Helping the poorest

Interview by Monique Eïd (WHO) and Jean Michel Jakobowicz (UNOG).

In your first interview to UN Special , back in 1998, you stressed that nobody was going to be fired in the proposed restructuring of WHO. What happened? 
It is very interesting to see that not only was nobody fired but we are today bigger than four years ago. That shows the increasing importance of global health issues. Although we have a regular budget that is frozen, we have been able to raise more extra budgetary resources and our activities are expanding. That is true both at headquarters, at regional level and at country level.

Are you satisfied with the restructuring of WHO?
We are still doing work in this area to improve our efficiency. In particular, we need to continue to strengthen our country level capacity. No organization that meets new challenges can afford to freeze every thing. There will always be additional workloads and challenges and therefore we will always need to adapt. However, the basic restructuring was done the first year I came here.

When you arrived you wanted to introduce the notion of “making a difference”. Did WHO make a difference during these years?
We have! There is no question that health issues are now much more present on the global health agenda, in particular the development agenda. That is the only way to ensure what one of my predecessor Dr. Mahler wanted to achieve, namely “Health for all”. During these last years we have been able to ensure that health would be included in all major summits, especially heads of states summits be it in Africa or at meetings of G-8. HIV/AIDS, malaria, tuberculoses have become a priority. There has been an increased awareness and the Millennium Declaration of the United Nations, has more health goals than one could have envisaged a few years ago. In fact what we have achieved is increased awareness, increased commitments of heads of states and of the international community. In this context a number of concrete objectives have been achieved, namely the recently created Global Fund to fight AIDS, TB and Malaria, which is being set up, GAVI the Global Alliance/*well, stop TB also. In the HIV field, the Global health fund will be moving as a financial system to supplement country action so that we reach more people.

Those are big achievements at global level. However big conferences and heads of state commitments, seem rather far from what you mentioned during your first interview where you insisted on the importance of the local action of WHO. 
No, we are not speaking about abstract declarations. We are speaking about 2 billion dollars, which will be used at country level. We cannot improve the health situation at country level by sending two or three WHO staff. That is not going to improve the situation in villages. There is a need for more funding for concrete projects based on technical expertise which WHO possesses, since countries that are poor do not have the resources to do what we advise them to do. What we are talking about when we speak of the Alliances for example, are the mechanism with which we can have increased funding. Because without increase funding there is not going to be country level action. I will continue to stress that everything is measured on how the situation on the ground is improved. How key health indicators are improved. That was and still is my only benchmark. In order to improve our ability to better service the countries, we have had two meetings of our WHO representatives. They have attended a week long seminar at headquarters to find out how better we could move forwards and sharing their experiences.

Who is going to monitor the Global Fund? 
The Global Fund is a mechanism set up by a number of donor countries with a board composed of seven representatives of industrialized countries and seven of developing countries, and three NGOs. WHO has an ex-officio place on the board, with the World Bank and UNAIDS. We contribute expertise. The monitors of the fund will be the donors and the recipient countries. WHO is there to advise developing countries on how to apply for funds, and how best to use them.

How is the cooperation between WHO and the private sector developing? 
When we first met I remember that you were quite shocked by the fact that I had started discussing with the pharmaceutical industry, even though many UN agencies had done so during the previous 25 years. But my approach has always been not to be dogmatic and discuss with industry because they are the one who manufacture drugs and developing countries need these drugs. There is no way not to have a dialogue with those who produce medical technology. At the outset, companies were donating their products for onchocerciasis for example or river blindness. However you cannot just send them with a plane and hope that the medicines will be delivered. That is where WHO comes in. We know how it should be distributed, how it should be administrated, and how you follow up the patient. This is done with river blindness and leprosy.

Why does the industry donate?
Nobody can say what is more important for a company but for us the bottom line is to help the poor people to become healthy. Donation is one way, trying to push down prices of essential medicine is another. In both cases our aim is achieved. There are now 25 public-private partnerships which deliver important health interventions to people. One example of such a project is something, which has happened in the last months, a partnership with the publishers of medical literature, so that developing countries can have access to publications either at no prices or at very reduced price. Until this partnership was signed, the publishing companies used the same price for their journals whether they were sold in Japan or in Bangladesh. This agreement will give greater access to medical knowledge to medical personnel in developing countries. There are many such programs.

Drug patents were also one of the main concerns when you took over? 
That was indeed a big problem. As you may recall, in 1998 GATT member countries had just signed the TRIPS agreement — Agreement On Trade-Related Aspects Of Intellectual Property Rights, Including Trade In Counterfeit Goods. The signatories of this agreement had decided that patent systems should be strictly followed. For the health sector it was a big issue. Subsequent decisions led to the safeguards, within the TRIPS agreements, to take care of public health concerns in the poorest countries, should be used, and countries should be helped to use them.

How do you see the future of WHO?
We will be measuring our success by our ability to contribute to concrete actions aimed at improving the health of poor people, that is the bottom line of making a difference. We have a role in helping countries and civil society to change society and we act as a catalyst, an inspiration, and a knowledge base. We have the experience.

You want to continue on the same line: “making a difference”?
Yes!

What is your policy as it relates to rotation of staff? 
The whole issue of human resources is a complex one. Rotation does not only mean people coming or going from headquarters to countries or vice versa, or moving to a regional office. The key factor behind rotation is exchange of knowledge. It is very important that people having an experience, let us say in Africa, bring it back to headquarters, or to the regional office in Manila, or to a country in Latin America. This diversity and exchange of experience is profitable not only to the staff member, but also to the organization and, what is even more important, to the countries themselves. We are now working on how to improve it. But it remains complex, because some people like to move, others, mainly for family reasons, prefer to stay where they are.

How does the organization address the stress problem faced by many staff members? 
First I have to say that people work hard. There is a general feeling of responsibility, because we work in an organization that has goals to help other people. Therefore, if people come to work here they are coming to try to make a difference for humanity. Therefore, people are working hard. The challenges are always bigger especially as we have launched many new projects. We are stretching our capacity. Many people love it and get inspired by it. But it also happens that people feel that it is too hard. And that is where the stress comes in. But one thing, which is key in this respect, is the working environment. A good team, a good management can change many things. We also have mechanisms to help people, like the ombudsperson, and the medical service. But I have to stress, that it is always a managers’ responsibility to be in dialogue with staff to see that they are being helped, to take care that they are being used in a good way, to make sure that they get the proper training and challenges which are achievable within a half year or one year. This is the kind of culture which can prevent unnecessary stress and help people.

After four years as head of WHO how do you like it? What is better to be a prime minister or the head of a UN agency? 
I am always most happy about what I am doing at present because my mind is focused on it. Time has passed quickly, there has been such a lot of challenges in such a short time. It is an inspiring and difficult job because you feel totally responsible to try to do the utmost. It is a very intense kind of work. As for my previous job, it seems very far away. It is already five years ago that I was prime minister and I am focused on the present and on the future.

What about the future? Are you going to run for another term? 
The future will tell you!