The WHO regional director elections must be reformed

In August the World Health Organization (WHO) Africa Regional Committee will elect a new director for its regional office. The election was met with some consternation on social media for the failure of the 47 member states in the region to nominate a woman to enter the contest. This is not the only recent WHO regional election that has been in the news. The WHO regional offices play several critical roles in our increasingly polarised world—but only if they are led by exceptionally talented directors chosen in fair and transparent elections.

In May 2023, we were part of a group of public health and governance experts who wrote to the WHO executive board chair Hanan Mohammed Al Kuwari and members urging them to reform the electoral processes and harmonise them with the selection process for the organisation’s director-general.1 We noted that they faced a historic opportunity, given the unprecedented situation of three regional election contests occurring that year. We argued for a transparent selection process that rewards candidates with the best mix of technical and managerial competence to support countries and the political savvy to ensure that health is paramount. This is opposed to short term national interests that do not best serve WHO and the public at large. The call echoed a report prepared for the Independent Panel on Pandemic Preparedness and Response, which recommended that with respect to “the recruitment of the RDs [Regional Directors] … the appointment might be more based on competencies and objectives, rather than on political merit.”2 Talented leaders would come to the fore if electoral processes were more fair, meritocratic, and transparent. The prevailing closed process does not serve the public interest best.

The chair of the WHO executive board was sympathetic to the concerns and the need for reform of the electoral processes. She indicated that renewal would constitute one of the priorities of her tenure. We then shared the proposed list of reforms directly with the chairs of the three regional offices where elections were to take place. The measures included public town halls in advance of elections where WHO staff, the public, and media have the opportunity to submit questions to nominees, independent professional scrutiny of applications, and public broadcasting of interviews.3 We didn’t hear back from any of the chairs, but were pleased to see the regional committees publish the applications of the nominees on their websites. Additionally, two of the regional committees convened and broadcast nominee debates, even if the public or press were not able to pose questions.

Despite these modest changes, we were disappointed in the lack of willingness to embrace reform potential for fairer election processes. In the South East Asia regional director contest, a country nominated the daughter of its head of government to the post, and she was elected. This was questioned by the Lancet,4 the Financial Times,5 and several national media outlets.6 She then won the contest and is presently in post. The current election contest in the AFRO region is taking place without the kinds of reforms which have been called for.

At the WHO executive board meeting earlier this year, the process of taking forward consultations on reforms was delegated to the regions. Global discussions on the topic are not scheduled until the World Health Assembly in May 2025. Although regional consultations are important, we are concerned about the direction of travel as there are indications of a desire to maintain the status quo.

In our view, a set of reforms is needed that span all regional offices of the organisation. These reforms should reinforce the One WHO aspiration of a more unified and vertically integrated organisation across its three levels, and also conform with a set of universal good governance practices and ethical norms, including the set of principles for officials elected to public office.7 WHO is heading into the first “investment round” in its history aiming to fund its core work while increasing the efficiency of receiving and disbursing funding.8 This means it is all the more important that donors can be confident in the effective management of all regions and that investments will go to evidence informed priorities and not be allocated on the basis of political favours and debts.

The absence of robust and transparent processes can only harm WHO—at a time when a strong and unified organisation is needed more than ever. There is a pressing need for regional directors who can manage a multinational workforce and bring member states together when a range of geopolitical challenges threaten to set back progress on health for all.