Three by five: The new WHO challenge

Like Kofi Annan and Michel Jarraud from WMO, you are an insider: does it help?
I also have another point in common with Kofi Annan, we both started in WHO.

So to become Director General (DG) or Secretary General you have to go through WHO?
I think it is a very good training ground (laugh)! To come back to your question, I don’t think it really matters whether the DG comes from outside or inside, but I think alternation is a good thing.

Is it the reason why most of your Assistant Director Generals (ADGs) are from outside?
Yes, indeed. Having been inside the system for 20 years I needed fresh views. Like in biology, I don’t believe in in-breeding, it is not always very good for the health of living creatures. I think the same applies to organizations.

Unlike your predecessor, none of your ADGs are coming from the private sector. Does it mean that you want to loosen the relation between WHO and the private sector?
No, not at all. In fact there is no ideological background to my choices. It is just a matter of competency. Had I found a person in the private sector who suited the post, I would not have hesitated to take her or him. By the way the person from the private sector who was hired by my predecessor stayed only two years. As for WHO’s relations with the private sector, I have no wish to demonise the private sector. I think that many firms and enterprises are crucial partners for WHO. That is why I want to be engaged with the private sector. Some of them are very strong contributors for health.

In the 1980s WHO’s slogan was “Health for all by 2000”, recently it was “making the difference”, what will be yours?
Health for all was a wonderful idea; the idealism and enthusiasm behind this campaign are still valid. The New health paradigm, mentioned by Dr. Nakajima was a very strong suggestion but because of a less than ideal situation in which Dr Nakajima worked, the theme didn’t really fly. Dr Bundtland wanted to emphasise that health is an essential component in development, and that anybody working in development field couldn’t do it without taking health into account. It was a very strong message but which didn’t really pass. As for my own “slogan” I don’t have any for the time being.

What do you mean by 3 by 5?
I have committed WHO to reaching the goal of providing 3 million people in developing counties with access to antiretroviral treatment for HIV by the end of 2005. When you know that today only 300,000 people are treated in all developing countries, it is a huge challenge which we have to win, multiplying by 10 the number of people who will have access to HIV drugs. The problem is raising the awareness of donors on this issue which unlike SARS is not a new one. AIDS is now 20 years old, and it has become a kind of chronic disease in developed countries where patients survive year after year. But it is not the case in Africa and in other regions of the world where HIV/AIDS kills millions of people every year.

How do you judge WHO’s reaction to SARS?
It was very impressive, we put in a lot of resources and a lot of effort and it worked. Now what we have to do is to better prepare ourselves for such events. We have to strengthen our capacity to react. We have pretty good standard operating procedures to respond to outbreaks but what we are lacking is standard political procedures. For example, how we declare that an area should be isolated, or travel should be limited. When we decide that people can travel again to these areas and so on.

Why is Dr. Heymann not any more in charge of the SARS problem?
My opinion is that people should not stay in their jobs forever. I myself have changed jobs every three-four years. We are an organization which should function not with individuals but as an entity.

Why was none of the regional directors candidate for the post of Director General?
It is true that when Dr Brundtland was candidate three of them did pose their candidature. This time none did, perhaps because they saw that I was a candidate and they all felt that they should support me.

What will be your relation with the regions?
I think it will be good because I spent seven years in the Manila office and before that three years in a country so that I understand the region and the countries, I understand their aspirations. I think there can only be an improvement of the relationship between headquarters and the regional offices.

Dr Brundtland mentioned to UN Special that she wanted more people in the field and less in Geneva. What is your point of view?
I want to discuss with my ADGs and Regional Directors a comprehensive plan of rotation. Not only to send people to the field but also to bring people to Geneva. It should not be a one-way road where people stay forever abroad. We need indeed their expertise here in Geneva and it is only fair that they should be able to come back. I want to do this rotation policy on a global basis; that is why I want a comprehensive plan, with one key issue being studied in-depth: namely its cost. Because rotation policy has not only a political dimension but also a non-negligeable financial aspect, which should be carefully investigated. We will do it slowly and carefully.

Other aspects of staff policy you would like to change?
A number of them are on my agenda, but in many cases I am tied down by the common system rules. For example, I would like to increase paternity leave from one week as it is now to at least one month. But I don’t know whether it is possible because of ICSC rules. Another small thing, which I would like to do, is to help working mothers with small children, perhaps by funding a kindergarten or something similar. I know that ILO is interested in a similar project. We could perhaps join forces.

What is your point of view vis-à-vis short- term contracts?
To my mind they create a very bad atmosphere. What I would like to achieve is that to the utmost possible WHO staff should have regular contracts, not just short term ones. Some of them have had this type of contract for 10 or 20 years. It does not help to create a good atmosphere in the organization. And it is not good for the professionalism of the organization.

One of your former directors used to say that one joins WHO as a good technician and leaves it as bad technocrats. What do you think of this assessment?
It is in some cases true, but what I would like to do is to fight against this tendency. The answer to it is training. When I was director of one of WHO’s departments, I always encouraged staff to get regular training. We found a number of ways to do it. Now as head of WHO I want to generalize that. A technical organization such as WHO cannot survive with people who live their entire professional lives with a training they acquired when they were 20 or 30. Everybody needs training especially with the scientific context in which we live today. That is why training will be one of my first priorities.

Why did you need to hire a private consultancy firm to advise on how to run WHO?
Being an insider and knowing the organization, I felt it was important to have somebody from outside look at it and give me their views. When you are so used to working in a certain structure you finally lose an overall sight of the organization. It was a very useful exercise for me.

You wanted to install an open space policy in WHO?
That was my intention but I had an architect estimate the cost of such a change. The price was extremely high, one million Swiss francs per floor. I could not justify such an expense so I am looking at ways of introducing these changes gradually. Another thing which we will do is to transform the old cinema into a more modern welcome centre where we will be able to present all WHO achievements to visitors.

Do you read UN Special?
Yes, I have enjoyed reading it for many years and I will not stop now that I am Director General of WHO.

Interview by Jean Michel Jakobowicz