WHO Director-General Tedros Adhanom Ghebreyesus washes his hands before visiting an Ebola treatment center in Itipo on June 11, 2018.

What Motivates Tedros: Part 2 of a Q&A with WHO’s Director-General

When he was the Minister of Health for Ethiopia, Tedros Adhanom Ghebreyesus used to worry instead about the health of 100 million people. Now as WHO’s Director-General, Tedros has 7.5 billion people to worry about.

In this second part of their Q&A, David Peters, chair of International Health at the Johns Hopkins Bloomberg School of Public Health, a longtime health systems researcher and WHO adviser, quizzes Tedros in an email interview on his leadership challenges, Ebola’s 2014 lessons for WHO and what schools of public health could be doing better.

Read Part 1 the Tedros-Peters Q&A here.

Ed. Note: This is part of a series of articles on public health leadership this month in Global Health NOW.

What’s most different in managing international politics from the role of a national leader to leader of a multilateral organization?

There are a couple of key differences. The first is that instead of making decisions based on national interest and other political considerations, WHO is an evidence-based institution that makes decisions according to what the science tells us.

The second major difference is that instead of 1 country with 100 million people, I now have to worry about 194 countries with 7.5 billion people. Of course, managing an organization with 8,000 staff in 150 countries is also no easy task. At 1 level that makes things much more complex, but it also means there is much greater potential for impact. I’m an optimist and I don’t think anything is impossible. There’s no other organization in the world with WHO’s global reach or broad mandate. The challenge we have is to make sure that we fulfil that mandate to the best of our ability. That’s what motivates me.

Disease surveillance and response is a global public good that you’ve prioritized. What do you think WHO has learned from West Africa’s Ebola outbreak?

Not only WHO, but the whole global health and humanitarian community has learned a great deal and has made substantial progress to ensure the painful lessons of that outbreak are not wasted.

Keeping the world safe from health emergencies is 1 of 3 key priorities in WHO's 5-year strategic plan, the General Programme of Work. We've set ourselves the ambitious goal of improving global health security, with 1 billion more people better protected from health emergencies. 

Building on the successful reforms begun under Dr. Margaret Chan, we’re redoubling our efforts to measurably increase the resilience of health systems based on WHO’s International Health Regulations. Those regulations focus on building core capacities to enable a rapid response at the source of an outbreak in every country in the world. 

In 2016 we established the new WHO Health Emergencies Programme. It was a profound change for WHO, adding operational capabilities to our traditional technical and normative roles. 1 of the lessons learned from West Africa is that disease outbreaks move faster than the money allocated to respond to them. As part of the Health Emergencies Programme, we set up a rapid response funding mechanism called the Contingency Fund for Emergencies (CFE) so that money is immediately available to jump-start an outbreak response. For example, when 2 separate Ebola outbreaks struck the Democratic Republic of the Congo this year, we were ready. Within hours of the first cases being confirmed, WHO allocated millions of dollars of emergency funding.

We've also set up an Emergency Medical Teams initiative to assist organizations and countries to build capacity and strengthen health systems by coordinating the deployment of quality-assured medical teams in emergencies. More recently, we’ve set up a mechanism with the World Bank to monitor and report on global preparedness to tackle outbreaks, pandemics, and other emergencies with health consequences.

Since the Ebola outbreak, some have emphasized the need to develop strong human resources, physical infrastructure and systems to rapidly identify and respond to outbreaks. Others have emphasized community engagement and integrated clinical and public health approaches at the local level. Most of the post-Ebola effort has gone to the former, and not the latter. Is this how it should be?

It’s not an either-or equation; both are exceptionally important. The best way to prevent outbreaks is to invest in stronger health systems that are oriented towards achieving universal health coverage. I often say that UHC and health security are 2 sides of the same coin. At the same time, community engagement is critical to an effective outbreak response. That was 1 of the big lessons learned from the West African Ebola outbreak, where effective community engagement helped turn the corner in the response.

Today, WHO sends community engagement specialists and anthropologists out to the field during an outbreak response just as quickly as we send epidemiologists and clinical care specialists. It’s critical to know and understand communities in order to effectively work with them in all phases of an emergency, from preparedness to response to recovery.

What should schools of public health be doing differently? What role do you see for universities in working with WHO? Are there new opportunities for collaboration?

WHO values the immense contribution of schools of public health to the education of global health advocates, leaders and practitioners, the generation of evidence, and collaborations to deliver innovative solutions for modern health challenges. But we can always do more, and we can always do better—we need more collaboration between universities, communities, health systems and practitioners to generate and share intelligence.

We need to identify and advocate for and with communities for solutions to tackle the health issues of greatest impact, with the most effective and efficient use of resources.

 Collectively, we need to grow public health leaders with skills in policy analysis and advocacy, to ensure decision-makers have the tools to affect real change. We also need to work harder to establish the case for investment in human resources in every country to achieve UHC and the SDGs.

Public health professionals play a vital role in advocating for universal health coverage and the health systems that deliver it, and in strengthening countries’ capacities to respond to emergencies in a holistic and sustainable way.

Just as capable health professionals are vital to the health of an individual, we need capable health managers, human resources scientists, planners and policy-makers to attend to the health of entire systems, all backed up by stronger evidence.

To have the greatest impact, those of us working in public health must stay aligned and consistent in our efforts to ensure the translation of knowledge into action.

We encourage universities to engage with the Global Health Workforce Network, which has established 7 thematic “hubs” for sharing intelligence to take forward the actions of the 2016 Global Strategy on Human Resources for Health and the recommendations of the High-Level Commission on Health Employment and Economic Growth. The hubs relate to gender equity, youth, education, data and evidence, health labor markets, community-based health workers and human resources leadership.

Ed. Note: This is the first installment of a Global Health NOW series on public health leadership.

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WHO Director-General Tedros Adhanom Ghebreyesus washes his hands before visiting an Ebola treatment center in Itipo on June 11, 2018. Image: Junior D. Kannah/AFP/Getty Images