Geneva,
2 March 1999

En français

Address to the Geneva Group – UN Directors
Change at WHO

I will spend some minutes to introduce to you some of the changes we are undertaking at the World Health Organization – how we perceived the need for change, and our strategic approach to change.

But let me first address the very notion of leadership of a UN agency.

WHO is a specialized agency – a technical agency with a broad mandate in global public health. By and large, WHO is technically strong. By and large, it has maintained a high standing and reputation in the global health community.

This is critically important, and I see it as my prime responsibility to maintain and further develop the technical excellence of the Organization. In addition I have wanted to bring a political dimension to the leadership of WHO. By political I mean a greater awareness of a changing world. A better sense of interaction with the countries and populations we are there to serve. A better corporate grasp of the key issues that shape the global development agenda of which health is such a critical component. A greater sensitivity to the role of other actors in health and development so that we can achieve more synergies, more efficiencies and greater impact.

I see leadership as sharing a reading of where we stand and charting a course of where we want to go – not go it alone – but in partnership with others.

The Geneva Group has spent a lot of time on analyzing the performance of WHO over the last years. As a background for the changes I have introduced, let me very briefly sum up the analysis I made before July.

Before any period of sustained change it is critical to have spent time analyzing the starting point. Right after I was nominated Director-General by the Executive Board in January last year, I had a Transition Team working systematically for six months analyzing what our Member States expected and what changes were needed at WHO to meet these expectations. As July approached the following reading was clear to me :

• During difficult years WHO staff has continued to provide important advice and assistance to governments. There are shining examples of excellent performance at all levels of the Organization. I have every reason to say that I have taken over a very competent core with important experiences and achievements to draw on.
• However, although still technically strong, WHO had gradually been sidelined, not only on the international development scene but also gradually marginalized within the field of health itself.
• Among the Member States there was a growing dissatisfaction with WHO's ability to deliver strategic advice and cope with new requirements in a rapidly changing world. This became more and more pressing as the need for a strong global source of expertise increased. The large majority of countries go through profound changes in the organization of their health systems - for economic and financial reasons but also because the health picture is changing dramatically with an ageing population and the rapid toll taken by the emerging non-communicable diseases.

There are many reasons why WHO failed to live up to the task - but let me point at some explanations linked to the Organization itself:

• WHO had a structure with a weak top management. This was not only linked to people, but also to structure. There was no formal senior management structure pulling together and setting priorities in an organized manner. The Assistant Director Generals had a weak mandate, no staff and no budget authority. Throughout the Organization there was a perception of lacking or very weak priority setting. This had several consequences :
  
  First, the unity of the Organization was weakened. People spoke of more than 50 WHOs – meaning the more than 50 individual programmes at Headquarters. They spoke of 7 WHOs, meaning Geneva and the six Regional Offices. They spoke about 2 WHOs, meaning the one financed by the regular budget and the one financed by extrabudgetary contributions.
  
  Second, the Organization was gradually developing into what I would call a "non-aligned Organization" - meaning that the different parts of it moved in different directions. The Regional Offices operated each in their regional sphere. At Headquarters, the programme directors did the best they could in a vacuum of priority setting. Some did very well – others did less well. The point is that one part of the house knew little what the other was doing.

• This was not an analysis we alone invented. Member states and indeed the Geneva Group itself raised management and priority setting as big issues.
  
  The first message my Transition Team received from the directors was that there were too many programmes, too many directors and too little coordination. The core of the measures we have carried through were conceptualized in close dialogue with staff during the transition months.

• Let me mention a few other points in the analysis we made.
  
  There was an obvious need to rethink WHO's strategic performace at the country level. One was too focused on input of what is and will remain a restricted budget – and too little focused on output – on the total result WHO could achieve – not only alone – but also by working closely with others.
  
  All too often WHO –like far too many agencies – delivered dispersed advice, without matching closely the real needs of our Member States. All too often a WHO staff member met a colleague at the airport or at the doorstep of the same donor agency – without knowing in advance that the other was expected at the same place at the same time.
  
  There was too little mobility throughout the different levels of the Organization.
  There was an underutilization of partnerships – with the rest of the UN family, with NGOs and with the private sector.

In short – I was elected on a platform of change in which I was committed to the following :

• To make WHO more focused in its work through better coordination and clear priority setting. To redirect dollars from the lower to the higher priorities and in particular from administration to technical areas.
• To make WHO One – not more than 50, not 7 and not 2.
• To draw on the skilled staff of WHO, to add to it some new blood, to move steadily towards gender balance and to introduce a new emphasis on training and staff development.
• To place health at the core of the international development agenda.
• To reach out to other partners and maximise our total effort.
• To contribute to UN reform and an enhanced UN reputation by demonstrating that WHO can really make a difference – by demonstrating that UN agencies can change – and by demonstrating to the people in this room that a dollar spent on WHO is a dollar not only well spent – it is a multiplier dollar – achieving more development than what that single dollar can buy.

With this reading – what approach did we take to the change process ?

I opted for determined and fast change. I decided to lay out in quite some detail the changes ahead – first to the World Health assembly in May – and then to all staff when I took office in July. Looking back I feel confident to say that we have been sticking to the pledges I made. Given that your governments elected me with that mandate has given me confidence to make the tough choices.

Fast, but steady. It needed to be fast. To respond to Member States who had legitimate demands to see real change in real time. But also to get staff quickly on to new tracks. That puts a burden on staff. I was aware of that. I told staff I expected it – and I have told them all along that I am working every day with my team to respond to legitimate problems or bottlenecks.

I have also commented on the alternative. Long haul change. Dragging on. Not turning the page. Not getting fully on to our technical work.

On the first day I created a real senior management team. I abolished the post of Deputy Director-General – what I was after was a really representative team to support my decision-making and to carry out real executive functions.

I invited the five Assistant Director Generals and two Executive Directors to make their posts available – not to resign but to stay with us for the remainder of their contracts. They all accepted my invitation.

The initial structural changes have been carried out with full employment security. We have not asked people to leave. Some have been reassigned and some have seen their job descriptions change. But that is reality at any workplace.

I replaced the level of ADG with a group of Executive Directors. Nine of them are heads of clusters – and one is head of my office. They are all D2s – with an extra allowance for their executive responsibilities. The Cabinet meets every Tuesday on a prepared agenda which is circulated – as are the conclusions of the meetings. We now have a four month plan for the Cabinet agenda. All background papers on strategic issues are circulated to the clusters and to the Regional Offices for input.

Among the ten Executive Directors, all WHO Regions are represented – they come from Mexico, the United States, South Africa, Tunisia, Germany, Norway, India, Japan, China and Australia.

Of the nine cluster heads, two were recruited from inside and seven from the outside. Of the seven, four had extensive experience of working for or with WHO. I believe a change in perspective was important. In addition to the wealth of WHO expertise, we needed an influx of new eyes, fresh experience from the realities in government, national health systems and the private sector.

WHO has had a relatively high average age among its staff and large under-representation of women. I have moved to change both.

Among the group of Director-General and Executive Directors there are six women and five men. The average age of the previous senior management team was 59. My team has lowered that to 49.

In the more than 50 programmes there were only 4 women Directors – less than 10 per cent. Among the current 35 Departments, 29 Directors have been appointed. 20 are men and 9 are women. Accordingly - the number of women at Director level has been brought up to about 30 per cent.

The World Health Assembly has repeatedly called for gender parity. I intend to follow up on that call. Cabinet has decided to secure that 6 out of 10 new appointments are women until parity is reached.

To secure a proper turnover of staff I have sent the clear – and to me obvious - message that retirement age applies. That does not mean that people over 60 or 62 have no contributions to make. But if selective extensions are given, an unclear message is sent to staff. Retirement remains the most important mechanism for ensuring turnover and to facilitate planning and change in an environment where it is difficult to put off staff who do not wish to leave

At the outset the more than 50 programmes were allocated to the nine clusters according to criteria of synergy identified by the Transition Team. I gave the Executive Directors three months to work with their clusters to define and sharpen the cluster mission and to suggest a streamlining of the programmes. 1 November was the target date. By then the clusters had their structure ready, and the number of programmes was reduced to 35 – now called Departments.

The filling of Director positions has taken place in three rounds. First, post descriptions for each Department head were advertised internally. I made a first direct selection of 18 Directors from the pool of existing Directors. We then proceeded to a second round where we advertised the remaining posts throughout WHO and the UN system and where we accepted external applications from women. As of today, four more Directors remain to be appointed and I hope to complete the selection in the coming weeks.

Those who were Programme Directors before and have not been appointed Directors of Departments have been assigned new responsibilities. This is also a question of mobility. There are many important tasks which do not include managing a large budget and a large staff. For these we need experienced people. I believe we need greater flexibility to draw on senior staff to carry out important tasks without being caught up in an hierarchical system where importance equals size of budget and staff to manage.

In the new selections I have applied an open and competitive process. In the second round all selections have been made on the basis of written tests and interviews with a panel. The final selection, however, has been my own.

In parallel with these selections we have encouraged a greater degree of mobility of staff. Some Geneva staff have been selected to work in countries. We have had transfers from Regional Offices to Headquarters. We have had transfers among Regions. This policy of mobility will continue as a regular part of our staff development.

Change has its costs. Before taking office I invited Member States to contribute to a Renewal Fund which would enable us to finance key change measures not budgeted for by the previous administration.

I am grateful to the countries who so far have committed 7 out of the 10 million dollars we intend to spend over three years – and let me invite those who have not contributed help us reach the 10 million target – it is money well spent. That money allows us to update our information technology base which will greatly enhance our efficiency. It will finance an integrated tele- and video-network which will allow us to link up Geneva and all the Regional Offices and to save large sums in unnecessary travel. It helped finance last week's historic gathering of all our WHO- Representatives in Geneva – the first time ever when we could directly discuss strategy and coordination throughout the Organization with those who serve where it matters most – in the countries.

The structural changes are nearly complete. We are now working closely with the Regional Offices to streamline the way they organize themselves to better respond to the new structure at Headquarters – the way we organize our work together, the way we budget and set priorities.

Let me also mention the budget itself, which we had to address urgently after July.

The previous administration had nearly completed the budget for 2000-2001 according to the old structure. My choice was to go with it or to change it according to the new drive. I opted for change – knowing from experience what a crucial instrument budgets are for any organization. We now have a budget cluster by cluster.

It is shorter, and I believe sharper. It is strategic. You can see what you are buying with your regular budget and voluntary contributions.

We have given you in the budget a firm basis for real evaluation. We have listed the broad expected outcomes. You can judge if they look like a good investment prospect. If you agree they are then in two years time you can assess whether we delivered and evaluate the outcome in health and management terms. In addition we will of course have detailed programme by programme monitoring and evaluation.

We have made shifts. In the 1999 budget – the second year of the current biennium – Cabinet drove through a painful exercise of 'sunsetting' a number of activities – freeing up resources to be spent on our new priority areas. The largest part of the freed resources has come from efficiencies in administration and management.

The trend is taken forward in the budget for the next biennium. There is now a clear list of priority areas cluster by cluster. At Headquarters alone we have proposed shifts of more than 22 million dollars from administration and process areas to technical work to such areas as communicable and non-communicable diseases and the Evidence base aimed at helping us and member states to get our priorities right.

Member States have generally welcomed this new approach and we are working hard towards the World Health Assembly in May to be even more specific when it comes to expected results and outcomes.

I would like to end on a comment on our strategy of reaching out. It is critical that we succeed if we are to make a real difference in the work we do in, with and for countries.

I am convinced that the only way you can change is to do so in the very way you work. Large parts of WHO's work goes on – because it is to the point, responsive to the needs and technically in the front. In addition I have initiated a new kind of working in two areas.

I am referring to Roll Back Malaria and the Tobacco Free Initiative. Among communicable diseases, malaria represents a daunting burden on the poorest countries, especially in Africa. Among the non-communicable diseases, no other cause of disease and premature death can compete with tobacco into the next century.

These are so called Cabinet projects – meaning that they enjoy the mandate and direct support of the entire Senior Management Team. The Project Managers have large autonomy to draw on the resources of the entire Organization, and they work on 6 months strategy plans adopted in Cabinet.

We call the projects Pathfinders. They are pathfinders in teaching ourselves to work differently inside WHO. Malaria and tobacco control concern broad parts of WHO – and the projects help to pull together all relevant parts of the house. They are pathfinders in developing new ways of seeing to it that our activities not only address a public health problem – but that they also help strengthen the health sector itself in the countries we serve.

And they are pathfinders in the way we work with others. WHO cannot claim its leadership – it must earn it. We can very well lead by working with others. I launched Roll Back Malaria with my colleagues in the World Bank, UNICEF and UNDP. Private industry is closely involved in the search for new medicines and ultimately a vaccine. The Tobacco Free Initiative works closely with UNICEF and the World Bank, as well as with a network of NGOs.

Our budget is now in the hands of the Member States. I have made the advice that it would not serve the interests of Member States to adopt a zero nominal growth budget. It would give us less to do a job we believe they expect us to do. It would reduce our ability to finance activities we believe could make a huge impact on development.

WHO led the campaign of smallpox eradication. That saved the world 2 billion dollars in yearly immunization costs. If we manage the final stretch of polio eradication we will save another 1.5 billion. Not to talk about the savings we could make if we managed to turn the tide of malaria, and push forward towards an HIV/AIDS vaccine. We deliver a global public good. The world spends about 2,300 billion dollars on health care and the figure is expected to rise significantly over the coming decades – in all countries. WHO's knowledge, expertise and evidence base can have a direct effect on the efficiency of that investment.

That is why we believe the time has come to make an exception for health.

Thank you.