Tedros Adhanom Ghebreyesus, director-general of the World Health Organisation (WHO), is serving his last few months in the post, and the Geneva-based organisation is set to enter the job market to fill the role. A call for nominations is expected soon.
This is not just another ordinary election; it is an election to select the next chief of the world’s largest global health organisation. The nomination process is set to attract a lot of interest from professionals in the field, ranging from ministers responsible for health in their respective countries to individuals now serving in other UN agencies, including the WHO itself.
While everyone awaits with great anticipation the revelation of the list of potential candidates, we believe the next candidate should be able to navigate several hurdles in an ever-changing geopolitical climate as well as lead institutional reforms urgently to ensure global health security.
The WHO came into existence on April 7 1948. It is one of the specialised agencies of the UN and boasts 192 member states, although the US and Argentina recently commenced the process of leaving the organisation. The only UN member state to have never been part of this global health agency is the tiny central European principality of Liechtenstein.
The main objective of the WHO, as stipulated on its website, is to “promote health, keep the world safe, and serve the vulnerable”.
“Our goal is to ensure that 1-billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.”
However, the organisation has faced numerous challenges achieving these objectives, including an overstretched budget and an unconducive and uncertain geopolitical climate.
The WHO is led by a director-general who is the chief technical and administrative officer. He is supported by an executive committee comprising an executive director of the WHO Health Emergencies Programme, a chief scientist, a chef de cabinet and three assistant directors-general who each have a distinct role.
Besides the headquarters in Geneva, WHO member states are grouped into six regions, each of which has its own regional office.
WHO and its operations in a global order in polycrisis
At the time of its establishment — and subsequently its first World Health Assembly meeting in 1948, which established as priorities addressing diseases such as malaria and tuberculosis as well as maternal and child health and nutrition — the organisation had a budget of $5m. It is worth noting that the global order at the time of the founding of the WHO was vastly different to the present day.
In 1948 the world was going through a post-war reconstruction period and increased globalisation. Now, the international rules-based order has been fractured and this has had a direct impact on the WHO and its operations. One such example is the US, one of the WHO’s largest donors, pulling out of the organisation. At present the organisation has several challenges, including that of a strained fiscal purse and political bias.
The Covid-19 pandemic and the response from the WHO exposed weaknesses in global health governance. The WHO was accused by various quarters during the pandemic of delayed action and poor communication, of vaccine equity and governance limitations. While the criticisms are valid, we argue as well that some critics of the WHO’s response to the pandemic fail to understand how the organisation carries out its operations and the limitations it faces set by its own member states.
The Covid-19 pandemic and the response from the WHO exposed weaknesses in global health governance.
For example, the limited autonomy placed on the WHO secretariat hamstrings the organisation’s ability to respond rapidly to public health emergencies, epidemics and pandemics.
So, what does an ideal director-general of the WHO look like? As highlighted above, the purpose of the article is not to pinpoint which specific prospective individual should be chosen but to highlight what character traits the next director-general should possess. We are of the view that the next director-general should be female.
Out of the eight former directors-general in the history of the organisation only two have been women. This stands in stark contrast to available data by the National Health Workforce Accounts, which says women comprise 67.2% of the health workforce globally but occupy only 25% of senior roles.
Leaving women, who make up majority of the healthcare force, out of healthcare leadership will only lead to worse health outcomes. Women are constantly denied their rightful place in several fields, including medicine/public health, and this trajectory needs to end. In Africa, only one woman (Dr Matshidiso Moeti) has been a WHO regional director, compared with six men.
The ideal WHO chief should possess the necessary skills to navigate the fractured international rules-based order, push for fiscal reform and transparency in the organisation. The ideal candidate should not only posses a track record in public health or medicine but should also be a strong administrator. This is essential given that the organisation faces mounting political pressure from certain countries to act in a certain manner.
The ideal candidate should be able to champion the voice of the Global South in the global health governance architecture and notably lead the reforms needed. Is it fair that Africa, which carries a disproportionate burden of disease, has limited involvement in global health governance, for various reasons.
The ideal WHO chief needs to champion vaccine equity without any preconditions. The hoarding of vaccines, or vaccine nationalism, we saw during the Covid-19 pandemic should never be repeated.
For many low- to middle-income countries the WHO plays an important role in ensuring they have scientific and technical support to achieve their goals. The next director-general must be able and willing to steer the institution through this turbulent period where the multilateral order is being stretched to its limit every day.
• Dr Makgana is CEO at Chris Hani Baragwanath Hospital and Kadima a lecturer at Wits Business School. They write in their personal capacities.
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