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BMJ No 7124 Volume 316
News Saturday 3 January 1998
WHO Special Report
WHO leadership candidate: Dr Aref Batayneh
BMJ analysis
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Dr Arif Batayneh (64), has been Jordan's minister of health since
1991. |
Replies to BMJ questions
What do you see as the major health challenges of the next five
years, and how should the WHO address them?
New emerging diseases and problems resulting from a lack of equity
created by the disparity in distribution of income within and
among countries will constitute a major challenge. The continuously
increasing cost of health services and health technology - which
may be prohibitive for some countries - will also add to these
challenges. The increasing occurrence of manmade and natural disasters;
the degradation taking place in the environment; and the negative
lifestyles, such as smoking, drug addiction, and violence, especially
against women and children, will continue to constitute a major
challenge for all health institutions and professionals.
A special think tank at the WHO's headquarters and regional offices
should use the available staff, expertise, and resources within
the WHO to monitor, analyse, and react to challenges. The WHO
should be able to assume a normative role as well as helping disadvantaged
countries build their health service infrastructure. The WHO should
take action in cooperation with member states to increase its
resources to monitor and reduce the negative effects of all these
challenges.
Should the WHO be addressing the effects of socioeconomic factors
on health, and if so, how?
The answer is yes, because health is directly affected by socioeconomic
factors. It is part of the definition of health that a healthy
person will have to have social, psychological, and physical wellbeing
and have a productive life. Historically, it was possible to reduce
the incidence of infectious diseases and tuberculosis long before
the introduction of antibiotics. Also, the reduction in infant
mortality is an example of the interaction of socioeconomic factors
and therapeutic measures. The role of medical interventions was
minimal compared with, for example, improvements in feeding, housing,
and sanitation. The WHO should improve its efficiency and be a
coordinator with other United Nations agencies, non-governmental
organisations, and governments whenever an action pertaining to
health is addressed. However, in certain instances the WHO needs
to support institutional capacity building to disadvantaged countries
and communities. The WHO can contribute to better health through
establishing a democratic participatory approach whereby people
will decide their health needs and work to address them, and through
ensuring that all health plans are fully integrated and in harmony
with socioeconomic development plans. The WHO can pilot projects
that have both a health and socioeconomic impact, such as the
healthy villages programmes. This experience can be disseminated,
and countries can incorporate it eventually in their plans.
How should the WHO's activities best reflect the long term needs
of individual countries rather than short term interests of donors?
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Strengthen countries' abilities to perform national needs assessment
and prioritise and develop clear objectives and targets |
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Encourage the countries to invest in meeting their targets and
accept such support that will fall in line with their plans |
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Orient international donors with the WHO's policies and strategies
and work to develop an international understanding in a form of
a code of ethics that will guide donors to support countries'
priorities |
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Study, investigate, and address the reasons that certain donors
have preferences for predetermined areas |
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Encourage investment, within countries and among donors, in sustainable
development, including appropriate staffing and technology; and
promote long term planning. |
Do you think constitutional reform of the WHO is needed, and what
would you like to see changed?
Although the WHO's present constitution has proved its validity
for almost half a century, I think that its validity should be
investigated with a view to accommodating the principles of cost
containment and cost efficiency. The WHO's constitution should
permit the recruitment of the best skills worldwide.
How should the WHO respond to the current domination of international
health by the World Bank?
I do not agree that the World Bank is dominating international
health. The WHO should lead a normative role and limit its role
in institutional capacity building to few situations and countries.
The World Bank is a financing body helping countries to build
their basic minimal institutional capacities, contain the escalating
cost, and economise on the use of high technology. This is in
line with rational growth of healthcare systems. However, negative
effects for recipient countries are inevitable. In such instances
mechanisms to shield the poor, who are susceptible to such adverse
effects, should be perceived and instituted. The WHO should encourage
the World Bank to invest in health in accordance with people's
needs. Health is too complex an issue to be claimed by one sector
or agency; what is needed is an international harmonious partnership.
Over the past 10 years, the WHO has suffered a collapse of international
prestige and internal morale. How would you restore faith in the
WHO?
The WHO's image and prestige can be restored by taking positive
and effective actions to meet deficiencies in areas of advocacy,
management, public relations, and international and interagency
cooperation. Financial credibility, leadership, and constitutional
changes that ensure the recruitment of suitable, knowledgeable,
and skilled staff are among the elements that need to be addressed
to restore the WHO's image. The WHO should analyse all criticism
and negative information related to the agency and address each
one of them. The WHO's budget should not be influenced by fluctuations
in political climates, thus giving its projects the needed sustainability
and credibility.
Why are you the best person for the job?
Nobody has the right to claim that he is the best for a certain
job. In this situation it will be unfair to the other candidates
if I claim that I know all their potentials, abilities, and plans.
However, I know myself, and I have clarity of mind and objectives.
If I am elected as director general of the WHO, I will put in
all my best, and use the best of others by inviting their contributions
and collaboration.
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