The World Health Organisation (WHO) recently appointed Dr Matshidiso Rebecca Moeti as the new Regional Director for WHO’s Africa Region (WHO AFRO) succeeding Dr Luis Gomes Sambo, who had served as Regional Director for the last 10 years. She is being thrown right in at the deep end with an ongoing outbreak of Ebola Virus Disease in Sierra Leone, Liberia and Guinea. Her biography can be found here.
As the Ebola outbreak escalated over the last year, the WHO was criticised for its initial handling of the outbreak. Several commentators suggested that the WHO underestimated the outbreak, expected the overwhelmed governments of the affected countries to handle it themselves and, when it finally did take charge, lacked the capacity to do so effectively. There have been about 14,000 confirmed Ebola cases and 8,500 deaths. Whether these claims are right or not will be exhaustively debated after the outbreak is over, but for now there is still much work to be done. During her acceptance speech, Dr. Moeti vowed to improve the WHO’s response to the outbreak. In an interview, she stated an intention to recruit more people to increase the capacity of the WHO. She also welcomed a resolution that is intended to improve the WHO’s ability to respond in emergencies.
Dr Matshidiso Moeti has a rare opportunity to fundamentally transform the World Health Organisation in Africa. During normal times, it has a reputation of being overly cautious and careful not to hurt the sometimes soft sensitivities of its member states. However, it will be impossible for it to achieve its stated goal to help all people attain “the highest possible level of health” if it cannot speak truth to power. Now, more than ever, before it has an obligation to stand firm, to speak and act for the best health interest of Africans, which do not always necessarily coincide with those of African governments.
Sadly, Africa carries a disproportionate burden of the world’s health challenges. We therefore need a WHO Regional Office on the continent that will go beyond issuing guidance documents and policy frameworks to leading in advocating for resources to be placed in the areas of most need, both internally within the organisation and in the countries where WHO works. One of the challenges has been that, under the Constitution of the WHO, its regional offices are largely autonomous and the directors are chosen by local ministers of health. In a perfect society, local ministers of health would represent popular and democratically elected governments accountable to the people. Sadly, this is not always the case on our continent. Where the interest of politicians and that of the people are out of sync, an organisation that is dependent on the politicians to elect its leadership becomes existentially threatened in its ability to carry out its mandate for the people.
This strange institutional structure is often a weakness, but at this moment could actually be an advantage. Africa needs a strong regional office and strong leadership. The eyes of the world will be on WHO AFRO, but more importantly the eyes of Africans will be on WHO AFRO. This is not a time to dither and reach slow consensus on the issues that matter but a time for bold courageous action on these issues. The long term existence of the WHO is far from inevitable – and, if there is one way to assure its longevity, it is to align itself on the side of the people, even if that happens to be on the other side of government. There is no better example for the need of this than the early months of the Ebola outbreak.
Prior to her election, Dr Moeti was the Deputy Regional Director and, later, Coordinator of the Inter-Country Support Team for the South and East African countries of WHO African Region. For more than 35 years, her career took her from the Botswana Ministry of Health through the UN organisations WHO, UNICEF and UNAIDS. Having spent most of her career in the institutions as they are, it may be wishful thinking to assume that radical change is imminent or indeed even possible. However, on the most important metric for us on the continent – corruption – she has an unblemished record. Coming from Botswana, the country with the best corruption score in Africa as ranked by Transparency International adds to the sense of anticipation and hope. She has one of the toughest but potentially most fulfilling jobs on the continent leading WHO’s biggest, costliest and most challenging region, Africa.
In an interview shortly after her appointment, she is quoted as saying that one of her goals is to make the African country offices more accountable and staffed with people hired on merit, not political promises; the region’s past issues with nepotism, she insists, are “history.”