23 January 2017
The WHO is a worldwide specialized agency within the multilateral UN system. It is one of the most decentralized entities of its kind, with its six regional offices and 150 offices in different countries and territories. Within decentralized organizations, the primary governance challenge is to establish an appropriate balance between being responsive to regional needs and reflecting global priorities. This is the case within WHO, where one of the questions most frequently asked by Member States in the recent WHO Web Forum was about alignment between the country offices, the regional offices and the Geneva office of the organization. How will the new Director-General contribute to concerted action across the three levels?
A Responsive and Adaptable WHO
The starting position is that the Member States are requesting the WHO secretariat at all times to be responsive to the needs of their people. This reflects the WHO’s organization-wide purpose – to help ensure that those who make decisions chose the actions which will have the greatest impact on the health of all people, especially those who have the greatest needs. To this end, the WHO is expected to deploy expertise, personnel and financial resources in ways that respond to people’s needs, in a manner that is ethically sound and that demonstrates professional excellence. The organization as a whole needs to be confident that this is the way in which it works at all times – a confidence that results from transparency of action and constant accountability to all interested parties.
The practical reality is that people’s health needs vary within, and between, countries. Institutional capabilities also vary. As a result, the Member States have different requirements of WHO. The articulation of these requirements will vary too. Some Member States prefer to draw on the skills within their domestic institutions, while others prefer to complement these with external technical support.
The WHO Regional Committees ensure that the work of WHO regional and country offices reflects the changing needs of countries. They also ensure that the support that regional and country offices receive from the global level is relevant and responsive. The Regional Directors are well placed to encourage the global parts of the WHO to reflect country and regional realities at all times. Taken together, the regional offices are a major strength of the WHO network.
A WHO with Consistent Core Values and Management Practices
At the same time WHO’s Member States require that the organization reflects a clear set of principles about people’s health – underpinned by core values about equity and social justice – in all that it does, everywhere. The principles include the need for management practices across the organization that are consistent, ethical and transparent – at all levels of operation. They include the need for all staff to be held accountable for the results they achieve and the ways in which they are achieved. They include the importance of geographic and gender diversity in recruitment, with the consistent application of rules and procedures. I will pursue this aspect of One WHO through ensuring mutually supportive relationships between the Regional Directors and Director-General acting as members of a single management team. I will maintain this approach in my interaction with Regional Committees, which form part of the organization’s Governance Network.
The WHO Works with Member States with Changing Health Needs
Many lower and middle-income countries have a mixture of health challenges - with double, or triple, burdens of disease. At the same time they are also home to a majority of the world’s absolute poorest. The relationship between the WHO office and national authorities in many of these countries is now much more than technical collaboration.
The WHO has a range of roles here. The first of these is advocacy (on the basis of sound evidence) in drawing attention to neglected health issues and populations. Second, technical resource in supporting local institutions – providing them with access to the best international expertise and to best practice. Thirdly, the WHO is a facilitator - helping countries to increase their influence on global and regional health policy and governance (in global/regional forums and through south-south collaboration).
So, given this mix of roles, the new WHO needs country office personnel whose skills and experience are commensurate with changing demands - which will often mean continuous development of the capabilities of personnel in countries. This is the part of the organization that plays the most significant role and where the greatest skills tend to be needed - it is, in effect, the heart of the WHO.
Increased Economic and Political Integration between Sectors at Regional Level
The regional offices of WHO continue to provide direct support to country offices, producing the tools that WHO staff at country level need to plan, implement and monitor programmes. These are valuable public goods. In addition however, in almost all regions of the world, organizations promoting political and economic integration are becoming stronger and more influential. Increasingly these organizations (such as ASEAN, the EU, as well as the AU and associated sub-regional organizations throughout Africa and Latin America) are getting involved in health and development. They usually work closely with regional development banks and regional economic commissions. WHO has an important role to play with these entities at regional level - to promote health as a priority input and outcome for development.
Importance of Systems for Strategic Leadership
These considerations highlight the central importance of systems for strategic leadership across the WHO. This is why the Global Policy Group (in which Regional Directors meet with the Director-General and Deputy Director-General) has a vital role in vision and strategy. The GPG is the primary mechanism for ensuring consistent strategic leadership across the WHO. Its focus is on the WHO as a whole, in a rapidly changing geo-political context, as well as on the different regional and national perspectives that affect the utility of the organization to different Member States. The GPG also plays a key role in enabling the Secretariat to be well placed to support meetings of WHO’s governing bodies.