Geneva, 21 July 1998

En français

Address to WHO staff

In May I told the World Health Assembly that being elected Director-General of the World Health Organization was a moment of great responsibility. Today - as I take up my position among WHO staff - I have the same feeling. Commitment to the cause of world health is a daunting task.

But serving WHO is also a privilege. We can make a difference. We can help build healthy communities and populations. We can combat ill-health. We can do our part to combat poverty and suffering. Nothing in life - as I see it - has more meaning.

Today, I am also filled with great expectation and excitement. I believe in the immense potential of this organization and its more than 3,500 staff. Today I want to share this expectation and excitement with all of you - in Geneva, Manila, New Delhi, Harare, Alexandria, Copenhagen and Washington - and with all those dedicated people serving at country level - in the field where our services matter the most.

Making a difference will demand all our dedication and commitment. It will demand that WHO works as one Organization - as a team - with a strong team spirit - turning our diversity into our strength. To succeed we will need the contribution of each and every one of us - at every level of the Organization. All have responsibilities.

I wish to extend a special welcome to representatives of the permanent missions here in Geneva. You are important to us. You represent the owners of WHO. You represent the national and local authorities who are the main providers of health services. I want to keep you well informed of what we do and how we think. And I expect that you will be frank and open in sending messages to me.

A warm welcome also to the representatives of the media. I appreciate having you with us today. We believe we have an exciting story to tell and I invite you to tell it with us.

Let us then turn to what lies ahead.

Yes there will be change. A change in focus. A change in the way we organize our work. A change in the way we do things. A change in the way we work as a team.

From your interactions with the Transition Team you know the broad guidelines of our initial thinking. You have already shaped a significant part of it by your active involvement and creative contributions.

We have carefully listened to your advice and your input. I will continue to do so. I believe we can do better by drawing on the broadest knowledge possible. It does not mean that there will always be agreement. Some of your advice has pointed in different directions. Some of you would have liked us to spend even more time to listen and discuss.

I can assure you that the small Transition Team has been stretched to the limits. I thank them for their extremely valuable contribution.

Be assured that 21 July is not the cut off date for our working together. It is the beginning. This is my first day at work. We can pull it together and chart a course that will have the ownership of many, not just a few.

As we go to work together I see two immediate features in the change process:

Internally:

• we must pull WHO together by focusing our efforts around our core businesses
• we must reconnect the organization through a flatter structure, better communication, more transparency and a clearer distribution of responsibilities
• and we must create an organizational culture not driven by bureaucratic rules but one that promotes performance and results.

Externally:

• we must reach out to the rest of the UN family and pursue imaginative ways of uniting our forces for health, development and poverty reduction
• we must reach out to the many stakeholders - in civil society, in the private sector and in the broad health and research community

Generally we must walk the way we talk - hard working, committed, focused - with a vital mandate for health and human development.

I will share with you how I intend to put forward a process of change. I have decided that in this first year I will limit my travel to the essential obligations. I will get to know the organization intimately and guide the change process with your support.

I believe the structure that I am about to present will give us the right start. But no model is carved out in stone. We will learn as we go - being open to suggestions and ideas. I will take a step back from time to time to see if we are heading in the right direction. This structure is made to initiate the change process. We will evaluate it after a while to judge if it is the best structure to pursue our goals.

Our Governing Bodies have sent clear messages on their desire to see a greater emphasis on how we carry out our work at country level. The time has come for us to give our response.

What we do here in Geneva and in the Regional Offices matters very little if it does not lead to a difference on the ground. It only matters if in the end children get better access to care - if health systems are better enabled to reverse the HIV/AIDS pandemic, eradicate polio and roll back killers such as Malaria and TB - if we can help countries address challenges as diverse as the threat from tobacco, a rapidly ageing population or the all too often neglected burden of mental illness.

It is a complex task. I told the Executive Board in January that the ultimate test is on the ground. And I told the World Health Assembly in May that we must be able to measure the impact of what we do.

The impact of our efforts on the ground is sometimes hard to measure. WHO is not and will not become a field agency. Our role is to give the best advice - support and develop the best policies - trigger and stimulate the best research.

We are not the prime health care providers. Governments and regional authorities, NGOs and civil society are. That is why we must link up with them in a more binding and committed way. I say this openly to health ministers: You are already on board - we need to reach a broader spectrum of decision makers including ministries of finance and planning and even prime ministers and presidents - we need to reach civil society and we need to reach the private sector.

I will initiate work to bring about a clearer flow of mind and resources from throughout the Organization to the country level. This will be the main agenda item when I meet with the Regional Directors in three weeks' time. I also intend to convene a meeting of all country representatives to listen to their experience and share with them my own thinking.

From today you will see that all existing programmes and activities have been grouped in clusters - each cluster sending a message of what business we are in. What will that mean for all of us? Many of you may ask - what will it mean for my daily work?

First let me say this: When you come to WHO tomorrow you should pick up the work you leave behind at the end of today. Programmes which have a workplan or a strategy should stick to it.

What we are after is a better unity of purpose - a purpose which is more than the sum of vertical approaches. As I told you in May - WHO must be one - and not 50 programmes working separately.

To link our different activities I am convening a new senior management team comprising of nine Executive Directors who will be heads of clusters, and a small group of advisors in my office, which will also be headed by an Executive Director.

The Cabinet - ten members in all, with the nine heads of clusters covering a broad range of experiences. All of WHO's six regions are represented. Five Cabinet members come from the North and five come from the South. There is first class experience from a country level, from international work, from the public sector and from the private sector.

Six of the Cabinet members are women and four are men. I did not go for a majority of either men or women. I went for a balance of experiences. And I got it. From the rostrum of the World Health Assembly I invited qualified women to put their names forward. So let this be a signal: We are on our way towards a better balance of experiences and the whole of the organization will benefit from it.

Under the general message of making a difference, we are sending four messages: WHO is there to help Building Healthy Communities and Populations - to Combat ill-health - to Sustain Health activities and to Support our internal work and Reach out to others.

Let me present the people and the clusters.

First we have the three clusters under the message of Building Healthy Populations and Communities.

I have asked Mrs Poonam Khetrapal Singh to head the cluster on Sustainable Development and Healthy Environments. Mrs Singh has extensive experience from the Government of Punjab in India where she has been Health Secretary on two occasions with a broad knowledge of health systems and health policy in a country in rapid social and economic transition. She has major experience in the financial sector and with the World Bank.

This cluster has a double mission. On the one hand to continue our work on the links between human health and environmental policies and practices. On the other hand I wish to see it develop the broader health consequences of economic development, trade and environmental changes and enhance the development of strategies to combat the vicious circle of poverty and ill health.

I have asked Dr. Olive Shisana to head the cluster on Family and Health Services.

Dr. Shisana has first hand experience from the complex transition process of the health system in South Africa, bringing health services to all and not only to the fortunate few - an experience which has relevance far beyond South Africa.

This cluster signals a departure from the past by bringing together groups which previously worked separately on health system issues and health care outcomes. The mission will be to help the improvement of health systems development and consequently health service quality - from the perspective of both providers and consumers - with a special focus on the needs of poor and disadvantaged populations.

This is a new approach. Supporting health sector development should be a cross cutting feature of all our efforts. A prime responsibility will be given to this cluster - being closest to the demands of the critical delivery function and the people in need. Succeeding will require extensive cooperation and consultation throughout the organization.

I have asked Dr. Yasuhiro Suzuki to head the Cluster on Social Change and Mental Health. Dr. Suzuki has broad public health experience from international engagements and key responsibilities in Japan. Most recently he was responsible for working out strategies to address the impact of a rapidly ageing population on the health system.

This cluster sends a new message on WHO's commitment to serving its Member States in addressing the critical challenges from social and demographic changes. Mental health and ageing will be prominent components, but we will also need a new look on emerging burdens of diseases coming from areas such as injuries, disability, conflict and changes in employment, family and social structures.

Two clusters convey the message of combatting ill-health.

I have asked Dr. David Heymann to head the cluster on Communicable Diseases. As you know, Dr. Heymann - until today Director of Emerging and other Communicable Diseases at WHO - has solid experience from many years of work in his own country, the United States, and in Africa and Asia as well as in creating new mechanisms to help the international community address the threats from new and emerging diseases.

The mission of the cluster will be to develop and strengthen WHO's capacity to mount an effective response to communicable and emerging diseases. The threat from these diseases is far from over, especially in the poorest countries. WHO must be an enduring advocate for continued attention to this struggle.

I have asked Dr. Jie Chen to head the cluster on Non-Communicable diseases. Dr Chen has broad academic experience in Public Health and Health Management, and she has held important positions at the University of Shanghai, specializing in fields related to tobacco control, control of chronic diseases, hospital management and environmental health.

The mission of this cluster is to strengthen WHO's ability to address the threat from non-communicable diseases. We have a long way to go, and we will need to expand our capacity. The strategies to pursue are complex. They require both substantial capacity for treatment and long term advocacy in favour of behavioural change. Particular attention needs to be given to institution building, especially in low income countries and countries in transition where the burden of non-communicable diseases is growing most rapidly.

Two clusters are placed under the message of Sustaining Health.

I have asked Dr. Julio Frenk to head the cluster on Evidence and Information for Policy. Dr. Frenk is a medical doctor and a sociologist with broad academic experience, internationally as well as in his home country, Mexico. Dr. Frenk has been a driving force behind promoting the need to use epidemiological and economic evidence actively in the design of more cost effective and equitable health systems.

This cluster signals the importance of having the right evidence for policy, introducing new areas of work and refocussing work already carried out by a number of programmes. The work of the cluster will enable us to give advice that will help member states reach critical goals of equity, cost-effectiveness and quality in their health services.

I have asked Dr Michael Sholtz to head the cluster on Health Technology and Pharmaceuticals. Dr. Scholtz has a Phd in Organic Chemistry from Germany and has spent his professional career in the pharmaceutical industry holding a variety of management and marketing responsibilities.

WHO needs to be able to influence the development, quality, cost and distribution of Health Technology and Pharmaceuticals in ways that positively impact on people's health. I have wanted first hand industrial experience as part of my team. Not as a representative of industry, but as someone who can add to the experience and knowledge base of the Organization. We need that broader view if we are to deal effectively with the complex field of health technology, drug and vaccine development and, most importantly, how to develop new drugs and make them available and affordable to all.

Two clusters are placed under the message of Support Services and Reaching Out.

I have asked Dr. Lyagoubi-Ouahchi to head the cluster on External Relations and Governing Bodies. As you know Dr. Lyagoubi-Ouahchi has been Tunisian Minister of Health and the Ambassador of her country to Geneva before she joined WHO in 1991.

The mission of the cluster will be to build partnerships and alliances with other key actors such as other UN agencies, NGOs and the private sector. It will organize the work of the governing bodies, strengthen WHO collaboration with all its Member States and help devise a broader strategy of reaching out to the outside world.

A lot needs to be done in this area. For example, I wish to see a higher WHO profile in New York. We need more open channels to regional organizations such as the OAU, ASEAN and the OECD. And I believe we need a more structured and better tailored collaboration with the European Union as it is also engaging more actively in health.

I have asked Ann Kern to head the cluster on General Management. Ms Kern has extensive management experience from the central and provincial health sectors in Australia and she has broad knowledge of WHO from working in the Organization and from advising a number of missions here in Geneva on international health isues. Since February she has been a key member of the Transition Team and she has detailed knowledge of the idea behind the cluster approach.

A key task of the General Management cluster will be to support the establishment of the cluster structure and guide the change management process in full transparency. We need a change in culture. A number of management functions should be moved to the clusters. General management should be perceived as a service center which is there to facilitate and support the work of the whole organization - and at the same time confirm to our Member States and donors that WHO's resources are managed in a professional and efficient manner with real transparency and accountability.

I have told the Executive Directors this morning: You are in charge of the clusters, working with directors of programmes and all staff to elaborate common goals - to look for synergies - to do away with duplications and to maximise cooperation with the other clusters, the Regional Offices and the country representatives.

I have told them: The bulk of your work should be devoted to your cluster - but your orientation should be to WHO as a whole. Contributing to a unity of purpose - that is your main criteria of success. Working across - engaging with other clusters - finding new ways of reaching out - maximising what we can do together - that should be your method.

Communication during these months of change will be essential. We will be providing new channels and venues for those who have questions. But the main questions should be raised and discussed within each cluster. As the Cabinet is a venue for sharing of knowledge - so must each cluster be for the staff attached to it.

The task of continuous learning will form an essential part of every cluster's work. A particular responsibility falls on the Cluster on Evidence and Information for Policy. One tool at our disposal is the World Health Report which I have located in the Evidence cluster. For 1999 I plan to focus on the theme of "Making a Difference".

The process of preparing this report should engage many and force us all to examine just how our units will make a difference and how we make the best contribution to health, development and poverty alleviation. I intend to work personally on this year's WHR and I hope you will join me in making it a successful vehicle for developing and communicating our priorities for the next few years.

Let me also share with you the initial composition of the Office of the Director General. I will need a group of senior policy advisors to support my daily work and help me keep in constant touch with the clusters, with the Regional Offices and Member States through the missions here in Geneva. These will be process people, supporting and encouraging the process of change, supporting the work of the Cabinet and the Director General.

I have asked Ambassador Jonas Støre, who you know from the Transition Team to head the office. He will be joined by Dr. Asamoah-Baah who brings extensive experience from the health sector in Ghana, Dr. Daniel Tarantola, from France, who brings a long and varied background in WHO from Geneva and from diverse operations in the field, and
Dr. J. W. Lee, from Korea, who brings solid experience from work at a regional level and during the last years as a successful Director of the Global Programme on Vaccines. I have also asked Dr. Tomris Turmen, from Turkey, and Mr. Denis Aitken, from the United Kingdom, to assist the work of my office, sharing their experience with us.

The Cabinet will be the venue for cluster heads to work with me as a team. We will meet on a weekly basis - taking shared responsibility for the broad guidelines of our work. I will be in frequent contact with the Regional Directors - seeing them as key members of my core group together with the Executive Directors. There will be different priorities at different levels of the Organization. But there will only be one WHO agenda.

The Cabinet will not be a centralizing function. By empowering the Executive Directors - by regular contact with the Regional Directors and Offices - I wish to share our goals and strategies throughout the Organization. I will expect Executive Directors and the Regional Directors to work with their staff in a similar manner. You will all be informed of the Cabinet agenda. You will all have access to the main conclusions of its work on the Internet.

We need a culture of information sharing. I challenge the clusters to put forward their own work to the rest of the Organization. Invite colleagues to bring sandwiches for an hour's brain storming. To reflect together on what we are dealing with – on the common challenges – to discuss new ideas. I will do what I can to attend.

Executive Directors will start their work today. I have asked them to meet with their staff later today and to bring their clusters together in the coming days. We need some time to get the new working arrangements to function.

Decisions to merge or split programmes or units need careful consideration. Those who assume we have some preconceived design in mind are wrong. This is - as I said - my first day at work. If and when we do make changes we will consult - with staff - and with our partners and co-sponsors. Communications during this period will be essential. The clusters, and their Management Support Units, will be the key venue for questions and answers.

I have asked the heads of clusters to present to Cabinet their recommendations on how the work within the clusters should be organized and how their missions and message should be formulated. This work must be completed by 1 November.

I know some of you are anxious. Let me be clear: I am not after a downsizing of WHO. The challenges to world health require the effort of the whole of our Organization.

But I do believe we can do more - and have more interesting and rewarding careers - if we have personnel policies that permit more mobility of staff - at Headquarters and between the different levels of the Organization. I have told the Directors and Programme Managers that I may invite some of them to rotate to offer fresh eyes and new experiences to the running of our activities. And we should welcome some recruitment from outside to add their experience to our work.

The new staff development package to help you refine your knowledge and expertise will be given considerable resources and I want everyone to be able to benefit from these new training opportunities.

I will initiate a structured dialogue with the Staff Associations on working conditions and other issues that affect office life. We will hold a meeting of all Staff Associations from the Regions and Headquarters before November to progress this. Transparent and equitable treatment of all staff will be the rule. Measures are being taken to strengthen the office of the staff Ombudsman. And as you may already know I intend to stick to the normal age of retirement.

Clusters offer the opportunity of creating a positive interdependence throughout WHO. I believe that management decisions are better if they are made as close to the people they affect as possible. That is why we intend to introduce a Management Support Unit for each cluster - supporting the Executive Director in her or his management tasks. In addition, the general service staff will have a major role in implementation and ensuring the changes work smoothly.

The Clusters will also give us a more unified approach to resource mobilization. We need to increase our resources and I believe we can get broader donor support to our programmes and activities.

But we should not artificially centralize our fundraising efforts. Donors expect to see first class expertise and hands-on experience before they allocate extra resources. We will show them that WHO is health value for money. We will do it by sending a more unified message of where we are heading, how our activities are related and how support to WHO really can make a difference.

In May, I announced the initiation of two projects: Roll Back Malaria and the Tobacco Initiative. Since then we have proceeded with initial preparations. The jobs for Project Managers have been advertised and applications should be in by tomorrow.

You are familiar with the role I attach to working in Projects. Projects approved by Cabinet will address broad cross-cutting issues - cutting across clusters, involving Regions, country offices and Member States - and more as a rule than as an exception - external partners - other UN agencies, NGOs and the private sector.

Some have concluded that Cabinet Projects are exclusive priorities. That is wrong. I was careful to tell the World Health Assembly that priority setting is a complex task. We need to strike a critical balance: Keeping our long term objectives of Health for All - and at the same time being ready and able to respond to a rapidly changing world. Over time there will be a number of priorities, there will be a number of projects and activities of a different nature, size and scope.

My message in May was this: If we organize our work effectively we will be able to say: The World Health Organization is our priority. WHO is one. A WHO that can engage where the needs are greatest. A WHO that is trusted to maximize its resources. A WHO with excellence. A WHO that can truly make a difference and where what we do in one field will benefit our efforts in another.

Right now - let me highlight one area that will require our urgent attention, and that is our contribution to the struggle against HIV/AIDS.

You know that WHO is the incoming chair of the Committee of Co-sponsoring Organisations of UNAIDS. We will take that responsibility seriously. I have invited the Executive Director of UNAIDS to meet with me next week to evaluate how we can bring the work forward and how WHO can lend its full support to the critical work of UNAIDS.

We have the knowledge: HIV is one of the most serious health problems facing the world, with the current situation worse than anticipated in the early 1990s. It is a significant obstacle to development, striking the productive workforce in its most productive years. Hard won gains in child survival and adult health are suddenly neutralised. Structures of entire societies are threatened. Health systems destroyed.

Our choice is as simple as it is critical: WHO will increase its efforts on HIV/AIDS by ensuring a better integration of HIV-specific activities in all relevant programmes. Such activities will be undertaken in a well co-ordinated fashion throughout the Organization, and core resources will be devoted to them. They will occur in close co-operation with other partners within the framework of UNAIDS.

So there is a lot to do and I am eager to get to work with all of you.

I wish to take this opportunity to extend a special appreciation to the Assistant Directors General and Executive Directors who made their posts available upon my request. I know that was not an easy challenge to face. I am impressed with the way you handled it and I am pleased that several of you have decided to stay on and serve the Organization in new capacities.

Today I have made some appointments critical for the proper continuity of our work.

I have appointed Dr. Wilfred Kreisel, Executive Director and well known for his qualifications and broad experience, as WHO's representative in Brussels, working towards the European Union, the OECD and OSCE.

I have appointed Dr.Andre Prost as Director in the cluster for Non-Communicable Diseases where his wide experience in WHO, including in the field and his qualifications in epidemiology will be an important step in my commitment to strengthen this important area in WHO.

I have appointed Dr. Bjørn Melgaard as Director of the Global Programme on Vaccines. Dr. Melgaard has extensive experience from the programme, in the field and in Geneva, and is well qualified to succeed Dr. J. W. Lee.

I have appointed Dr. Carlos Morel as Director of the Special Programme in Research and Training in Tropical Diseases. Dr. Morel has been widely recommended by our partners. He will be replacing Dr. Tore Godal. Dr. Godal has made himself available for advisory tasks for the remaining time of his contract. In the first stage I have asked him to serve as intermediary Project Manager of Roll Back Malaria until a person has been selected to that position.

Similarly I have asked Dr. Derek Yach to act as Project Manager of the Tobacco Project until an appointment has been made.

I have appointed Dr. Chris Murray to head a new Programme on Evidence, Equity and Quality within the Evidence and Information for Policy cluster. Chris Murray will bring energy and new perspectives into WHO's work in this priority area.

Dear colleagues,

Transition has come to an end. It has been long for you and for me. It has probably been short and hectic for the new Executive Directors who were all recruited after the World Health Assembly in May.

To each and every one of you - here in Geneva and throughout the Organization - I wish to say: I look forward to this endeavour with you- there is a lot of hard and meaningful work ahead of us.

And let me say - as of today there is no outside team and no inside team - one in transition and one waiting for change to come. As of today there is one team - our team. If there are questions, rumours or anxiety - step forward - ask - speak out - and don't let it fester.

As a team I am convinced we will make it - that together we will be making a difference.