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Electing the new Director General of WHO: Increasing Transparency?

On May 23rd the World Health Assembly, the governing body of the World Health Organization, elected a new Director General, Ethiopia’s Dr. Tedros Ghebreyesus.

This was the first time all Member States cast a direct vote, replacing the earlier practice of deciding by a vote of the Executive Board and presenting for approval to the WHA.   This new process, the main elements of which were approved by the World Health Assembly in 2013, was watched closely as a means to address earlier conflicts around transparency and alleged “votes for favours”, and as a model for wider reform among other agencies in the UN system. 

Did this new approach succeed?   Yes and no. 

The new framework, which included a code of conduct was a clear improvement in many respects but highlighted how much still needs to be done.  The code of conduct focused on both candidates and Member States, and set out categories that can be loosely defined as behaviour (respect for candidates, agreement not to disrupt campaign activities), fairness and transparency (agreement not to influence or promise benefits in exchange for a vote, disclosure of grants or funding between Member States involved in the election for the previous two years, availability of candidates’ statements to all interested parties), and resources (aligning visits around existing meetings, minimising costs so as not to favour wealthier Member States or better resourced campaigns). 

The criteria and principles included equitable geographical representation (acknowledging that no DG to date had been elected from EMRO, SEARO or AFRO regions); technical qualifications including background and experience in public and international health; skills in leadership; commitment to the values and mission of WHO; and principles including merit, transparency and equity. 

The process was opened in several ways including an open call for nominations, a candidates’ forum at which the Member States were able to become acquainted with the positions and personalities of each candidate; a vote at the January 2017 Executive Board to select three final candidates, and continued campaigning by the finalists including  joint interviews, a debate at the Graduate Institute and meetings with Member States.   

What worked? 

The shift from a closed-door to open process was regarded in positive terms, though there was also skepticism about how much of a “flattening” effect the one-country-one-vote approach actually had, given the recognised though unofficial influence larger states likely had on the outcome. 

The financial transparency worked up to a point, though it was never entirely clear how much supporters of the campaign were spending outside of the candidates’ declared funding

What did not work

This can be summed up as “candidate narratives,” which were circumscribed by the need to keep all potential voters happy by not saying too much about which programmes might be scrapped and the ways in which indirect and direct media coverage assumed more importance in drawing distinctions among the candidates. 

The process of seeking votes from all countries made it difficult for any of the candidates to develop positions that differed substantially from one another.  All agreed WHO needed to be better in emergencies, universal health coverage, and reform, though within that there were actually quite notable distinctions and positions. 

But the absence of clear distinctions meant that how each candidate was covered by the media assumed greater importance, and the coverage was more often than not misleading and confusing.  For example, David Nabarro, who often described himself as “preparing for the role” for his entire career, was portrayed by others in ways that seemed to de-emphasise his diplomacy and skills in favour of a focus on an oversimplified version of a frontline warrior, with a “Boris Karloff voice”.  An unfortunate amount of attention also focused on twitter feuds that were a distraction.  Tedros Ghebreysus’ coverage oscillated between glowing and confusing, ranging from high profile endorsements in The Guardian to unfortunately timed reports shortly before the vote. 

Sania Nishtar’s candidacy was consistently downplayed and, despite almost four decades of leading through challenges starting with becoming head of her household at age 15 in Peshawar near war-torn Afghanistan, she was often painted as more of a dilettante and academic than a highly qualified and courageous leader.  Gender bias in language and emphasis was an issue in several pieces, most prominently the New York Times, with Women in Global Health offering a sensible alternative.   Finally, media coverage in the weeks before the election also conflated the campaign with a fight on social media that broke out between alleged supporters of the two other candidates, upending what had been until that point a largely balanced and positive three-way race and creating a misleading “whoever wins the fight wins the election” mindset.

Some recommendations for the next time:

  1. Financing. Clarity and transparency around the financing of the campaigns were stated principles of the campaign process, but there was some ambiguity in how and when numbers were reported and if the full amount was reported.  Similarly, proposals to have a spending cap and more standardised reporting were not taken up and should be considered for future elections.   Further, the requirement to address WHO budget challenges should have been more explicit and a requirement of the candidates, given how fundamental issues including potential cuts from traditional donors, the high level of voluntary funding, and stresses on the budget from legacy costs are. 
  2. Clarity and weighing around gender and geography.  After a campaign for UN Secretary General in which there was a broad (though ultimately unsuccessful) campaign to elect the first female SG, the new SG promised to increase the number of positions held by women across the UN system, where over three-quarter of the 40 or so agencies and programmes are led by men.   While all candidates stressed the importance of overall qualifications, improved geographic representation was an underlying theme and the election of Tedros means that AFRO has its first DG, with EMRO (the region represented by Sania Nishtar) and SEARO still without a DG.  In the wider UN context, most of, much of top posts are held by individuals from Europe (37%), followed by the Western Pacific (22%), Africa (19%), the Americas. (16%), the Eastern Mediterranean (6%) and South-East Asia (0%).   Should additional weighting be given to underrepresented regions and to gender?
  3. How the DG will engage with the changing role of donors and other non-state actors should have been made more explicit, tied to financing but also to successful implementation of the SDGs in an increasingly multipolar world.   A clear plan for this should be included in the criteria.   

The election was an important first step in a much wider movement towards UN reform.  The global health community is to be commended for embracing this approach and the process itself generated much more attention and visibility for WHO and the serious issues it is facing than would have otherwise been the case.  Now it is time to focus on supporting the new DG in the daunting work that lies ahead while ensuring that the openness, transparency, and transformation that the election process represented continue to be a central part of the WHO and UN agendas moving forward.

Johanna Ralston is a Fellow of the Geneva Centre for Security Policy and former CEO, World Heart Federation.