Union Executive Director José Luis Castro: new World Health Organization head must lead deep reform

This week, the top health officials from every nation will gather in Geneva for the World Health Assembly, where they will elect a new head of the World Health Organization (WHO). Three candidates are vying for the role of world’s most influential public health leader: Tedros Ghebreyesus, former Minister of Health of Ethiopia; David Nabarro of the UK, an international civil servant and Special Advisor to the UN Secretary General; and Sania Nishtar, former federal minister of the government of Pakistan and founder of a the non-profit Heartfile. All three are highly credentialed global health leaders.

Regardless of who is elected, the new Director-General must lead a deep reform agenda that guides WHO out of its current state marred by entrenched bureaucracy and political partisanship, and into a future where it delivers a high-functioning balance of policy and operations. Without a sea change from within the organisation during the coming years, WHO will become less and less relevant. Ultimately, other entities will replace WHO’s role in providing expert guidance to national decisionmakers. Regional alliances, or global philanthropies hungry to further their mission, or even corporations determined to increase market share all stand at the ready. WHO’s advantage of being the only entity in global health that boasts 194 member states and the ability to mobilize global opinion and shape political will should not be underappreciated. With the right leadership, WHO can ensure a healthier future for all the world’s people.

The key to change at WHO will be a leader that can strategically improve the organisation’s overall management. Management theory and practice were barely a science when WHO was created in 1948. In 2010, epidemiologist and former head of the U.S. Centers for Disease Control and Prevention William Foege declared, “lack of management skills appears to be the single biggest barrier to improving health throughout the world.”

The World Health Assembly should take heed. They should select a new WHO Director-General who is not only a principled diplomat, but also a skilled manager capable of implementing the following reforms.

First, WHO should improve its capacity to monitor global health needs in real time, then seek to add value to countries’ own abilities to prevent, detect and respond to disease. WHO cannot be all public health fixes to all countries and people. A value-added system focused on core priorities and WHO’s actual expertise, in response to emerging needs, will set a new standard for the organisation and for global public health. 

Defining priorities through input from WHO’s leadership and internal experts, governments and other external stakeholders in a way that treats all populations with equal consideration—and then making tough decisions based on the greatest needs—will give WHO greater credibility. It is critical that WHO management designs systems and programs with input from a broader community of social scientists and legal experts, in addition to medical professionals, to help the organisation better deliver on its mission in different cultural, political and economic contexts. 

Achieving the above will require more flexible funding from WHO donors. Inflexible, unreliable funding is one of WHO’s greatest difficulties. The new Director-General should negotiate for more leeway to distribute member-state dues in the form of technical support and capacity building as they deem appropriate. They should not allow earmarking by philanthropic partners, a change that would enable faster response to crises.

Lastly, it is imperative that the new Director-General unravel the governance issues that challenge the organisation. Rewards and accountability are linked principles in well-managed organisations. WHO should reward positive outcomes while also developing stronger accountability within the organisation and its partnerships.

These suggestions are based on the reality that, whatever predictable health challenges we face across the globe in the coming years, there undoubtedly will be new outbreaks and epidemics that require WHO to respond effectively and efficiently. The continued rise of anti-microbial resistance alone practically guarantees this reality.

The outgoing Director-General Margaret Chan has worked hard to bring improvements to the organisation. The process for electing the new Director-General is far more transparent than in the past. And when Dr. Chan sought to evaluate what went wrong in WHO’s response to the 2014 Ebola outbreak that lead to the death of nearly 12,000 people—largely in West Africa—an independent expert panel called upon the organisation to reform its internal management. Chan has taken steps to advance this reform.

A new Director-General must push the process much further. This is a tall order requiring a skillful manager who can tackle today’s health challenges in their immediacy and complexity. It is the only way to create the WHO that the world needs today.

José Luis Castro

Executive Director, International Union Against Tuberculosis and Lung Disease


Read the latest Director's Corner: A message from José Luis Castro at the 70th World Health Assembly