Brundtland replaces top staff at the WHO

BMJ 1998; 317 doi: (Published 25 July 1998) Cite this as: BMJ 1998;317:229

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  1. Adrea Mach
  1. Geneva

    The World Health Organisation's top staff has been replaced by an entirely new team. The announcement came on 21 July--the day Dr Gro Harlem Brundtland, former prime minister of Norway, assumed office as the WHO's new director general.

    Since January Dr Brundtland's transition team has been working to mastermind a radical break with the WHO's tarnished past in terms of a new leadership, structure, priorities, and operations. Despite nervous grumbling about the “heavy input” from headquarters and a lack of transparency in the “Scandinavian-Anglo-Saxon mafia” the transition team seems to have achieved its goal.

    The names of the new appointees to the WHO's cabinet were unveiled in Dr Brundtland's first teleconference address to the WHO's 3500 staff around the world on the day of her arrival.

    It is rumoured that the Norwegian government has placed a sizeable sum ($30m; £19m) at the WHO's disposal to ease the departure of staff whose services will no longer be required.

    Cabinet make up

    Unusual within the United Nations system is the broad spectrum of background and experience that the new leadership brings to bear. Of the 10 holders of the cabinet positions, eight come from outside the WHO, and, remarkably for a traditionally male dominated organisation, six (including Dr Brundtland) are women. All of the WHO's six regions are represented, with an even split between north and south.

    The head of the director general's office is ambassador Jonas Store from Norway. He is a career diplomat who effectively led the interim transition team and who, it is predicted, will run the office along a governmental model.

    The cabinet comprises Dr Brundtland herself and nine executive directors. Each executive director will have a different area, or “cluster” of areas, of responsibility. In charge of social change and mental health, with a special emphasis on ageing, will be Dr Yasuhiro Suzuki from Japan. Dr Olive Shisana from South Africa will be in charge of the family and health services cluster. She has gleaned first hand experience from her country's complex transition process and will apply it to a new approach bringing together groups that previously worked separately on health system issues and healthcare outcomes.

    In charge of sustainable development and healthy environments is Ms Poonam Khetrapal Singh from India, who brings extensive experience from the financial sector, the World Bank, and from her post as health secretary in the Punjab. She will have a double mission: to link environmental issues to health on the one hand and to break the vicious circle of poverty and ill health on the other.

    Dr David Heymann from the United States is one of only two appointees to come from within the WHO. He will continue to work in combating new, emerging, and other communicable diseases, especially in the poorest countries. In charge of non-communicable diseases is Dr Jie Chen from China. She will use her broad academic experience in public health and health management (in part at the University of Shanghai) to concentrate particular attention on advocacy for behavioural change around smoking related diseases and chronic and other non-communicable diseases.

    In charge of the area on evidence and information for policy is Dr Julio Frenk from Mexico. He will use his experience as a doctor and sociologist to design more cost effective and equitable health systems.

    Dr Michael Scholtz from Germany, who has a background in the pharmaceutical industry, will be entrusted with the complex field of health technology, including development, accessibility, and affordability of drugs.

    Ann Kern from Australia, who has previous experience in the WHO and a background in national public health management, is in charge of general management of the organisation. Dr Lyagoubi-Ouahchi, the other in-house appointee, is the former Tunisian minister of health who will have the task of “reaching out” to build better partnerships and alliances with other sectors and organisations.

    Dr Brundtland described the “new” WHO as having a “flatter structure, [with] better communication, more transparency, [and] a clearer distribution of responsibilities.” However, replacing a rambling labyrinth of fiefdoms with a more straightforward, streamlined organisation that is driven not by bureaucratic rules but by performance and results will not be an easy task.


    Internally, the top priority will be getting the new structure under way and fine tuning the clusters until 1 November, when the restructuring will be finalised. Externally “making a difference” remains Dr Brundtland's leitmotiv, especially in relation to her previously announced campaigns against malaria, tobacco, poverty, and HIV/AIDS.

    The WHO must earn its health leadership and be able to measure its impact, according to Dr Brundtland. The ultimate test of, she said, the WHO's ability to “support and develop best policies, trigger and stimulate the best research” will not be in grand words but on the ground--at country and community level.

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    DONALD STAMPFLI/ASSOCIATED PRESS Dr Brundtland has made a radical break with the WHO's past

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