Despite the polycrisis confronting our world, as UN Secretary-General António Guterres counsels, we must rebuild trust and restore hope in 2024. In global health there are grounds for optimism, and opportunity too. Some of that lies in the World Health Organization (WHO). When Dr Tedros, WHO’s director-general, assumed helm of WHO in 2017, Anders Nordstrom, a former senior WHO member of staff decried the performance of WHO’s country offices and declared that “radical change is needed.”1 Arguably Tedros is delivering. What happens “on the ground” is central to his WHO Transformation initiative and the empowerment of country representatives. Crucially, Tedros will play a role alongside regional directors in jointly selecting future country representatives.
The process for the election of regional directors provides another opportunity for critical WHO reform. Last year demonstrated the need for change with one WHO regional director dismissed over misconduct2 and the election in another WHO region questioned, rightly or wrongly, for nepotism and breach of the existing code of conduct.3
WHO has placed the issue on the agenda of the meeting of the Executive Board this month, signalling that it appreciates the need for change. The Secretariat’s background note sets out a series of options for the board to consider.4 Many of the proposals are ones that we have advocated to the board and chairs of the WHO Regional Committee last year.4 These include term limits, introducing minimum requirements for the post, establishing search and/or evaluation committees (possibly with the support of recruitment firms), live candidates forums (including the proposal to allow the press to pose questions), establishing an oversight mechanism where breaches of the code could be tackled, more precise guidance for campaigning (and limits to travel), strengthening disclosure of campaign activities. Crucially, it suggests the possibility of introducing “wording on conflict of interest for candidates” which might be interpreted as tackling concerns around nepotism.
We understand that when these measures were discussed at an informal meeting in preparation for the board meeting, some members stressed the need to respect the autonomy of regions. While we appreciate the benefits of regional approaches to much of the work of WHO, in the case of governance practices, we think a more universal approach is warranted. Standards of governance should be set globally by the Executive Board to reinforce the reputation of the WHO as the world’s leading global health organisation. It is worth bearing in mind that all UN staff must swear a common Oath when they are appointed, suggesting that universality is important when it comes to matters of public office.
We commend the Secretariat for putting forward proposals that would help align the process with the principles of good governance expected for the 21st century and which promote ethical standards in public life.
We call on the board to adopt a bold set of ambitious reforms to guide the future selection of regional directors that will promote integrity and effectiveness—another legacy for Dr Tedros and a contribution to health for all in the coming years.
Footnotes
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Competing interests: The authors declare no conflicts of interests.
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Provenance and peer review: not commissioned, not peer reviewed.