through 
public sector authorities further restricts the ability of country 
offices to effectively harness and engage all skills/institutions 
available in country. What actions will the DG put in place to 
strengthen the regional and country offices of WHO to lead and coor-
dinate health systems development and service delivery activities, 
particularly at country levels?

Dr. Lola Dare
Executive Secretary
African Council for Sustainable Health Development [ACOSHED]
Abuja, Nigeria
mailto:chestrad@yahoo.com

23rd November 2002

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