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BMJ No 7124 Volume 316
News Saturday 3 January 1998
WHO Special Report
WHO leadership candidate: Dr Ebrahim SambaBMJ analysis
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Dr Ebrahim Samba (66) was born in the Gambia. He is the former
head of the widely acclaimed Onchocerciasis Control Programme
and has been the WHO's regional director for Africa since 1995.
In the past two years, he is reported to have lead the region
away from ineffective bureaucracy and petty corruption and to
have reinvigorated the region's staff and finances. His chances
of becoming director general are likely to be lessened by the
recent appointment of three other Africans as heads of major international
organisations. Of the four WHO insiders, he offers the greatest
chance of reform. |
Response to BMJ questions
What do you see as the major health challenges of the next five
years, and how should the WHO address them?
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Economic: because of the unfavourable economic climate fewer resources
are being allocated to health by the national and international
communities. Poverty is increasing in the developing world, especially
in Africa. The gap between the rich and the poor is widening.
With globalisation of the world economy the poor are at a disadvantage.
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Political: political will is always positive, but it is rarely
matched with concrete action. Political instability and civil
wars result in millions of refugees and displaced persons, with
attendant ill health, disability, and death.
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Technical: tools and the means for controlling emerging and re-emerging
diseases such as AIDS, ebola disease, malaria, and tuberculosis
are lacking. We have to pay special attention to the health implications
of some technologies in industry and agriculture.
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Environmental: adverse environmental changes are causing floods,
drought, and variations in epidemiology patterns of infectious
diseases such as malaria, trypanosomiasis, yellow fever, and meningitis.
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Behavioural: lifestyle factors, such as smoking, alcohol consumption,
use of harmful drugs, and obesity also represent an important
health challenge.
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The above are not exhaustive. The WHO should address them through
the director general, who should take the lead and make contacts
at the highest level with, for example, governments, United Nations
agencies, and non-governmental organisations (NGOs) to form active
partnerships. No single agency can do it. Equity and social justice
in health should be prominent in the agenda.
Should the WHO address the effects of socioeconomic factors on
health, and if so, how?
The answer is definitely yes. The WHO should have sociologists
and economists in decision making positions. Secondly, the WHO
should collaborate closely with agencies that have special competence
to address socioeconomic factors influencing health.
How should the WHO's activities best reflect the long term needs
of individual countries rather than the short term interests of
donors?
This should be done by closer collaboration. Working with the
countries concerned, the WHO should help to prepare long term
plans based on realistic situation analysis, feasibility studies,
and sustainable budgets. The countries should be in the driving
seat. The countries must be encouraged to own their programmes.
It is advisable to have many donors rather than one dominant donor.
The WHO should encourage the countries to take the initiative
and contribute to the funding. WHO should help the countries to
train the appropriate staff to take the lead role.
Do you think constitutional reform of the WHO is needed, and what
would you like to see changed?
Constitutional review should be done at regular intervals and
reform be undertaken where necessary. The following should be
changed:
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Method of selection of the director general and regional directors; |
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Country contributions to the regular budget;
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Distribution of the regional budget to the countries;
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A broader partnership in health should be institutionalised to
involve NGOs and "civil society" in the work of the WHO.
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How should the WHO respond to the current domination of international
health by the World Bank?
It should respond by requesting a high level meeting of the UN
and Bretton Woods system with a view to defining the roles of
the agencies. Currently there is a great deal of competition,
duplication, and waste. Since the World Bank has much more money
than any other agency, it dominates the show. The WHO should also
perform better. Both sides have made mistakes in the past--the
World Bank by being aggressive and paternalistic because they
are so powerful and the WHO by being bureaucratic and poor in
resources. It is possible to bring together the WHO's technical
competence and the World Bank's financial resources. This happened
in the onchocerciasis control programme that I directed from 1980
to 1994. The result has been very successful. This is also the
spirit of the UN's special Initiative for Africa (of health sector
reforms).
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 best staff should be recruited by respecting sex and geographical
distribution, with competence as the dominant criteria. Management
should be transparent and professional. The WHO cannot do everything;
priorities, therefore, should be set and respected. Proper plans
and strategies should be prepared. Implementation should be rigorous,
with regular monitoring and evaluation. Evaluation, both internal
and external, should occur at regular intervals. Following results
of the evaluation, reforms should be done as necessary. Partnership
should be developed with NGOs as appropriate. Member states should
be encouraged to respect their obligations and pay the financial
contributions regularly and on time. The "regular budget" should
be allocated to countries according to need. This should be reviewed
regularly. The extrabudgetary funds should be regularised. At
this moment it is haphazard and unpredictable
The global function and specific country technical cooperation
should be reviewed and be made more appropriate. The roles of
headquarters, regional offices, and country offices should be
redefined to avoid duplication, conflict, confusion, and waste.
Research at all levels should be encouraged. Equity and social
justice should be respected in all activities.
Why are you the best person for the job?
I know the WHO, having represented my country on and off since
1974, worked as the WHO's director of the onchocerciasis control
programme from 1980 to 1994, and contributed to the success of
the WHO's biggest programme in Africa. I have a proved track record
of international health management. I am from the Third World
and was born and brought up in poverty. I therefore know poverty
and hope to be in a better position to address its health challenges.
I collaborate very well with partners of all disciples and colours.
My management style is transparent and seems to be internationally
recognised. I am politically independent, and I do my job without
fear or favour but with diplomacy. I therefore get on very well
with people.
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