New WHO Director Tedros--Time for Change at WHO

Becky McCall, MSc

Disclosures

July 25, 2017

A Far-Reaching Sphere of Influence

Dr Tedros has experience in some of the world's foremost health organizations, including as chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, chair of the Roll Back Malaria (RBM) Partnership Board, and co-chair of the Board of the Partnership for Maternal, Newborn & Child Health.

An election game-changer may have been his achievements in his native Ethiopia, where as minister of health he led a comprehensive reform of the country's health system, including a significant expansion of the national health infrastructure, and initiated financing mechanisms for expanded health insurance coverage.

"This strong and successful background within politics signals a cultural change for the WHO."

This strong and successful background within politics signals a cultural change for the WHO. Dr Tedros's attendance at the G20 was a first for a director-general of WHO, where previously the organization held a place on the sidelines.

In the recent G20 Leaders' Declaration, he highlighted that universal health coverage (UHC) [whereby everyone in the world is guaranteed access to basic healthcare, regardless of location or economic status] and health security are two sides of the same coin, noting that this year, 400 million people around the world—mostly poor women and children—remain without access to healthcare. The communiqué also covers the need for stronger health systems, emergency response, and strategies to combat antimicrobial resistance.

"Strong health systems will not only be our best defense but will also be critical for attaining the [sustainable development goals]," he said. "Now the issue is how to make the best use of this political will, opportunity, and support, as expressed at the G20, in order to meet our objectives."

Prof Piot pointed out that achieving global health required action from each individual country, and asked Dr Tedros how he would ensure that this approach was adopted, given that some countries (such as the United States) appeared to be moving backwards in this respect.

Prof Piot (left) in conversation with Dr Tedros.

"WHO should lead both technically and politically," Dr Tedros pointed out. "One of the political issues should be universal health coverage, and WHO should advocate this as a rights issue and an end in itself. But also, universal health coverage is a means to development that can bring prosperity to society. This is the center of gravity for me and I want to focus my resources there."

Speaking from the audience, former LSHTM director, Sir Andy Haines, MD, commented that internally in WHO there was often a disconnect between disease-specific programs and cross-cutting programs like health systems and environment. "Will your reforms address these disconnects? Also, externally, how will you ensure that health is at the center of the [sustainable development goals] and play a role across the UN and World Bank?" he asked.

Dr Tedros acknowledged the disconnect that Prof Haines referred to, stressing the need to understand not only how the whole system works but also how the parts within the system affect each other. "People are busy in their own silos and this is dangerous for our organization, because by not working together we lose the synergy that is gained through joint working. But also, what one department does can actually undermine what another is trying to achieve, and this undermines the whole organization. This has to be addressed."

He continued, "We cannot discuss harmonization at a regional level until we deal with the headquarters level first—we sit next to each other but we don't talk to each other!"

Editor's Note: This article is based on a private talk given by Dr Tedros Adhanom Ghebreyesus to staff and students at the London School of Hygiene & Tropical Medicine on July 10, 2017.

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