Welcome to all of you and thank you for coming.

When I last met with many of you in a similar setting on 21 July I told you that the Missions - representing the owners of WHO - were important to us. I also told you that I wanted to keep you well informed of what we do and how we think.

I have met many of you in recent weeks. But I wanted to wait until 1 November was behind us before I invited all of you to come and get an overview of the new WHO.

There have been changes - deep changes. Yesterday I paid tribute to staff at Headquarters for their commitment and readiness to undertake three months of intensive structural change.

I told staff on 21 July that there would 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. I told the new Executive Directors - the heads of clusters - to go to work and organize the work of their clusters - and to fully report back by 1 November.

Since then 1 November turned into somewhat of a crossroads. Some felt that 1 November was an ambition coming too soon - others felt it could not come soon enough!

Now that magic date is already behind us.

I wish to take this opportunity to convey three messages to our Member States:

• First: We have now carried out the structural changes on which I announced the broad guidelines to the World Health Assembly in May.

• Second: An important and critical global health agenda lies ahead of us.

• Third: We invite Member States to join us as we now move on to address this agenda.

When the new administration took office in July we had a clear vision of the changes we saw as critical to make WHO more responsive, more focused and more visible. We agreed to start reforming at Headquarters - to start drawing the Regional Offices into more interaction and collaboration, and to make significant advances in placing WHO among the outspoken agencies for development.

The target date was 1 November.

You have seen the organizational structure.

Fifty programmes were grouped into nine clusters, each headed by an Executive Director. Since then the number of programmes has been reduced to 35 departments. Each cluster has its mission statement worked out. The departments will be headed by Directors.

We are right now in the midst of the selection process. In the first round priority will be given to those Directors who used to head a programme. But we also take advantage of the reassignments to encourage more mobility among staff at Headquarters, Regional Offices and Country Offices. We wish to see an increase in the number of qualified women and we wish to see some newcomers join our senior staff.

Yesterday I told staff: Well done! Let's now devote all our energy to the technical activities. Let's further and refine the excellent technical cooperation that has made this Organization respected worldwide.

I told the World Health Assembly in May that we had to earn our leadership. I am convinced that we can do just that.

We have changed - not by laying off people. Not by closing down offices. Not by closing in on ourselves. Let me highlight some of the developments during these last months:

• We are changing our structure and our partners are now coming to discuss directly with the clusters - not with 50 individual programmes. The donors are focusing on the clusters. That gives us new opportunities to see WHO's activities more in connection, to secure more unity of purpose.
• We are putting health on the global agenda. We have established a new working relationship with the World Trade Organization. We have structured our working relations with the World Bank. Two weeks ago in Washington the Managing Director of IMF explicitly asked WHO to contribute health indicators to the Fund so that structural adjustments can take due account of health and social needs - especially of the poor and vulnerable. I told Michel Camdessus: WHO will respond to that challenge.
• We are reaching out: This fall we have had a number of roundtables - with NGOs and with Industry. Our projects - Roll Back Malaria and the Tobacco Free Initiative - are built as partnerships with others. There is a new atmosphere.
• We are making a difference in the way we work. The Tobacco Free Initiative is changing the global agenda with its clear direction and solid focus. Ten days ago we launched Roll Back Malaria together with UNICEF, the World Bank and UNDP. Secretary-General Kofi Annan told the ACC: This is UN reform in practice.
• We are gradually speaking as One WHO: Cabinet - gathering the Director-General and the Executive Directors - has met 15 times since July. It is learning to work together and is proving to be an important tool to share experiences, opportunities as well as difficulties. I now want this method of work to spread to the clusters and the way Executive Directors work together with Directors, Team Leaders and all staff. Then there will be more unity of purpose.
• We are building closer ties with the Regions. I have had two day long meetings with the Regional Directors and I have visited all Regional Committees and met with many country representatives. Regional staff have been included in a number of activities as we have shaped the clusters and departments. Together we are building a networking organization.
• We are putting together a new budget - new in its structure - new in its orientation. The pressure has been hard. When we came, the previous administration had nearly completed the 2000-2001 budget. And even more challenging - it had done substantive work on the Programme of Work for the next six years - that means beyond my term in office!
  Although it has stretched our staff to the limits we decided to change. In the budget we are aligning budget categories in accordance with our strategy. You will read a Headquarter Budget cluster by cluster. In the current biennium - and in planning for the next one - we have made tangible reorientations of resources to areas of work which we wish to see highlighted in the next biennium. This is as much as we could manage before the budget has to go to print in two weeks in order to reach the Executive Board for January. More remains to be done next year - as we approach the real implementation in January 2000. We need to address the budgets of the Regional Offices and our Country Offices - with the same goal: To have more unity of purpose throughout the Organization and to see the same broad priorities reflected at all levels.
• We are expanding our communication facilities. The Information Technology Project is well under way. Even in the age of satellites things take time, and I am told that we may have to wait one year before we have the first class internal telenetwork operational - linking in real time all parts of our Organization in sound and picture.
• We are strengthening our internal dialogue - bringing together staff and management in a new forum. Last month staff and management from Headquarters and the Regional Offices met to address the same issues. That was a first and very important event on which we will build.
• We are putting emphasis on staff development. The process of mobility is meant to support staff in their career development - providing more stimulating jobs - and new opportunities throughout the Organization. It was never meant that people would join one station of WHO and take a permanent seat.
  Other UN Agencies have mobility as a normal part of human resource management. People spend some years in the field - then they return to Headquarters or a Regional Office and vice versa. That enhances the learning process throughout the Organization. This will be our path.
• We are taking new steps towards gender balance. The composition of Cabinet sends a first signal - six women and four men. We are now putting in place a recruitment procedure in which we should see to it that 6 out of 10 new recruits are highly qualified women.
• We are moving ahead to give our managers more efficient tools in the way they run their activities. In the UN they are still discussing how to better enable the line managers. With the creation of the Management Support Units we have done precisely that.
• Each Executive Director now has staff available who deal with personnel, finance and budget. One hundred staff have been reassigned - through an open and competitive process. The exercise has not increased the number of staff. It has not cost us more money - to the contrary. But an answer, a piece of information or administrative advice is now near to those in charge - not corridors, departments and often months away.

These are some highlights of the structural changes. From now on we will be changing as a normal part of our ongoing work. That means learning as we go - adjusting the course when needed.

Let me comment briefly on the next step in our work towards One WHO. Now that the structure is in place at Headquarters we need to improve communication and networking throughout the Organization.

We should not copy Headquarter structure at the regional level. But I believe we would benefit from two innovations:

We need clearly designated focal points for the Executive Directors in the Regional Offices. Seven identified people - one at Headquarters and his or her colleagues in the six Regional Offices should be able to pick up the phone - go on video - and discuss joint plans and events ahead.

We would also clearly benefit from developing a more similar structure among the Regional Offices. That would add to transparency, it would make our budget processes easier, it would enhance our planning processes and better enable us to meet our targets.

I started this discussion with the Regional Directors last week and I look forward to discussing it further. In the coming months we will avail some of the staff here in Geneva who have been instrumental in the change process to assist the Regional Offices in their internal adaptation.

Then we need to focus on the country level. As I announced in July I will invite all the WHO Country Representatives to Geneva - and we aim to hold this meeting in February.

What is the purpose? To establish direct links between Headquarters and the country level. To introduce to them what the clusters have to offer. To learn from them the realities, challenges and opportunities at the country level. To start the process towards one country programme for each country - grouping and focusing all that WHO has to contribute.

I see no model as carved out in stone. I will take a step back from time to time to see if we are heading in the right direction. Now my prime responsibility is to get to work with my staff on a critical agenda for global public health - and that is my second message today.

Look around, look at how immediate and long term health challenges are lining up:

• Hurricane Mitch has killed thousands and devastated an entire region. Millions face emerging diseases such as cholera, dengue and malaria. Large parts of the health infrastructure is destroyed. WHO will be needed to gather support and lend its best advice in the daunting reconstruction period ahead.
• Population projections from the UN recently hit the headlines telling the story of how the HIV/AIDS pandemic threatens to upset and destabilize entire societies in Africa. Those figures were not new - they are one year old. WHO will be needed to push the health component of the UNAIDS alliance - to support work towards a vaccine available to the many, to strengthen blood safety, to support the advocacy efforts and not least by giving advice to health officials on how best to enable health systems to meet the challenge.
• Malaria is killing 3000 children every day. WHO is the lead agency in Roll Back Malaria - the first global partnership to strike back against the biggest killer of the poor.
• WHO is given a lead role in the Stop TB Project, aimed at uniting forces against a disease that continues to kill by millions - and which now is spreading into countries from which it has been absent for decades.
• WHO is the driving force in the final stretch of the polio eradication campaign - there are 26 months to go and a lot of work to be done to rid the world of this crippling disease.
• Tobacco is likely to develop into the largest single killer and burden of disease into the next century - increasing the death toll from 3.5 million today to beyond 10 million after 2010. WHO is the lead agency in a broad partnership to strengthen tobacco control and save our children from this new epidemic.
• WHO has to take on the crucial role of advising countries in transition of how to refocus their health systems. How to cope with the double burden of disease - the old agenda of communicable diseases - and the new agenda of noncommunicable diseases which demand a quite different approach - quite different training, and quite different resources. How to structure a sustainable health financing system. How to withstand financial turmoil and safeguard the basic health services that should be there for all to share.
• And more broadly: WHO has to be the vocal force to drive home the message that poverty remains the biggest source of ill-health - and that ill-health in turn breeds poverty. We need to present the evidence and develop the language to demonstrate that the right investments in health - to all - but especially to children and women - means investing in a strong economy - bringing people out of poverty - and enabling countries to harness the human resource - the ultimate success factor in the 21st century.

We will give substance and direction to the work of WHO to better cope with these challenges. You will receive today the collected structural overview of all clusters and their mission statements. In the elaboration of the budget for 2000-2001, the Cabinet has decided on areas of work that will be given a particular focus.

Let me summarize very briefly cluster by cluster:

In the cluster of Communicable Diseases, the main focus will be to reduce the negative impact of malaria and tuberculosis through global partnerships and continue to strengthen global systems for monitoring health problems of international public health importance and building systems that enable effective responses to epidemics.

In the cluster of Noncommunicable Diseases, the main challenge is to develop and test preventive strategies which can address several major diseases through their common risk factors. A special focus will be given to cancer, cardiovascular disease and tobacco.

In the cluster of Sustainable Development and Healthy Environments, a special focus will be placed on supporting countries in promoting policies which can address poverty as a major cause and consequence of ill-health.

In the cluster of Health Systems and Community Health, particular attention will be given to the delivery of high quality health services and on developing WHO's role in the international response to the global HIV/AIDS epidemic.

In the cluster of Evidence and Information for Policy, the initial focus will be to develop methods, tools and standards to collect evidence for health policy analysis. The cluster is expected to help develop robust methods for examining the effects of different approaches to health care financing.

In the cluster of Health Technology and Pharmaceuticals, special attention will be given to the area of clinical technology, assuring the safety, quality and cost-effectiveness of blood transfusion, products and services. Attention will also be given to further developing WHO's role in the field of immunization. The last stretch in the long march towards polio eradication will be given an important focus.

In the cluster of Social Change and Mental Health, mental health - source of a growing burden of disease - will be given particular attention.

In the cluster of External Relations and Governing Bodies, the key challenge will be to succeed in our policy of reaching out to external partners - other UN Agencies, the Bretton Woods Institutions, the private sector and NGOs.

Finally, in the cluster of General Management, the focus will be to pursue management reform with the overall aim of reducing administrative costs, strengthening our information technology base and developing new policies for staff development and training.

Many of these goals cannot be reached in one cluster - they will require extensive collaboration across clusters. One such area is the critical field of research. WHO has an important vocation to be a focal point for the best of research. How can we best play that role? When we now get to work I believe we seriously need to consider the best answer to that question - internally and with inputs and suggestions from our partners around the world.

We are ready to move ahead on another critical issue. In January - when I addressed the Executive Board before the nomination - I told the Board that Health Sector Development should be a cross-cutting feature of everything that we do. I told them that unless what we do contributes to strengthening the health sector at a country level we should consider not engaging.

Now it is time to turn this objective into practical work. From 1 January I will introduce a new Cabinet project along with Roll Back Malaria and the Tobacco Free Initiative. It will be called Partnership for Health Sector Development.

The challenge cuts across all clusters. The idea of the project is to complement and support health systems and sector related work at all parts of WHO.

This is about WHO renewal - renewal in the way we work - renewal in the way we focus in order to be more relevant to countries' needs - to develop health system indicators and a language which can give us strength when we engage with national authorities beyond the Health Ministries and partners such as the Bretton Woods Institutions.

In short: We need to ensure that we offer countries integrated rather than vertical advice - based on each country's situation and priorities.

There is a challenging and exciting agenda ahead of us. It will take the contribution of all of us to make a difference - including the Member States. That is my third message.

Let me take this opportunity to thank those Member States who have contributed to the Renewal Fund. It was a vision of the Transition Team and it has been pursued by my Office after July - to raise resources to support the reform process itself. I see it very clearly - with our tight budgets, this Fund is key to providing us with the necessary flexibility in the process of change.

We are aiming at raising 10 million dollars to be spent over three years. As of today we are half way towards the target. Our partners, in supporting this Fund, have shown their confidence in us.

I told Health Ministers in May that I may ask for more than you have been used to being asked. I told them that in my view, Member States must take responsibility for the targets they set and provide the resources.

You know the agenda. You have placed a lot of expectations in our work. We are ready to respond. But it cannot be done at any price. Look at the figures: Over the last 10 years WHO's budget has been cut by 22 per cent in real terms. I do not want to look to the past - my focus is strictly on the future.

However, having worked my way through this Organization I feel confident when I say: This trend cannot continue. The very notion of zero nominal growth is itself misleading. It has nothing to do with zero. It is all about downsizing. A reduced role for WHO. A weakened public health agenda. If that is what our Member States want - and I cannot believe that this is the case - then I would expect them to suggest how to cut the health agenda itself.

I am confident that we will not come to that stage. I wish to engage our Member States - in direct dialogue - and through their Missions in Geneva - in a more forward looking discussion - on how together we can make a real difference for world health - how we can combat ill-health and build healthy populations and communities.

As a first step we will invite Missions to monthly briefings on what is on our agenda. We will focus on the news of the month and we will share with you key aspects of our ongoing work. The first meeting is scheduled for 9 December.