According to the Constitution of the World Health Organization (WHO), the director-general (DG) is the chief technical and administrative officer of the organization. In light of growing global health challenges and the international health agency’s sustaining budget woes, having a capable and visionary WHO DG is not only central to its day-to-day administration, but also crucial for maintaining its leadership in global health governance. For these reasons, an assessment of the performance of past and current WHO DGs would provide us insight as to which candidate would be the best fit to succeed Dr. Margaret Chan.
Since 1973, six individuals have served as the WHO director-general: Halfdan Mahler (1973-1988), Hiroshi Nakajima (1988-1998), Gro Harlem Brundtland (1998-2003), Jong-wook “J.W.” Lee (2003-2006), Anders Nordstrom (2006-2007, interim), and Margaret Chan (2007- present). Each has achieved varying degrees of success in terms of reforming the organization and fulfilling its mandate of directing and coordinating international health. In April 2016, with support from the Rockefeller Foundation, CFR’s Global Health program launched the Next Director-General of the World Health Organization project to examine past and present election processes, assess the performances of previous DGs, and consider what sort of individual is suitable to lead the organization. As part of the project, we conducted a “straw poll” asking respondents to choose their favorite DGs. The survey received a total of fifty-six responses, a number of which were recorded after the publication of our first blog post analyzing its results. It is important to note that this pool of respondents is not representative of all those invested in the future of global health governance, but may prove indicative of general opinion on the subject.
When asked to rank the top two directors-general of the agency since 1973, an overwhelming majority (67 percent) ranked Dr. Gro Harlem Brundtland as their first choice. In explaining the rationale for his/her choice, one commented that “[Brundtland] understood the need to be a policy leader and had respect from the international community.” In contrast, no respondent ranked Dr. Hiroshi Nakajima as his/her first choice. Although the respondents did not explain why they ranked Dr. Nakajima so poorly, Professor Larry Gostin, in his book Global Health Law, noted that the former WHO DG was accused of “cronyism and corruption, an autocratic management style, and financial mismanagement” (p. 133). Indeed, an argument can be made that loss of confidence in the WHO leadership and the demand for greater control over spending by major donors led to efforts to supplant the WHO core funding with extrabudgetary support. It was in the wake of this leadership crisis that Dr. Gro Brundtland took the helm and navigated the sinking WHO ship through treacherous waters. During her tenure as WHO DG, Brundtland made sweeping changes throughout the organization, used WHO’s treaty-making power to negotiate the Framework Convention on Tobacco Control, and issued the first travel advisories in the organization’s fifty-five year history during the 2003 SARS epidemic.
One might be curious as to how Dr. Margaret Chan ranked among the six individuals. While 20 percent of the respondents ranked her as their second-best choice, only one person rated her as the most successful. When asked to rank her overall performance on a scale of one (worst) to five (best), 80 percent of respondents gave her a score in the two to three range. In explaining their choices, people spoke about Chan’s lack of “strategic vision,” a “safety approach” lacking innovation, a “failure to reform the WHO bureaucracy,” a “slow and politicized response” to international health emergencies, and failure “to assure that science, not ideology, guides policy.” That being said, people also commented that Chan “surfaced tensions to resolve relationships among the country/regional/global levels of WHO and build very constructive bridges with other multilateral actors.” In addition, she “highlighted and successfully promoted some important efforts, including the noncommunicable disease agenda and universal health coverage.”
A more systematic evaluation of Dr. Chan’s performance as WHO DG was provided by Dr. Tikki Pang, a former WHO director of research policy and cooperation. When asked to share his thoughts on Chan’s tenure, Pang remarked that Chan’s strengths include her engaging personality, candor, and good people skills, demonstrated by her proven ability to broker consensus among numerous parties. Pang then went on to highlight two major weaknesses, the first being the tendency to “lead from behind,” shown by her unwillingness to stand up to member states and instead looking to them for consensus and guidance. The second major weakness, according to Pang, was her overall lack of accountability throughout and after the 2014 Ebola crisis. However, Pang argued that it is important to view Chan’s leadership in context, as she served two terms in times of “powerful, perhaps even intractable, structural and financial constraints,” which include earmarked budgets, reduced contributions from member states, governance weaknesses, and disorganized regional offices. Pang felt that Chan has learned from these events, shown by her expeditious reaction to the Zika crisis.
In addition to contextual and structural factors, a fair performance assessment may have to take into account individual DGs’ professional experience prior to taking the job. It is probably rare to find a DG like Dr. Brundtland, who brought to the table not only training in medicine and public health, but also years of service as Norway’s minister of health, minister of the environment, and first female prime minister (1986-1989 and 1990-1996). In her capacity as minister of health, she served on multiple WHO committees and the executive board. In other words, Brundtland had been equipped with a unique set of leadership skills and capabilities when taking WHO helmsman. Not seeking a second term, she took office owing nothing to particular nations, hence in a much better position than her predecessors to pursue independent actions in addressing the sorry state of the WHO. It is therefore unfair to expect a WHO director-general who does not have prior and proven political and international experience to face the member states that ask the organization to do more, but fail to provide sufficient support to accomplish the tasks at hand. Not surprisingly, recent requests from the WHO leadership to raise funds to close the agency’s $500 million budget gap were rejected by the member states. In the absence of a well-respected candidate who is politically savvy and professionally prepared, the future of WHO would look bleak. Hopefully, these insights will help member states make the right decision in casting their ballots at the World Health Assembly in May 2017.