There is a very important election process underway in Geneva and some capitals around the world. It is one that will elect the person who will lead the World Health Organisation (WHO) for the next five, possibly ten years. It is very likely that you have not heard about this. That is the way the WHO wants it, partly because it is inefficient and partly because the health sector worldwide is fairly corrupt and non-transparent.
The final vote will not take place until May 2017 officially, but the jostling and the positioning is furtively happening. September was the cut-off point for candidates to present themselves. In the run are six, one each from Ethiopia, Italy, France, Pakistan, Hungary and The United Kingdom of Great Britain and Northern Ireland. « Procedures have been substantially revised since 2012 when Margaret Chan was elected to serve a second term. It is likely that this lengthy process will therefore be more transparent, accountable, and disputatious ( and considerably less corrupt) than past elections, » the highly-respected medical journal The Lancet commented in its 30th April 2016 issue. Many other health journals and editorials have been written about along the same lines.
To say that the WHO has long lost its global health leadership place would be an understatement and therein lies the irony. The United Nations’ (UN) global health policy-setter is the organisation that the world turns to for responsible and accountable guidance on a daily basis and more so during emergencies. We have all heard of « according to the WHO… » or« WHO rules require that… » which suggest that the body is truly a leader and can be counted on for reference. Health data ranging from epidemiology to cost of health care, disease surveillance to relations with the private sector are some of the critical areas the WHO is expected to provide leadership on. It does not and this is no laughing matter. Millions of lives depend on it.
So why is everything it does so secretive, especially the election of a new head ? Nobody will be able to give you a convincing reason because nobody really knows and those who do –largely rich donor countries and poor recipient countries – will not speak. It is largely a numbers game - money and votes. The WHO's press office in Geneva does not return calls and the voice mails are permanently activated. It is useful to recall that the WHO’s budget is partly funded by member countries and partly from extra-budgetary money provided by individual or country donors keen to prime some programmes. People have a right to know where money meant for public health truly goes as large parts of the world are increasingly unhealthy. The WHO does not like questions of this nature. Asked about the Ebola crisis at the World Health Assembly (WHA) in May 2015, the Director General Margaret Chan told a journalist from francophone Africa that she does not speak French. The organisation's handling of the Ebola crisis was stoutly criticised.
A few hundred metres from the WHO in Geneva is the home of UNAIDS and a little further away, the Global Fund as well as GAVI. These organisations deal with different aspects of public health ranging from HIV to malaria, tuberculosis, vaccine development and distribution. They bear testimony to the simple fact that the world’s major donors prefer placing their money and hope in organisations other than the WHO. The UN’s health body is not a funding agency, it must be said, but it has also lost it’s hand in guiding the world through policy decisions. A stone’s throw from all these organisations is the World Trade Organisation (WTO), the world’s free-trade police. It has the power to impose trade sanctions on critical health issues including access, research, food and environment. The WHO and the WTO do not speak to each other in any meaningful way. You would think that should be an obvious conversation in the interest of public health. There is nothing obvious in the health sector to politicians and bureaucrats in whose hands rests policy and progress.
Anyone who says policy must say politics in the same breath. All of WHO's member countries - basically the whole world - have health as a basic right in their Constitutions. But, when national budgets are cut, health ministers are left holding the short end of the stick. This happens because in most countries including some developed states, governments see health as a cost and not as an investment. The situation is so complex that some rich countries and most poor and middle-income countries find themselves in the same situation - they are unable to afford health.
Instead of leading a global discussion on health and public expenditure, the WHO and regional an country offices spend their time writing reports about multi-sectoral engagement, cross-sectoral stake holders, the importance of placing people at the centre of health ( they actually say this), the vital need for health ministers and finance ministers to speak in one voice, the Sustainable Development Goals (SDGs) and before it the Millennium Development Goals (MDGs), bench marks, etc. etc. When they are not in a meeting, they are traveling. One joke doing the rounds is that while CEO's of large corporations travel economy, NGOs and UN officials fly business. Not everyone who works for the WHO wastes public money, but the good people rarely rise to leadership positions in the organisation.
The health sector in India is unhealthy. It has a double disease-burden (communicable and non - communicable diseases) but investments in health are woefully meagre. With 1.3 % of the GDP, India is among countries which have the lowest investments in health. The BRICS countries, for example, spend a higher proportion of their GDP on health ranging from just under 4% to almost 9%. Speciality and multi-speciality hospitals in the private sector are doing brisk business in India (has some of the world’s best doctors work in India) even as where tuberculosis and tobacco-related deaths are increasing. Both diseases are preventable as are many others. For that to happen, health has to be seen as an investment and healthy people as indispensable engines of economic growth.
Makes you wonder why the parliament has never allocated even one day to discuss India’s health priorities. Most recently the discussions on the GST bill and its passing showed that when Indian lawmakers want, they can rise to the occasion and pass legislation that is beneficial to the world’s largest democracy. Health never makes it to the high table because most if not all of India’s politicians do not go to public hospitals and when they do, they get preferential treatment and service.
Lack of leadership at the WHO is a serious issue. Public hearings are scheduled for early November when according to the WHO website, people including journalists can ask questions about the next head. It will most likely be a fixed match as many of UN's top jobs are. An unwritten agreement is that since the P5 (US, UK, France, China and Russia) are permanent members of the UN's Security Council, it's agencies is where the rest of the world gets a chance to place its people. When the world’s health ministers gather in May 2017 for the WHA to formally pick a new head, there will be a waltz of expensive cars and expensive hospitality. It is an eye-sore as it shows how one part of the world lives and the other part dies. The WHO can try to bring it all back with courage and determination. But, by all accounts, the world is not holding its breath.
Note: The views expressed are the personal opinions of the author.
(Disclosure: The author held a senior position at the WHO in the former WHO Director General Dr. Gro Harlem Brundtland's flagship tobacco-control programme.)