Partnerships with the drug industry would be constructive

Partnerships with the drugs industry would be constructive

Karam Karam is minister of tourism and a former minister of health in the Lebanon

What will be your priorities on taking office?

Health should be envisioned as a basis for sustainable development, and priorities need to be defined on the basis of a number of factors, including severity, disability, and economic impact. As director general of WHO, it will be essential to establish a healthy, stable, and productive working environment to be able to properly address these priorities. Resources need to be mobilised where they are most needed. Emphasis must be placed on public health programmes—tackling such issues as nutrition, access to essential health needs, access to medicines in developing nations, maternal and child care, and access to primary health care. We must also place emphasis on cost effective public health programmes such as immunisation and the development of safe and effective new vaccines for diseases of poverty.

Moreover, in addition to the recent epidemics of AIDS and other resurgent infections, chronic endemic diseases such as cardiovascular diseases, cancer, and arthritis need to be addressed through innovative approaches.

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

During the last few years international agencies, including WHO, have emphasised the role of health as the basis of sustainable development. Strengthening of national and global capacities to address the problems in developing countries is best advocated through close collaboration between various health institutions. In developed and developing countries, WHO collaborating centres should have a leading role in this respect.

Priorities would centre on:

· Maternal and child health, the building blocks of a healthy society and future generations—without them essential ingredients for health will be missing, and

· AIDS, which if left unabated will be a real threat to humankind, especially in developing countries, where making drugs available for its treatment should be a priority for international aid programmes and concerned agencies. Concerted efforts to prevent it and to find treatments that are more efficient should continue.

I would also aim to strengthen national health research institutions and would advocate that social and public health scientists should contribute to the setting of national as well as global health research policy.

I would advocate ensuring sustainable capacity in developing countries to generate, interpret, and provide evidence for policy makers by encouraging development and implementation of national plans to strengthen health surveillance systems. Developing low cost and flexible surveillance systems with a higher chance of successful implementation should be a priority in under-resourced countries.

As director general I would concentrate efforts on providing sound evidence on how we can best reduce health inequities. Proper approaches would include joint global efforts to combat diseases of poverty and ensuring access to essential health services.

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

We need to focus on the development ofa healthy, stable, and productive working environment, with a team approach across various levels, as well as across the organisation. I feel that there is a need to improve staff morale across WHO. This can be achieved by developing a more secure organisational structure and a sound human resource policy with proper attention given to staff recruitment and retention policies, staff performance appraisal systems, and career development. Encouraging staff members to participate in policy making and strategy development and implementation would build up staff motivation, creating a spirit of empowerment that would lead to the promotion of the exchange of ideas and experiences among them and to greater openness, communication, and internal debate. I definitely would support the ongoing initiative of organisation-wide planning and the "one WHO" approach.

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

I would strongly promote collaboration and exchange of experiences between WHO regional offices and between regional offices and headquarters. I believe there is a greater role for management committees, both at headquarters and throughout the organisation. There is an important role for both the global policy council, withregional directors, and the global management group, with regional directors and deputy regional directors.

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

I would support the ongoing initiatives for a strong partnership with international donor agencies, local authorities, civil society organisations, the private sector, and professional and scientific organisations.

Specific public health projects needing funding should be presented to major grant giving countries. Any cooperation stemming from this effort would benefit global health and should be a major concern for potential donor countries. Monitoring and evaluation of such programmes should be an essential part of the implementation process.

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

The basis of partnership should be the recognition of WHO’s role as the world’s health conscience, the leading agency for global health, and an organisation with a fixed vision of attainment of health for all. I would also vouch for strengthening ties with other partners for the purpose of mobilising additional resources to support public health.

Partnerships with the research based pharmaceutical industry to improve public health would be constructive. Some renewed attention to the problem of access to medicines, the quality of accessible medicines, and innovation in new therapeutic and preventive technologies is needed.

Moreover, it is important to define the roles of each partner and encourage scrutiny by external, peer reviewed evaluations. There are a number of methodologies that can be used for such evaluations. The expertise of epidemiologists and health researchers should be sought to tackle measurement issues.

Will you repeat the controversial exercise of comparing health systems worldwide?

The recommended actions laid down in the scientific peer review group report on health system performance assessment are a good basis for developing this important domain. As stated by the group, methods and data sources should be robust, credible, sustainable, and cost effective before implementation.

Meanwhile, we need to acknowledge the limitation of any standard approach to assessing health system performance across countries. Such approaches or indices should be used to initiate discussions within various countries and regions, rather than to rank them against one another.

Finally, the assessment of health system performance needs to be related to the objectives that each system sets for itself. One of the primary tasks of the countries (with WHO assistance) is to define the short and long term measurable objectives for the healthcare system and to direct the assessment to those objectives. In this process, WHO should institute some comparability across countries with respect to the standards and methodology.