The Right Person at the Right Time for Global Health

This week, Dr. Tedros Adhanom Ghebreyesus takes the helm at WHO following a decisive victory in the most transparent election in the organization’s history. He is the right person at the right time to build on the foundations laid by his predecessor, Dr. Margaret Chan.

I have known the new Director General since the early days of his appointment as Minister of State for Health, and have watched him closely as he became the senior Minister of Health in Africa before becoming Minister of Foreign Affairs, a post he left to focus on the WHO election. Tedros is among the most visionary leaders and capable managers I have ever met.

Tedros inherited one of the weakest ministries of health in the world, and rapidly transformed it to one of the most effective, achieving virtually all of the Millennium Development Goals (MDGs). He succeeded for two fundamental reasons: he set a clear direction with goals and accountability, adjusting as the data on the ground required, and; he rapidly reorganized, reformed and repopulated the ministry.

The new Director General’s North Star was universal health coverage before it became the guiding light of global health as captured in the Sustainable Development Goals (SDGs) that followed the MDGs. He built more than 16,000 health posts, enough for every village, and hired two community health workers, nearly all women, for each of them. He linked the villages to the districts to the provinces to the national system. The initial results were far less than expected. Rather than taking the bureaucratic approach, digging in and defending what he had done, he immediately assessed the data and adjusted. As he often says, “the hardware was there, but the software wasn’t.” So he created several highly successful initiatives to mobilize community engagement and ownership. The remarkable results followed. He also led the entire support community, including international funders, to support his vision. As a result, his multi-partner “pooled” fund was highly successful.

It was not just in the villages that transformation was needed. The Ministry had been filled with former revolutionaries without significant experience in, or even knowledge of, health. Tedros strategically, systematically, and with care for the people involved, moved the “old guard” to retirement or otherwise opened the positions he needed. Then he looked for the best and brightest to fill them. As an example, he selected his deputy, who succeeded him as Minister, after watching him criticized his performance as Minister on national television. The new team was known as “Arsenal” after the football powerhouse because they were young, dynamic – and incredibly effective.

During his time as senior African Minister, he served in many capacities, including as a highly effective Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria. These various roles helped prepare him for his next phase as Minister of Foreign Affairs, where he managed many things from peace in Somali for the region to rescuing from a fractious debate the Financing for Development agreement that set the stage for adoption of the SDGs, Tedros proved himself a highly skilled diplomat and statesman. He also followed his playbook from the Ministry of Health and instituted similar reforms, creating a second Arsenal team in Addis.

The vast experience, expertise and skill the new Director General has honed over a highly successful career of public service will be needed to build on Dr. Chan’s advances to transform WHO. As the Ebola and Zika crises showed, and the risk of reversing the huge gains in childhood vaccines, HIV, tuberculosis and malaria make clear, running WHO requires technical knowledge, expert management and remarkable diplomacy.

While WHO is filled with some of the most talented and dedicated health experts, its headquarters is bureaucratic and inefficient. There are major challenges with the quasi-autonomous regional directors and offices. Major donors are expecting significant reform at a time when budgets are tighter and tighter. And the SDGs call on all countries regardless of income levels, not just low-income countries, to advance towards, and achieve, Universal Health Coverage. It is the job of WHO to set standards and hold everyone accountable. For the first time that includes WHO’s donors. That is not an easy task.

It is fortunate that the Director General has great expertise, experience and skill in dealing with similar issues throughout his distinguished career. When a new leader takes over, especially in an international organization of more than 190 member states, there is a tendency for everyone to provide their view of what should be done and who should be hired. It is my great hope that we will all resist that temptation, step back, recognize that a highly transparent process selected a tremendous leader with vision who is also a great manager, and give him space to do what he has done so well for so long: be a spectacularly successful transformational leader.

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