Three words of advice for WHO Africa's new chief

The World Health Organization says the number of new Ebola cases per week rose twice this month for the first time since December.

This rise in incidence of new cases - if proven to be a trend - will be just one of the challenges facing WHO’s new regional director for Africa, Matshidiso Rebecca Moeti, as she attempts to overcome the multitude of criticism launched against WHO in recent months for its failure to act earlier and more competently during West Africa’s ongoing Ebola outbreak.

“This is a critical moment for the WHO,” said Michael Merson, director of Duke University’s Global Health Institute. “It’s a real crossroads as to whether or not they’ll be able to reform and become an effective and efficient organization, particularly at the regional level.”

Moeti, who officially took office 1 February, has vowed to make fighting Ebola WHO’s “highest priority,” while supporting countries to develop strategies to build up their health care systems, and reduce maternal and child mortality, tuberculosis, HIV/AIDS and non-communicable diseases.

Many international observers say they have high hopes for Moeti, a medical doctor who has more than 35 years of experience working in the national and global public health sector. But she has a tough road ahead – particularly as the number of Ebola cases continues to rise, nearly a year after the outbreak was first declared.

Here’s some advice from a few experts as Moeti begins her five-year term:

1. Think Local

Having competent and qualified staff on the ground, whose skills and expertise are matched to the needs of the country, is key to effectively implementing WHO policies and recommendations.

“Everyone tends to discuss WHO at the global level and the regional level, but I don’t think this is where the problem lies,” said Fatou Francesca Mbow, an independent health consultant in West Africa. “It really lies in what the WHO is meant to be doing at country level. It is of no use to have very technical people sitting in Washington [D.C.] or Geneva, and then, where things are actually happening, [they become] politicians.”

Mbow said that despite a wealth of technical documents being produced at headquarters, very often the staff from the field offices are appointed based on political motives. Country and field-level office meetings are often dominated by talk that, while politically correct, says “nothing of real meaning”.

Staff reform at the local level will require both investing in employee development, including recruiting new and existing talent to the field offices, as well as making posts in “hardship” countries more attractive to the most qualified experts.

“What often happens is that when people in-country are seen as being quite effective, they tend to get headhunted by the headquarters of the institutions that represent them,” said Sophie Harman, a senior lecturer in international politics at Queen Mary University of London. “So we see a type of brain-drain among people working in these sectors.”

She said that improving salaries and offering more benefits, as well as taking into account what these people have to offer, could go a long way in incentivising them to stay at their field-level posts.

“Good documents are interesting,” Mbow said. “But unless you have people at country level who understand them, who participate in writing them, who are able to implement them, who are passionate and committed to doing so, they’re just going to be reports.”

2. Strengthen health systems

There were many factors that contributed to the unprecedented spread of the Ebola outbreak, but inherently weak local health systems in the three most-affected countries meant that local clinics did not have the capacity, resources or expertise to handle even the smallest of caseloads.

WHO must now work with local governments, partners and other on-the-ground agencies in all African countries to train and employ more doctors and nurses, implement universal health care coverage, and invest in better vigilance and surveillance measures.

“I think the real test will be… how the WHO turns this outbreak into an opportunity to use our energy and thoughts and actions to build health systems that will not only help people [day-to-day], but will be able to respond to health crises like this in the future,” said Chikwe Ihekweazu, a managing partner of the health consulting firm EpiAfric.

Increasing the number of health workers will be particularly important post-outbreak in Guinea, Liberia and Sierra Leone, where more than 400 health workers have died from Ebola, including some of the countries’ top doctors and nurses.

“The WHO also needs to help minimise the knock-on effect that the Ebola outbreak is having on other health priorities in the region, such as HIV/AIDS and maternal health,” Harman said. “What we are seeing is that because of Ebola, people are afraid and so they are not accessing health facilities, which might actually reverse some of the many gains we’ve seen in the MDGs [Millennium Development Goals].”

3. Rebuild credibility

Despite WHO having, admittedly, acted much too late, both in terms of identifying the Ebola outbreak and then mobilizing resources to contain it – and losing much of its credibility in the process – experts agree that WHO remains a much-needed and relevant global health body, particularly when it comes to technical expertise.

“We all recognize that the WHO has had a fairly good history in the past,” Ihekweazu said. “And while it was certainly criticized for its slow response at the beginning of the outbreak…the WHO is seen as the leading organisation that provides guidance for countries and I think…we are at a stage where [Africa] needs the WHO as a mutual partner who provides leadership for the continent going forward.”

Mbow agreed: “What I would say is that when you are criticised, take the blame fairly, but don’t lose sight. And don’t lose confidence in the resources you do have to offer.”

Restoring donor confidence in WHO will be particularly important, as the regional office for Africa has the largest budgetary needs, the most countries, and, in many ways, the most challenging health problems to deal with.

“No one wants harm done to the WHO,” Merson said. “We will be a much better, healthier planet, if the WHO is strong and effective… But it is never going to have a huge budget and so I think its strengths should be in standard-setting, norm-setting and providing the best technical sound advice in health that countries need.”

jl/ha