If we learnt anything from the recently concluded Health Watch Forum 2017, it is that the leadership of an organization matters as much as the organization itself. This is why the change in leadership of an organization as critical to global health as the World Health Organisation (WHO) is worth our full attention.
The WHO plays a pivotal role in directing and coordinating the numerous health interventions necessary around the globe. On Tuesday, 23rd of May, the WHO member states elected Dr. Tedros Adhanom Ghebreyesus of Ethiopia as the new Director-General to serve for a 5-year renewable term, at the World Health Assembly in Geneva.
The new Director-General, Dr Tedros Adhanom Ghebreyesus beat Dr David Nabarro of Great Britain and Dr Sania Nishtar, a Pakistani National to become the first African to hold the position.
Dr Tedros Adhanom has had a strong track record in public health and health systems interventions as Former Minister of Health in his country Ethiopia. He caught our attention for the changes he has proposed to bring to the WHO. In a recent interview with Richard Horton and Udani Samarasekera of The Lancet, he explained:
As Director-General of WHO, I would focus on five priorities:
- Transforming WHO into a more effective, transparent, and accountable agency that is independent, science and innovation based, responsive and harmonised, with a shared vision at the headquarters, regional, and country levels. WHO has to strike a balance between bold reform and organisational stability to deliver results;
- Advancing universal health coverage and ensuring all people can access the services they need without risk of impoverishment. This includes driving domestic resources for health, strengthening primary health care, and continuing to expand access to preventive services, diagnostics, and high-quality medicines for diseases like HIV, tuberculosis, malaria, diabetes, heart and chronic respiratory diseases, cancer, and mental health conditions;
- Strengthening the capacity of national authorities and local communities to detect, prevent, and manage health emergencies, including antimicrobial resistance, and promote global health security;
- Putting the wellbeing of women, children, and adolescents at the centre of the global health and development agenda and positioning health on the gender equality agenda;
- Supporting national health authorities to better understand and address the health effects of climate and environmental change.
Anyone who would rise as Nigeria’s health ‘hero’ would need to take a few lessons from Dr. Tedros aggressive approach to health reforms in his country during his time as Minister of Health.
Even though he understood that building structures should be secondary to strengthening the primary healthcare system, the dearth of health facilities in the country was not ignored.
During his time as minister, the Ethiopian health system experienced expanding access to Universal Health Care. New initiatives led to the construction of more than 3,500 health centres and 16,000 health posts, up from the paltry 600 centres which were serving Ethiopia’s population of 76 million on his assumption of office.
Increased health access has been identified as a key to reducing child mortality. Ethiopia once again was an example of this as improved access to health services saw the nation meeting its target of reducing child mortality by two-thirds between 1990 and 2015. Ethiopia’s maternal and child mortality was reduced by 70 percent under his tenure. At the same time, mortality due to tuberculosis was reduced by 64 percent. This is arguably one of his most considerable and admirable achievements in his time as Minister of Health. Ethiopia is one of the few African countries that achieved under-five mortality (U5MR) by two-thirds three years before 2015. In 2014, it was announced that Ethiopia had achieved MDG 4- reducing the maternal mortality rate (MMR) through the use of low-cost impact interventions.
One factor which we believe contributed to the success of the primary healthcare reforms in Ethiopia is Dr. Tedros’ belief that communities need to own their own health in order for any interventions to be successful.
In a statement at The Harvard School of Public Health Forum, Dr Tedros said:
“Our priorities could be addressed through simple public health solutions focusing on the primary healthcare, if especially you mobilize communities to produce their own health, meaning having the knowledge, transferring knowledge to communities, transferring skills, and then helping them to do it themselves. That means centring on health promotion and prevention.”
In 2006, Ethiopia was experiencing the same shortage of health workers Nigeria currently laments. Ethiopia’s medical doctors at the time also faced immense challenges in training and achieving their career goals.
In an innovative approach, Dr Tedros during his tenure as Minister of Health from 2005-2015 responded to the issue of shortage of health workers by rolling out a Health Extension Program (HEP), which trained and deployed 38,000 health workers—the vast majority of them women. HEP revolutionized health service delivery throughout the country by fostering more assertive care-seeking behaviour among women on behalf of themselves and their families.
What was his motivating factor? He says he believed that the issue of shortage of health workers was not caused primarily by brain drain, but rather a mismatch between supply and demand. For him, this meant the ministry of health had to take ownership of the problem.
By linking leaders at the global, national, regional, and district levels with women’s groups in every village across the country, Dr Tedros leveraged the HEP platform to realize his overarching vision of building a sustainable health system with women at its core. Today, Ethiopia’s HEP model of community-based health service delivery is being replicated in more than a dozen countries.
The continued shortage of health workers and absence of jobs for graduating medical students in Nigeria is also not necessarily a brain drain issue, it is largely a function of a mismatch between supply and demand. Our own health ministry should take a cue from Ethiopian reforms, cut the bureaucratic tape and connect well trained health workers with community members in dire need of their services.
In his address at the Director-General candidates’ Forum in November 2016, Dr Tedros raised key issues which he asked member states to do some soul-searching on. These issues are as pertinent to the Nigerian health space as they are to WHO member states.
First, he challenged the fact that member states’ contributions dropped from 80% in the 1970s to just 20% today. He asked “Why are we not having the commitment to really own WHO? Unless we empower WHO with resources I don’t think we would expect results, as ownership is important.”
With only 6 percent of funds for health in Nigeria coming from the Nigerian budget in the last year, we believe that our nation should also be asking this question and seeking practical, timely, relevant and sustainable solutions.
Dr Tedros went further to say that Universal Health Coverage, ‘Health For All’ has been the mantra of the WHO from 1945 till date. Despite this, more than 400 million people still do not have access to essential health care services. This prompted the DG-hopeful to say: “We are not walking the talk, we have just been making promises for more than 6 decades.”
Bringing it home once again, we must ask ourselves the same questions that Dr Tedros asked WHO member states: If we as a nation are not investing the majority share in our own health interventions, how can we claim have ownership of our own health space?
The tenacity, vision, and track record of Dr. Tedros in his public service in Ethiopia makes him a worthy candidate for the position of the next WHO Director General. At the recent Commonwealth Health Ministers’ Meeting, he promised to bring a fresh perspective, the perspective of developing countries to the work of the WHO.
Among many endorsements that he received was one from the legendary epidemiologist, the late Hans Rosling.
We hope that the passion and commitment to improving the health of ordinary people that he has shown in his work thus far will continue now that he has been selected to lead WHO’s efforts.
Ultimately, we are hopeful desire that his leadership will mean new strides for Africa with increased focus by WHO member states on policies and programs that will improve the dire health indices across the continent. Perhaps this election will inspire African leaders in health to bring their expertise, their will and their love for the continent to bear under the inspirational leadership of the new DG, leading to better health for the people of Africa, and the world.