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The new World Health Organization director general last month announced a range of officials to serve as programme directors, touting the unusual achievement of naming almost all women to add to an overall women’s majority in the senior leadership of the organisation – a first for the UN. Now after some questions arose over the choice of a Russian official to head up efforts against tuberculosis, the WHO defended its choices as fully merit-based, including in an email to Intellectual Property Watch and its sister publication Global Health Policy News.

From the original message to staff from WHO Director General Tedros Adhanom Ghebreyesus of Ethiopia (Dr Tedros) on 15 December, the new directors are:

“Ms Elizabeth Iro, whose appointment was announced during the Western Pacific Regional Committee Meeting in October, will be joining WHO as Chief Nursing Officer. Ms Iro is from the Cook Islands and is a registered nurse. She is currently the Secretary of Health of the Cook Islands.

Ms Dominique Hyde as Director for Strategic Engagement in the new cluster for External Relations. Ms Hyde is from Canada and has joined us from UNICEF, where she was deputy director of public partnerships.

Dr Samira Asma as Director in the new Cluster for Metrics and Measurement. Dr Asma is from the USA, and she is currently on secondment to the Transition Team from the US Centers for Disease Control and Prevention, where she is Chief of the Global Noncommunicable Diseases Branch.

Ms Sheenaz El-Halabi as Director in the Office of the Director General. Ms El-Halabi is from Botswana, and she was previously Permanent Secretary of the Ministry of Health of Botswana.

Dr Tereza Kasaeva as Director of the Global Tuberculosis Programme in the Communicable Diseases Cluster. Dr Kasaeva is from the Russian Federation, and she is currently Director of the Department of Medical Care in the Ministry of Health of the Russian Federation.

Dr Hama Boureima Sambo as Director in the new Climate and Other Determinants of Health Cluster. Dr Sambo is from Niger, and he is currently WHO Representative in Gabon.

Ms Min Whee Kang as Director in the Office of the Director General, from 1 December. Ms Kang is from the Republic of Korea and has also joined us from UNICEF, where she was Chief of the Central Region in the ‎UNICEF Afghanistan Country Office.

Ms Diah Saminarsih as Advisor on gender and youth in the Office of the Director General. Ms Saminarsih is from Indonesia, and she is currently Special Advisor to the Minister of Health of Indonesia.”

Selection “Based on Merit”

In a 7 January email to Intellectual Property Watch from the WHO press team, the secretariat stressed that the appointments were based on merit and made in consultation with others.

“It’s important to emphasise that merit was the first criteria for all appointments, while secondary consideration was given to gender and geographical diversity, to make WHO more representative of the world we serve. The new appointments were made in consultation with WHO’s six Regional Directors, who helped to identify the best candidates.

Dr Tedros also sought to appoint qualified people with country-level experience, as a vital complement to the technical expertise that already exists within WHO. This will help to accelerate progress at the country level. These same principles will continue to apply to future senior appointments.

Dr Tedros’s overarching objective is to have the best possible structure and staffing at all levels of the Organization to align with the 13^th Global Programme of Work  and ensure its full and effective implementation. So review, change and revitalization  is happening across WHO – not just at senior levels – to improve results and deliver on our bold ambitions, especially at country level.

This applies to the appointment of Kaseava as well, they indicated.

Concern about Appointment

Some NGOs were quoted in reports from Brussels and London as raising concern particularly about the naming of Kaseava after Russia hosted the “WHO Global Ministerial Conference on Ending TB in the Sustainable Development Era” in November. The conference website is here. It resulted in a commitment to end TB by 2030, press release is here. The Russian government reportedly committed millions to WHO at the conference.

Well over 100 nongovernmental organisations and individuals from around the world, particularly India, Brazil and various parts of Africa, sent a letter [pdf] dated 11 December (the day of his announcement of new directors) to Dr Tedros specifically calling for a “competitive, open process to identify an experienced, change-oriented leader that is needed to drive forward evidence-based guidance and advance human rights in this pivotal moment on TB.” They urged him to “lead a transparent process that gives full consideration to a range of candidates from diverse backgrounds and perspectives, to identify the best leader for WHO’s work with a range of constituents to end TB.”

Such a process, they said, “would include an opportunity to solicit the input of various stakeholders, including civil society, into the selection process.”

Dr Tedros replied with a very positively worded letter [pdf] on the same day, in which he stresses that ending TB is a “very high priority” for him personally and for WHO, and offering vigorous support for his choice of Kasaeva. He mentioned that the November ministerial conference in Moscow gave them “a significant boost moving into next year’s UN High-Level Meeting on TB.” He also tied TB efforts into his broader goal of universal health coverage, and cited Japan among others for their support for that.

Then he told the NGOs that he has “invested significant time and energy engaging with TB organizations and civil society.” The new directors are “highly qualified,” he said.

He acknowledged, however, that the selection of the TB director was not done in the same way as in the past, which is what the NGOs’ requested, because “with WHO facing urgent challenges – and unique opportunities such as the High-Level UN Meeting on TB – I felt strongly that we needed to fill these director positions with high-quality individuals who could hit the ground running urgently, without waiting for the unusually long recruitment process.”

“I am confident that we have found the right person to lead the TB Program at WHO – Dr. Tereza Kasaeva,” he said, noting that she is an MD with a PhD in public health, focusing on TB treatment, plus a Master’s degree in international relations. She will work closely with new Deputy Director General Soumya Swaminathan, herself a renowned TB expert, he added.

“We are committed to make WHO’s TB program truly world-class,” Dr Tedros wrote.

Meanwhile, the Stop TB Partnership, a UN-affiliated group in Geneva, has indicated support for Tedros’ choice of director, according to reports.

Analysis of Leadership Team

A look at the eight directors who were named does not appear to show any particular patterns other than an emphasis on women and geographic diversity. There were: Three from Asia or the Pacific, two Africa (one francophone, one anglophone), two North America, and one (Russia) that crosses Europe and Asia. One might note an absence of Latin America or Europe in the list.

The countries represented at director level are: Botswana, Canada, Cook Islands (Western Pacific),Indonesia, Korea, Niger, Russia, and United States.

Where the officials are coming from also seemed fairly random, but with an emphasis on people from outside of Geneva and the WHO. Only one came from the WHO (from the African region), with two from partner UN agency UNICEF, and five from the national level.

Tedros earlier named (IPW, WHO, 3 October 2017) his top leadership team of deputy and assistant directors general, also displaying a prominence of women and geographic diversity, though with more representatives from Europe. Only Russia saw an appointment at both the top level and director level. Meanwhile, there does not appear to be any representative of a Spanish-speaking country at any level of the leadership.

The New WHO Model of Gender Equity

Meanwhile, Dr Tedros’ arrival has ushered in a new era in which women outnumber men at the top of a UN agency. In his 15 December message to headquarters staff announcing the appointments, he stated:

“Dear colleagues,

I am pleased to announce the following appointments of senior colleagues who are joining the WHO leadership team. These outstanding public health leaders were selected during the recent transition period and bring a wealth of knowledge and experience to WHO. They further demonstrate the professional, gender and geographic diversity that characterizes the new leadership team – and that is critical to fulfill our mission of health for all at the World Health Organization.

Particularly on the issue of gender, despite setting a target of achieving 50% gender equity in 1997, WHO has not lived up to that goal. Two decades later, only 28% of the directors are women.

As you’ve seen, we’ve started to change that, first when I appointed nine extraordinary women in October to the senior management team. For the first time in WHO history, women outnumber men in the senior leadership. Now, with this appointment, we’re adding eight extraordinary individuals to the leadership team – seven of whom are women.

Despite this progress, I fully recognize that a lot of work remains. To continue this work, we are already working with experts on refining the recruitment process to tackle some of the unconscious biases that have created gender and geographic inequalities – and to ensure we can more quickly and efficiently bring in diverse talent where we have gaps. I firmly believe that reaching this goal is the right thing for the organization and for global health.”

The WHO press team also emphasised these points in the email to Intellectual Property Watch and its upcoming publication Global Health Policy News:

“Dr Tedros campaigned on a promise to achieve gender equality and greater geographical diversity in WHO’s top leadership. The fact that he was overwhelmingly elected by the Member States was a strong endorsement of this approach, and we fully expect that the Member States support him as he now works to fulfil his campaign promises.

More than 60% of WHO’s senior leadership are now women, making WHO the first UN agency to have more women than men in its top ranks. Additionally, 7 of the 8 newly-appointed directors are women, a 40% increase in the number of women at director level at headquarters. In terms of geographical diversity, 14 different nationalities are now represented among WHO’s 14 Deputy and Assistant Directors-General.

It’s important to emphasise that merit was the first criteria for all appointments, while secondary consideration was given to gender and geographical diversity, to make WHO more representative of the world we serve. The new appointments were made in consultation with WHO’s six Regional Directors, who helped to identify the best candidates.

Dr Tedros also sought to appoint qualified people with country-level experience, as a vital complement to the technical expertise that already exists within WHO. This will help to accelerate progress at the country level. These same principles will continue to apply to future senior appointments.

Dr Tedros’s overarching objective is to have the best possible structure and staffing at all levels of the Organization to align with the 13^th Global Programme of Work  and ensure its full and effective implementation. So review, change and revitalization  is happening across WHO – not just at senior levels – to improve results and deliver on our bold ambitions, especially at country level.”