E-drug: New leadership in WHO (BMJ article)
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Brundtland replaces top staff at the WHO
Adrea Mach, Geneva
The World Health Organisation's top staff has been replaced by an
entirely new team. The announcement came on 21 July--the day Dr Gro
Harlem Brundtland, former prime minister of Norway, assumed office as
the WHO's new director general.
Since January Dr Brundtland's transition team has been working to
mastermind a radical break with the WHO's tarnished past in terms of a
new leadership, structure, priorities, and operations. Despite nervous
grumbling about the "heavy input" from headquarters and a lack of
transparency in the "Scandinavian-Anglo-Saxon mafia" the transition
team seems to have achieved its goal.
The names of the new appointees to the WHO's cabinet were unveiled in Dr
Brundtland's first teleconference address to the WHO's 3500 staff around
the world on the day of her arrival.
It is rumoured that the Norwegian government has placed a sizeable sum
($30m; £19m) at the WHO's disposal to ease the departure of staff
whose services will no longer be required.
Cabinet make up
Unusual within the United Nations system is the broad spectrum of
background and experience that the new leadership brings to bear. Of
the 10 holders of the cabinet positions, eight come from outside the WHO,
and, remarkably for a traditionally male dominated organisation, six
(including Dr Brundtland) are women. All of the WHO's six regions are
represented, with an even split between north and south.
The head of the director general's office is ambassador Jonas Store from
Norway. He is a career diplomat who effectively led the interim transition
team and who, it is predicted, will run the office along a governmental
model.
The cabinet comprises Dr Brundtland herself and nine executive
directors. Each executive director will have a different area, or "cluster"
of areas, of responsibility. In charge of social change and mental health,
with a special emphasis on ageing, will be Dr Yasuhiro Suzuki from Japan.
Dr Olive Shisana from South Africa will be in charge of the family and
health services cluster. She has gleaned first hand experience from her
country's complex transition process and will apply it to a new approach
bringing together groups that previously worked separately on health system
issues and healthcare outcomes.
In charge of sustainable development and healthy environments is Ms
Poonam Khetrapal Singh from India, who brings extensive experience from
the financial sector, the World Bank, and from her post as health
secretary in the Punjab. She will have a double mission: to link
environmental issues to health on the one hand and to break the vicious
circle of poverty and ill health on the other.
Dr David Heymann from the United States is one of only two appointees to
come from within the WHO. He will continue to work in combating new,
emerging, and other communicable diseases, especially in the poorest
countries. In charge of non-communicable diseases is Dr Jie Chen from
China. She will use her broad academic experience in public health and
health management (in part at the University of Shanghai) to concentrate
particular attention on advocacy for behavioural change around smoking
related diseases and chronic and other non-communicable diseases.
In charge of the area on evidence and information for policy is Dr Julio
Frenk from Mexico. He will use his experience as a doctor and sociologist
to design more cost effective and equitable health systems.
Dr Michael Scholtz from Germany, who has a background in the
pharmaceutical industry, will be entrusted with the complex field of
health technology, including development, accessibility, and affordability
of drugs.
Ann Kern from Australia, who has previous experience in the WHO and a
background in national public health management, is in charge of general
management of the organisation. Dr Lyagoubi-Ouahchi, the other
in-house appointee, is the former Tunisian minister of health who will
have the task of "reaching out" to build better partnerships and alliances
with other sectors and organisations.
Dr Brundtland described the "new" WHO as having a "flatter structure,
[with] better communication, more transparency, [and] a clearer
distribution of responsibilities." However, replacing a rambling labyrinth
of fiefdoms with a more straightforward, streamlined organisation that is
driven not by bureaucratic rules but by performance and results will not
be an easy task.
Priorities
Internally, the top priority will be getting the new structure under way
and fine tuning the clusters until 1 November, when the restructuring
will be finalised. Externally "making a difference" remains Dr
Brundtland's leitmotiv, especially in relation to her previously announced
campaigns against malaria, tobacco, poverty, and HIV/AIDS.
The WHO must earn its health leadership and be able to measure its
impact, according to Dr Brundtland. The ultimate test of, she said, the
WHO's ability to "support and develop best policies, trigger and stimulate
the best research" will not be in grand words but on the ground--at
country and community level.
Copyright c 1998 by the British Medical Journal.
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