A joint campaign between THE LANCET and the Rockefeller Foundation aims to instill transparency, accountability, and vigorous public debate about the election of the new Director-General of WHO. THE LANCET is this week publishing an open letter to WHO's Executive Board to highlight the most critical issues that the new WHO incumbent will face at a time when health inequalities between rich and poor nations are dramatically widening--and at a time where WHO's external failures and internal conflicts urgently need addressing. The open letter--the result of a recent meeting in Tanzania between key organisations committed to the future success of global health, including WHO itself--challenges WHO's 32-strong Executive Board to address 10 critical questions to the five shortlisted candidates who will be interviewed for the new WHO Director-General appointment in late January. Key issues posed in the letter include the future vision of WHO, how WHO should collaborate with global and country-wide organisations, the role of WHO in setting the agenda for health research, and questions about improving internal processes within the agency at a time when staff morale is at an all-time low.
In addition, the campaign seeks to elicit responses to the questions in the open letter from the nine candidates in contention--WHO's Executive Board will reduce the number of candidates to five in a secret meeting taking place on January 20, 2003. This week's Lancet Editorial comments: 'We invite all nominees for Director-General to respond to these questions in advance of the January Executive Board meeting. Candidates might welcome an opportunity to use these questions as a means to define their personal platforms for election. At present, there remains no other way for them to do so publicly. Their willingness to take part in this open debate will also signal their commitment to a transparent and accountable election process.'
An accompanying Commentary (p 1799) by Lancet Editor Richard Horton and Ariel Pablos-Mendez from the Rockefeller Foundation critically reviews WHO's recent failings in order to identify key priorities for the new Director-General. WHO is criticised for lacking leadership, "….there has been no sense of urgency in WHO's leadership, no sense that WHO must reinterpret its mandate to advocate on behalf of the world's poorest people.". Horton and Pablos-Mendez comment how Africa--with its appalling scale of humanitarian disaster, HIV/AIDS epidemic, and a severe problem with corrupt Governments in many of its countries--is a crucial yet presently neglected future priority for WHO. They also comment on the severe underfunding of WHO, suggesting that the new Director-General could move in one of two directions: to campaign for appropriate funding rather than having an over-reliance on outside donations, or--more radically--to re-address and reinvent its overall function. WHO, they argue, could be a more effective global agency if it concentrated on fewer projects by reducing the duplication of work of other agencies, such as UN AIDS in tackling the HIV pandemic.
Richard Horton and Ariel Pablos-Mendez comment: "For WHO in 2003, the right leader will be someone who is prepared to lead the global health community on behalf, first and foremost, of the world's poorest people; a person with strong public-health instincts, a demonstrable commitment to advocating global health equity, evidence of transparent and democratic management, and a history of inclusive decision making, especially concerning civil society; a leader, in other words, with the courage to redistribute WHO's budget to countries, to give staff greater autonomy, and to be prepared to upset and irritate enough governments to ensure that the new Director-General may serve only one term."
Richard Horton comments: "This election will, directly and indirectly, affect the lives of every person on the planet-and yet there will be no manifestos published for debate, no formal hustings for analysis of the predicament of the world's most vulnerable people, and no forum to discuss a role that carries more influence on human life than any single presidency or Prime-ministerial position. This election demands public scrutiny and rigorous debate – and there are only 6 weeks to go."
George Soule, Office of Communication, The Rockefeller Foundation, 420 Fifth Avenue, NY, NY 10018, USA; T) +1-212-85-8456; F) +1-212-852-8441; E) gsoule@rockfound.org; W) http://www.rockfound.org.
Journal
The Lancet