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Meet Dr Dirk Cuypers, Chair of PBAC and Financing Dialogue

Director of Planning, Resource Coordination and Performance Monitoring, Elil Renganathan, spoke to Dr Dirk Cuypers on the role of the Chairman of the Programme, Budget and Administration Committee of the Executive Board (PBAC), his experiences of reform and the financing dialogue.

Portrait of Dr Dirk Cuypers.
WHO

Elil Renganathan (ER): Many of us know you as the Vice-Chairman of the PBAC, member of the Executive Board and the incoming Chairman of the PBAC, but what is your professional background?

Dr Dirk Cuyper (DC): I graduated from the University of Gent in 1979 as a general practitioner, and practised for one year before I switched to the private sector to work in the pharmaceutical industry. I worked in the medical departments of the pharmaceutical industry, including in the position of Medical Director.

Reflecting on my skills, I realized that I had a lack of knowledge of management matters, so in the early eighties I decided to get a Masters in Business Administration. I was the first medical doctor (in Belgium) to get that degree, as physicians at that time were not interested in combining medical and business education.

"Everyone needs to have the same understanding of the strategic vision and direction we want to go."

Dr Dirk Cuypers, Chair of PBAC and Financing Dialogue

My business education was very applicable for my later positions, especially my current position in public service. In 2002, I switched back to the public sector because the Government was looking for people with experience in the private sector to contribute to the ‘Copernicus’ reform, which covered the whole administration.

They established 14 positions and I was appointed as Chairman of the Board of Directors of the Federal Public Service for Public Health, Food Chain Safety and Environment of Belgium. I was one of the first to accept the challenge – to move from the private sector to the public sector – and to start a new career.

ER: Was it an eye-opener for you, switching from the private sector to the public sector?

DC: There were two main differences between the private and public health sectors that I had not realized before gaining experience in both. There was a lack of coverage diversity in the pharmaceutical industry. More simply, the medical pharmaceutical industry was geared narrowly towards developing medical treatment and therapeutics; whereas, in the public service of health, you add the other aspects of health, such as prevention, curative health care, working with the elderly and all the different diseases.

The public health sector covers a very broad perspective, and that was the real challenge. You really need to work well in a team with different experts, as there are a wide variety of topics to cover. Secondly, the public sector was managed differently from the private sector; it was not managed at the level of the private sector. This was a major difference, and there was a large amount of work needed for this purpose.

ER: You have been involved in reforming the health administration in Belgium, please tell us some more about this experience.

DC: We started the ‘Copernicus’ reform, our reform in the public health sector, in 2002. The reform was focused on implementing the principles of new public management, with structural modifications and new tools. We shifted from large ministries to smaller public service agencies, with one for policy making and the other for policy execution. We imposed structural modifications based on “business process reengineering,” which requires that the organization be based on processes and that the staff be involved in bottom-up redesign of the organization.

We aimed to have less bureaucracy, and fewer management layers to become leaner. We had to employ different tactics; one was to produce a principle of good governance. We fully redesigned the human resources aspects of our organization so that there is a clear connection between processes and job descriptions. We began selecting staff based on general competencies rather than merits. So we put the right people in the right places. We constructed a professional communication department, which didn’t exist before – as you know, in health and in crisis management it is important to inform our citizens and stakeholders.

We introduced new management tools; at my level, jobs were given on a six-year mandate. You need to be evaluated before renewal. Now I am currently in my second term. This evaluation process for our staff was something new. Furthermore, we began writing management objectives with targets and key performance indicators to increase accountability and responsibility. For some, this aspect is sometimes difficult as it requires many discussions on targets, prioritizing, planning and evaluating.

We have also implemented the use of a yearly evaluation cycle with balanced score cards to determine our progress within our planned timeframes. One of the indicators of our successes is that in 2012 our department received the Randstad award; our department was the most attractive employer in the public services, and also well placed in competition with the private sector. It was an exciting indicator of our success given by an independent consultancy.

ER: Based on this reform experience from Belgium, what advice would you have for the WHO Secretariat when it comes to reform?

DC: The principles remain the same: first of all try to involve all the staff members through bottom-up redesign of the Organization and its processes. That is very important – reform will only work if everyone is heading in the same direction. Everyone needs to have the same understanding of the strategic vision and direction we want to go. Secondly, transparency and engagement are very important. Ensuring that all staff work in line with the changes and new procedures is key, for example making sure they do fundraising in WHO according the principles of the financing dialogue.

As a one-WHO image is very important for the reform process to be effective, everyone needs to speak with the same language. Staff must also be involved structurally when preparing the general programme of work and the programme budget to increase their understanding on the strategic vision behind these pieces. This will enhance acceptance when they are approved.

Once the Executive Board and Health Assembly have approved the programme budget and general programme of work, the priorities should remain unchanged unless there is an urgent need.

ER: So for your time as the Chairman of the PBAC, what are your priorities and what are the areas that you would like to focus on?

DC: Well, of course, although I am the Chairman of the PBAC, it is the Member States who are making the decisions. I only have a facilitating role but I think it’s an important role. I think one of the critical achievements of the reform is the reinforcing of the PBAC’s role. It is my wish to fully use and implement this reinforcement in order to give guidance and to help the Executive Board and the Health Assembly to be well informed and to carefully consider decisions.

I also prioritize making sure that the PBAC members receive all the correct information that it needs to give such guidance as described by the mission of the PBAC. They need this information to provide guidance and promote good interactive discussions. Good document management is necessary. When I listen to the members, they want good documentation that is on time and to the point.

ER: What about the financing dialogue. What are your hopes and expectations for the next meeting. Let me start with a very open question – why a financing dialogue?

DC: It think the financing dialogue was a necessity in the reform, and it is now one of the steps of the reform process. In support of management of WHO it is necessary to have more predictable financing. The financing dialogue is marketing our core business and programmes to our stakeholders. It is important that Member States and all donors understand and engage in financing the priorities as established by the Organization based on public health needs – at global, regional and country level.

The financing dialogue is a necessary step in doing our business. It also provides an opportunity for all donors to exchange their views. That is very important to enable us to understand each other. The African problems are not necessarily the same as the Nordic or Asian health problems, this creates a forum for creating this understanding. And to discuss how to possibly finance it.

ER: Dirk, you chaired and facilitated the first financing dialogue in June – what are your thoughts on the outcome of the meeting?

DC: Well, the first meeting was a very constructive meeting. We saw that both Member States and other donors have the flexibility and the will to adapt to a new way of working with the reform process. I may say that no one was unhappy, everyone was happy to continue with the new way we were approaching the problem. It is not easy for the Secretariat, nor for Member States and donors, to make the switch in mindsets, but it is essential that we all commit ourselves to this new way of working.

Our discussions helped us start on a path – it was a small step in the total adaptation process. Slowly but surely, I think we are progressing towards the three main aims of the reform: programmatic, governance and management. The presentation on the reporting tool [portal] was very good, it’s a very attractive tool and if it functions well in our operating processes later on this will improve reporting. Finally, we agreed on six outcomes that we have to work on further before the next meeting.

ER: Looking ahead to the second meeting – how would you suggest Member States prepare themselves, in order to get the most out of it?

DC: I think that all Member States should reflect on the six agenda items agreed in the first meeting, as we have to start with these at our next meeting. It is important that Members States also have open and transparent discussions on their expectations and the expected outcomes of the meeting. I think that all Member States have their needs but they also have to give. The balance between giving and receiving to and from the Organization is different for every country.

We will also have bilateral meetings where we discuss this balance in preparation for the second meeting. Thirdly, I believe that the Regional Committee meetings will provide an excellent opportunity to engage in such discussions because Member States can play a role in the Region. The Regional Committees all take place before our second meeting.

ER: It’s good to hear your perspective on what Member States should be doing, but it would also be good to hear your thoughts on what the Secretariat should do in order to make this meeting a success as well?

DC: For the Secretariat I think it is especially important to work on the six outcomes. Son where are we? What is the progress? And, information on the reporting tool, has progress been made? If there are any problems or delays we should discuss them. Then there is the need for transparency: if there are gaps that have been identified during the bilateral meetings and, if so, reporting on them – “everything has been going well” or “we have noted these problems”.

The last thing that I need to mention is the implementation of the resource mobilization instrument. I think that there are big expectations from the Member States on the resource mobilization instrument that will be used. How it will function? Is the programme on track?

ER: So let me conclude with asking you what are your hopes and expectations for the financing dialogues?

DC: The implementation of the dialogue is one step in the direction of the implementation of the full reform. We cannot do everything in one year, but I think that we can make steps every year. It is my hope that the future financing dialogues will evolve so that they become the Organization’s most important resource mobilization instrument, and so that the remaining financing gap will centred on a coordinated resource mobilization steered by the Director-General.

I hope to change the mindset in the stakeholders in a progressive evolution towards a better alignment of finances with the approved programme budget and more flexible resources; and in a step towards a more broader donor base; and, last but not least, more transparent and predictable financing.

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