Jul 23, 1998

HEALTH: BRUNDTLAND TAKES OVER, WITH SWEEPING CHANGES, AT WHO

Geneva, 21 July (Chakravarthi Raghavan) -- Former Norwegian Prime Minister, Mrs. Gro Harlem Brundtland took over the top post at the World Health Organization, reiterating her campaign promise to "change the course of things" and to "make a difference", and announced some sweeping changes in the top echelons of the secretariat at Geneva.

Heads of organizations usually bring with them a few top aides, but this is probably the largest team brought in with a new head of the organization among UN agencies. 

She also announced a new code of conduct for financial disclosure by high-level WHO officials, and if judged necessary divest themselves of financial and other interests affecting their independence from external authorities.

The 'cabinet' style of administration announced, and the changes made, on the recommendation of her transition team -- which was headed by the 38-year old Norwegian diplomat, Jonas Gahr Store, and who will now head the Office of the Director-General, and be her spokesman -- may have cut out government nominations, clearance and influence in the appointments. 

The new appointments appear to have been the result of a "non-transparent" process of selection, atleast insofar as the developing world is concerned, and some are not the "best" candidates that the country or the region could have provided. There is already some talk among delegations and the staff of other influences.  

Influence and pressures of member-governments in appointments may have been replaced by other influences, some observers fear. The US Rockfeller Foundation has already announced a major funding support of about two million dollars to enable her to get "outside" advice.  

Cutting out levels of administration, Brundtland has appointed a 4-member team headed by Store, an Executive Director, to run her executive office, and nine other executive directors to run various "clusters" of WHO activity, presumably reporting to her and in practice perhaps to her executive office chief.  

The ten executive directors - six women and four men - will be her Cabinet of senior management team.  

Store was head of the department of international affairs in the Norwegian Prime Minister's office from 1995 until his appointment this year at the Norwegian Mission to UNOG, where he was heading Brundtland's 'transition team'.

The other members named to her executive office were: Dr. Anarfi Asamoa-Baah of Ghana (who was in the transition team), Dr. J.W.Lee of Korea (and director of the WHO global programme for vaccines and immunisation) and Dr. Daniel J.M.Tarantola of France (who has been at the Harvard School of Public Health).  

One of the key Executive Directors named is Michael Scholtz of Germany who is to head WHO cluster on Health Technology and Drugs, and comes to this post from the Pharmaceutical transnational SmithKline Beecham, and before 1991 Swiss pharmaceutical TNC Ciba-Geigy.  

And Mrs. Brundtland's response to a question about her stand on the last Health Assembly discussion over essential drugs, public interest and IPRs, made clear that she did not envisage the health organization going contrary to or following a policy different from that of the World Trade Organization and its TRIPS accord.  

The other Executive Directors named are: Dr. Jie Chen of China for the cluster on Non-Communicable Diseases; Dr. Julio J. Frenk of Mexico to head Evidence and Information Policy; Dr. David L. Heymann of US to head cluster on Communicable diseases (including eradication of leprosy, control of tropical diseases and TB), now Director of WHO Programme on emerging and communicable diseases; Mrs. Ann Kern of Australia to head general management (including budget, finance, information systems management and personnel issues); Ms. Poonam Khetrapal Singh (an Indian administrative service official who was permanent official heading the department of health and social welfare in the Indian state of Punjab, and has been a World Bank project officer on health) to head a cluster on sustainable development and healthy environments; Dr. Souad Lyagoubi-Ouahchi of Tunisia (now director of WHO's division of publishing, language and library service; Dr. Olive Shisana of South Africa (until recently was Director-General of the South Africa's Department of Health, but according to a questioner at Brundtland's press conference, which she did not rebut, was removed from that job recently); and Dr.Yasuhiro Suzuki of Japan, to head the cluster on Social change and Mental Health.  

Ten of the top appointments are 'outsiders', and three from inside the WHO. Neither her speech to the WHO headquarters staff on taking over, nor the background material provided by the media office, nor her responses at a press conference provided any clue as to how particular candidates were "selected".  

And on first blush, the appointments and some of Mrs. Bruntland's remarks, suggest greater influence at the WHO for the transnational pharmaceutical industry and the World Bank style health care policies for the developing world.

But, it is possible that with the appointees owing the job to her, she may be able to use them to get her way and implement her health philosophy.  

But this remains to be seen, and she needs to the support of member-governments

While Mrs Brundtland was articulate, in contrast to her predecessor Dr. Hiroshi Nakajima, who was handicapped by a speech defect, details of her policy and philosophy did not clearly emerge.  

In her speech to the staff, she said there "will be change, a change in focus... in the way we organize our work.... in the way we do things ... in the way we work as a team:"  

She also spoke of the internal task of  

• pulling WHO together by focusing efforts around the core business,
• reconnecting the organization through a flatter structure, better communication and more transparency and clearer distribution of responsibilities,  
• crating an organizational culture not driven by bureaucratic rules, but one promoting performance and results.

As for the external tasks, Mrs. Brundtland spoke of

• reaching out to the rest of the UN family and pursue imaginative ways of uniting our forces for health, development and poverty reduction, and 
• reaching out to many stakeholders - in civil society, in the private sector and in the broad health and research community. 

The ultimate test (of her and WHO success) she reiterated "is on the ground" and hard to measure, since WHO will not become a field agency and its role is one of giving advice.  

"We are not the prime health care providers. Governments and regional authorities, NGOs and civil society are.... (and) we must link up with them in a more binding and committed way.."  

Health Ministers (of countries) are already on board and "we need to reach a broader spectrum of decision-makers including ministries of finance and planning and even prime ministers and presidents -- we need to reach civil society and we need to reach the private sector."  

She also announced top priority in the campaign against tobacco and malaria and increased efforts on HIV/AIDS.

Mrs. Brundtland started off her press conference with the statement that she was new to the job and could not answer specifics.  

Asked how, though new to her job she had made such changes to the structure of the organization and who really behind it, Mrs. Brundtland said that the major structural change was part of the philosophy she had outlined in her speech to the staff earlier. 

Asked at her press conference about Shisana's appointment, in the light of her being sacked recently from her job in South Africa, Mrs. Brundtland thought she had been 'fired' from her cabinet or sub-cabinet political post, while the questioner said that according to South African media reports she was an 'official' and not a minister.

Mrs. Brundtland was also asked, in the light of the executive appointments announced, what was her position on the issue of "public health over commercial interests in formulating pharmaceutical and health policies" -- the subject of an WHO Executive Board recommended resolution which on a US-Italian initiative, and pharmaceutical industry lobby pressure, has been sent back to the Executive Board for further study.  

Before she took office, public interest Health NGOs, like Health Action International, in a reference to the Assembly failure, had appealed to Mrs. Brundtland to show "firm leadership" and ensure public goals receiving priority over commercial interests.  

Mrs. Brundtland in her reply said the discussions at the last health assembly had been a "difficult one" and it could not be said that one country was responsible for the Assembly being unable to adopt the Executive Board recommended resolution. 

That resolution had asked Member-States to review their options under the TRIPs accord of the WTO and to act to safeguard access of their peoples to essential drugs and ensure that "public health rather than commercial interests have primacy in their pharmaceutical and health policies" Mrs. Brundtland said that several international organizations had responsibility in this matter. The WTO, whose member governments also came to the WHO, had rules under the TRIPS agreement, and the WTO members had reached that agreement after a broad negotiating process, she claimed. But in the WHO people with a health focus come and address the same issues from a health perspective, she complained. 

"We cannot do something here which violates WTO rules.... The ministries of commerce of various countries and ministries of health should coordinate on how it should be interpreted. At national capitals there is too little communication and discussion between ministries. In the same way there is too little discussion between institutions..." 

"We will have to have consultations and dialogue at the WHO among member governments on how to interpret the TRIPS agreement and public health interest in the area.. But it needs more dialogue and consultations..."