WHO must strengthen partnerships at a global level

WHO must strengthen partnerships at a global level

Ismail Sallam, a former professor of cardiac surgery, was Egypt’s minister of health and population from 1996 to 2001

What will be your priorities on taking office?

As director general of WHO my priorities would be driven by a commitment to equity and alleviation of disparities. I believe that the world community, which makes up the WHO membership, genuinely wants to alleviate the true causes of ill health and disease.

Public health and primary healthcare systems should be the cornerstones at the country and global levels. As director general, my priorities would be to focus on:

· Leadership and advocacy—the significant changes on the world stage demand a WHO that can assert a strong leadership in promoting health so that it is given priority in the complex and highly politicised global development agenda. The director general should work towards a convincing justification that would place global health as an integral component of a global system for human development and security.

· Strengthening partnerships—towards global health goals, at the national, regional, and global levels, and with the industry, academia, research institutions, and non-governmental organisations.

· Developing a strong evidence base to enable WHO policymaking and governing bodies to take sound decisions on WHO programmes priorities and related resource mobilisation and allocation, and to enable them to improve managerial processes and governance.

· Ascertaining that the health programmes designated by countries and WHO governing bodies as priorities—such as HIV/AIDS, malaria, tuberculosis, vaccine preventable diseases, child health, and essential medicines—are provided with timely and the best possible technical and managerial support needed to deliver on these programmes.

· Boosting the morale of the WHO staff by ensuring that they are given clear objectives.

What will you do to champion the needs of the developing world?

As mentioned in my reply above, the director general’s priorities must feature a strong commitment to equity and alleviation of disparities. The director general has to ensure that public health and primary healthcare systems should be the cornerstones at the national and global levels.

Because developing countries lack the global support for health and the presence of efficient healthcare systems, the director general should focus on strengthening WHO’s leadership in promoting global health as an integral component of a global system for human development and security.

He should promote political commitment and partnerships for health at national, regional, and global levels. He has to ensure the development of a strong evidence base to enable policy makers and governing bodies to make sound decisions on health system development and on resource mobilisation and allocation, and to enable them to improve managerial processes for the sake of the unprivileged groups.

The director general has to ensure active participation of countries and regions within the organisation in a collective manner to optimise the reach and the effectiveness of WHO’s global health policies and recommendations. WHO should address the concerns and aspirations of its different members in a democratic manner, maximising the utilised input and effort of every member state.

What will you do to change the culture of WHO so that there is greater openness, communication, and internal debate?

We will have to have transparency as our norm and method of work. Transparency is the result of confidence gained internally and externally.

As director general, my first duty is to ensure that country health authorities are well oriented to WHO’s ways and means and are actively sharing in the decisions on the work of the WHO Secretariat. The decisions of the governing bodies should be well and genuinely executed. Interactions and critique from countries and partners would be promoted and welcomed and objectively pursued.

Greater transparency calls for improved tools for better planning, sensible resource allocation, and a management information system that truly ties objectives to programmes, to resources, to ongoing and planned implementation, and to formal evaluation and effectiveness auditing. I would strongly welcome a regular, international, independent, expert external audit of WHO’s work.

What kind of reform is needed to WHO’s regional structure? How will you achieve this?

WHO will not change much unless a sound reform is taken at the regional level. What I know is required, and which I address below, is the need for managerial reform. What needs to be constructively reformed is the management of the regional programmes, resources, and secretariat. The managerial reshaping and improvements needed should include the introduction of the same level of transparency, as discussed in my previous answer, to apply throughout all echelons of the WHO Secretariat, including at the regional level.

The performance of WHO personnel cannot be expected to reach a level of excellence unless they are provided with an insightful, supportive leadership and a suitable working atmosphere, as well as performance based incentives.

I strongly believe that WHO’s major resource as a technical agency is its personnel. WHO’s technical successes can be attributed almost entirely to the quality of the work of its staff. This is equally critical at the regional level.

What new ideas do you have for funding WHO’s core activities?

WHO will be able to raise more resources if it succeeds in prioritising health on the global agenda. This requires strong leadership, as I previously stated.

It will also be able to raise more resources if it pursues strong partnerships with the various health sector players and if it provides proper evidence and information to stimulate the private sector and other partners to play their respective role on certain issues.

Other ideas include:

· Encouraging government healthcare services to cooperate with the private sector and, possibly, non-governmental organisations.

· WHO has to show that it has optimally used its existing financial and other resources. It should put forward concrete examples of such "optimal uses" as part of its fundraising efforts. This should wipe out the wrong image of the organisation, which arises when resources are not fully used owing to inadequate planning.

· The national political authorities in countries have to be stimulated in order to obtain a major political commitment to health.

· Countries have to be encouraged, through health sector reform, to use their resources to better effect. Countries could also be encouraged to study the introduction of a "health tax," which may produce a relatively small financial return but which can be effective in public health and primary healthcare terms. For example, the health insurance for students and children in Egypt has been secured through a health tax imposed on cigarettes.

· Actively seek and encourage bilateral and multilateral projects, especially in public health affecting border areas. The example of the cooperation between Egypt and Sudan to control malaria is relevant here.

What rules or policies should there be to govern WHO’s partnerships?

I would strongly promote global and regional partnerships for health with various partners, such as civil society organisations, foundations, donor agencies, the private sector, and new bodies.

In my opinion, the WHO has a very important role to play in increasing and strengthening the partnerships at global level. This could be achieved through the following:

· WHO should provide a forum for global health, inviting all international partners to reach a consensus, for example, on how to promote and maximise the benefits for poor communities and vulnerable groups.

· WHO must ensure that it has the authority to monitor, foresee, and work on preventive measures for all potential hazards affecting health.

Where there are commercial interests, WHO should ensure that the conditions and permissible boundaries are known and agreed to by all the partners.

Will you repeat the controversial exercise of comparing health systemsworldwide?

WHO has developed a conceptual framework for health system performance assessment that highlights the main goals and the functions needed to implement them and that uses several tools and methodologies for assessment. This exercise was considered by many countries to be merely academic and not satisfactory.

I would prefer that we focus on:

· Simplifying the tools and methodologies for decision and policy makers, and

· Helping countries to increase the limited investment in developing the necessary capabilities to own the tools and methodologies and to use them for the sake of improving health system performance and to contribute to their eventual refinement.