Opinion Pieces

A turning point for global health governance

Health diplomacy for the 21st century

News coverage of last week’s meeting of the Executive Board of the World Health Organization (WHO) missed the new sense of purpose and willingness of member states to address politically complex issues head-on and work towards acceptable compromises in the interest of global health.

This was exemplified in the negotiation of a proposal from the African group of countries to institute a policy of rotation between geographic regions for the election of future Director Generals of the WHO. The issue could have led to political deadlock on the board, but it was artfully avoided through a deft show of statesmanship and above all a collective desire to see the board succeed in its work.

A turning point

Initially, the Executive Board was composed of experts nominated and elected by member states to provide the WHO with technical guidance, but it shifted in the 1990s to become a political board where members represented their countries’ national interests and seemed more inclined to support the many new global health initiatives established outside the WHO, such as the Global Fund, GAVI, PEPFAR, and the Stop TB and Roll Back Malaria Partnerships, to name a few. With last week’s meeting, a turning point was reached. The complexity of the global health challenges and the fragmentation of the many actors has now reached a stage where countries – donors and recipients alike – are keen to have WHO “act as the directing and co-ordinating authority on international health work” as stipulated in its constitution.

Landmark consensus on WHO leadership

The will to move forward expressed itself in the discussions on the future financing of the WHO – an issue that is a catch-all for a debate on the role of WHO in the 21st century. Everyone in the room agreed that WHO must be the organization at the centre of global health governance – a shared opinion that would not have been expressed with such force and clarity a few years ago.

Notable statements, particularly from the African group of countries, called for a greater involvement of developing nations and emerging economies in global health governance. Concrete proposals for how to move forward with a sense of urgency were raised, and Director General Margaret Chan received a clear mandate to develop reform proposals for discussions at the World Heath Assembly in May.

A more inclusive and higher standard for future boards

This board has shown that a new skill mix is required for global health governance: a combination of technical health expertise and statesmanship combined with a sense of common purpose. It is clear: serving on the board requires a high level of commitment, preparation, and diplomatic skills, more evenly spread across the regions. No longer can one just fly in and out and read prepared statements. Global health governance increasingly affects social and economic development around the globe – it must be prepared with earnestness at home, conducted with responsibility in Geneva and, most of all, followed through.

Prof. Ilona Kickbusch, Director of the Global Health Programme at the Graduate Institute Geneva, and Chair of the Global Health Europe Task Force, is one of the world’s foremost experts on governance for global health. Her experience spans several reform initiatives and WHO Director General Administrations. She has published numerous papers and articles, including a response to the seminal 1994 BMJ Godlee series on the future of the WHO