Examination of Witnesses (Questions 580
- 587)
MONDAY 21 APRIL 2008
Dr David Heymann, Dr Paul Gully, Mr Pat Drury and
Dr Max Hardiman
Q580 Chairman:
Can I just ask you to step outside your current roles for a moment
and take a look at the area in which you have been working and
tell me and the Committee what you think are the main organisational
changes you would like to see, looking at this whole area. There
are many, many organisations involved. If you stood outside it
and said what is the ideal structure, what would it be? What are
the biggest problems at the moment?
Dr Heymann: If I were to step outside WHO and
look at how could we make WHO function better, I would say it
is an issue of the constitution.
Q581 Chairman:
What would be the key issue?
Dr Heymann: The key issue is, of course, election
of our Regional Directors. As I understand when the constitution
was initially interpreted, it was interpreted based on the fact
that one of our Regional Offices was the Pan American Health Organisation,
which was already in existence and which had an elected Director.
That elected Director was also to become the WHO American Office
Director. The interpretation was therefore that the five remaining
Regional Directors should also be elected. No Director-General
would be mandated to work this through the system of change—this
would need to be initiated by the Executive Board. A possible
recommendation for the World Health Organisation would be to make
the Director-General or Regional Director term one instead of
two, one term after election, and during that term, which could
possibly be longer than it is today, there would be no consideration
of re-election. Those are two constitutional issues that in my
personal view could possibly be examined by member countries.
Q582 Chairman:
Would any of the other witnesses like to flag up anything new
or comment on that?
Dr Gully: I have only been in WHO for two years
and, therefore, I am not qualified to comment in the same way
that David has. One thing I have discovered is that an understanding
by Member States of the way WHO does operate and then inter-relates
with other UN organisations, other international organisations,
is only possible once you work within the organisation. It is
very difficult to come to the Health Assembly or an Executive
Board and really get a sense of how problematic it is from day-to-day
and, therefore, what the possible solutions are. A close understanding
from within the Department of Health and whoever represents the
UK Government at the Assembly, I am not saying it is not good
now but having people who have spent time perhaps in WHO who then
can advise the Department of Health who come to the Assembly and
work with the Assembly and WHO would be extremely valuable.
Q583 Lord Avebury:
Do you get secondments from most States?
Dr Gully: There are many secondments from many
countries. There will be a new policy about secondments, because
one of the challenges is that developed countries can afford to
second whereas developing countries cannot. In fact, in some ways
it would be better for the developing countries often to spend
some time. That is up in the air at the moment. Often there are
secondments from countries like the US or Canada or the UK much
more so than developing countries.
Q584 Lord Avebury:
How about asking Gates to help with the funding of secondments
from developing countries?
Dr Gully: That is an interesting point.
Mr Drury: There is a practical problem with
that: they do not go back. Seeing as I have my boss's ear, if
I could say a word. The single most significant structural change
has already taken place, that is the establishment of the national
Focal Points of the IHR. We are at a very early stage in how these
Regulations eventually get legs and get up and walk around, but
we have a situation now where in the WHO firmament there is this
new animal which is called the national Focal Point for the IHRs
and it is how that gets developed, both as a focus for this systemic
approach to risk management within strengthening health systems
at a national level and the demands that they put on the Secretariat
is how things might be driven as we take things forward.
Q585 Baroness Whitaker:
Is the one UN country office helpful to you?
Mr Drury: It is helpful on a day-to-day basis,
yes. There was an outbreak of Ebola in Uganda recently and they
are a Country Office which was in a very strong position within
the health cluster and was able to mobilise the UN system resources
there quite effectively. There is an undercurrent of criticism
of WHO in this because that position within the health cluster
is something that is new and needs to be developed carefully,
and in some countries, the Country Office, the WR as we call them,
the representative is politically able to do that, but in others
it is generating some criticism from other partners and big NGOs
who have deliberately stayed outside the health cluster.
Q586 Baroness Whitaker:
So it needs a little bit more?
Mr Drury: It needs more and we need to look
at that and that is tied into the MDGs, the big UN agenda on delivering
support to countries, while WHO has the International Health Regulations
and a legal framework, and somehow as we go forward we have to
look at how these two things dovetail so there is a real impact
in countries.
Q587 Chairman:
A lot of people are concerned about the multiplication of organisations,
both intergovernmental and non-governmental organisations, involved
in this whole area of disease. You seem to be slightly less worried
about the confusion of the architecture and seem to feel that
it can be coordinated. Is that a fair statement or not?
Mr Drury: There is an analogy somebody uses
that if you throw a frog into boiling water it is a very explosive
reaction; if you put him in cold water and turn up the heat under
the water and gradually cook him the frog does not know what is
going on.
Dr Heymann: No-one can top that!
Chairman: Thank you very much for your
evidence, it has been very helpful. If you feel that anything
has been left out, do let us know and feel free to send in any
more information. Thank you very much.
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