WHO Western Pacific candidates vow to rebuild staff trust

Candidates vying for the regional director position at the World Health Organisation Western Pacific regional office fielded member states’ questions in a unique online public forum meant to gauge their priorities and fitness for the job.

They shared their vision and proposals on how to address the burden of noncommunicable diseases, the threat of climate change, the creeping challenge of aging, the shortage of human resources for health in the region, and ways WHO can help the region prepare for the next health emergency.

Some of them also highlighted the need to address antimicrobial resistance and mental health and find solutions to the social determinants of health. They also laid out ways to rebuild staff members’ trust after the racism scandal involving the office’s former regional director.

“Staff that are content, that are happy, excited with the workplace, know their roles are respected, valued — they work better and they will deliver,” said Dr Jimmie Rodgers, current secretary to the prime minister of Solomon Islands and among the five candidates. The others include Dr Susan Mercado from the Philippines, Dr Saia Ma’u Piukala from Tonga, Dr Song Li from China, and Dr Tran Thi Giang Huong from Vietnam.

The forum took place on Friday and ran for over six hours, a rarity in the WHO regional director election processes that traditionally held such exchanges behind closed doors, away from the public. This, experts said, left little room for scrutiny of candidates and their competencies.

But this year there was clamor for change as over 60 experts penned a letter to WHO and its board, asking for more transparency in the process, including through an online public forum. It came ahead of three regional director elections in October, including in Western Pacific.

While the forum only allowed questions from member states, it provided an avenue for other health experts and members of the public to hear how the region’s next WHO leader would deal with existing and emerging health issues confronting Western Pacific.

Most of the candidates expressed the need to create and maintain an open and respectful working environment in the office. Staff accused Dr Takeshi Kasai, the WHO regional office’s former director, of often using racist language toward staff of certain nationalities. They described an office culture that was “toxic” under his leadership, as reported by the Associated Press. Kasai was eventually dismissed from the job over misconduct after an internal WHO investigation.

Dr Rodgers highlighted the need for staff to have recourse mechanisms to address their issues, whether it’s sexual harassment or other forms of inappropriate behavior, and ensure respect for staffers’ diverse cultures.

Piukala, the current minister of health of Tonga, said that if he’s elected “there will be zero tolerance to any misbehaviour.”

He said the regional office needs a culture change and called the effort “healing hearts,” a process in which “staff feel they are part of the team” and are supported and empowered. Some of the ways this can be done is through training and setting up a task force or working group to hear out staff issues and views, he said.

While more transparency in the three upcoming WHO regional director elections won’t take out geopolitical considerations and vote bargaining, experts are hopeful it would at least ensure all candidates are qualified for the job.

Mercado, who previously served as the regional office’s director of NCDs and health through the life course and who is running for the regional director position for the second time, said she would make herself accessible, would be willing to have lunch with “anybody at any time” at the office cafeteria, and would encourage staff to engage in extracurricular activities, not necessarily related to work.

“I think we need social prescriptions for our staff as well when they’re feeling burnt out,” she said, and added the need to create an environment “where it is safe to speak to share your ideas, even where there’s disagreement.”

All candidates recognised the challenges of NCDs and the impact of climate change in the region. Some also spoke of the need to address the region’s mental health crisis.

Tran, who is currently serving as the regional office’s director of the division of programs for disease control, said NCDs are one of the biggest challenges the region is facing, accounting for more than 80% of deaths. If not addressed, the region’s health care system will collapse, as there are insufficient resources to build health facilities for patients with NCDs. This is why she placed health promotion as one of her priorities, she said.

Mercado wants to address the growing problem of vaping in the region and emphasize tobacco control. In some countries, she said 30 percent of children aged 9 to 13 are already vaping.

When it came to aging, which the member state representative from Japan said will pose challenges for universal health coverage, Li, who is the director general of the Department of Maternal and Child Health in China, emphasised the need for NCD prevention and to ensure primary health care is able to respond to the needs of the elderly. She said it’s vital to build elderly-friendly communities, society, and hospitals.

“This is a life-course issue. From womb to tomb,” she said.

Migration, conflict, economic losses: The interlocking effects of climate change are now widely recognised, but the impact on global health — from tropical diseases to the next pandemic — has largely flown under the radar. That’s beginning to change.

Candidates also recognised the huge threat of climate change in the region and the need for a multisectoral response, saying neither WHO nor the health sector can do it alone. Some of them mentioned seeking assistance from other development agencies and funds such as the Green Climate Fund to help countries build climate-resilient health systems.

They also laid out ideas for how the region can prepare for and respond to a crisis, whether a pandemic such as COVID-19, a natural disaster, or one fueled by climate change.

Piukala spoke of harnessing the use of technology, which he said was helpful during the COVID-19 crisis. Technology can help people access health information quickly and access health advice such as through telemedicine.

Tran placed an emphasis on enhancing preparedness capacities in the areas of surveillance and early warning systems to mitigate the impact of a crisis on the population. She also recognised the human resource challenges in the region, particularly in Pacific island countries, and argued for training health workers at the primary care level so they are equipped to respond to multiple health challenges.

Mercado wants all member states to have developed policies, plans, and the required resources that are fully aligned with a potential pandemic accord. She wants to have a regional adviser for nursing and sees a role for the regional office to coordinate the procurement of supplies such as vaccines for pandemics.

Health leaders are banking on the meeting to galvanise high-level political support for strengthening pandemic preparedness and response. But the latest draft says “nothing transformative” to change the status quo, they say.

Li said that if elected, her first priority is achieving equity through high-level advocacy and broad partnerships. The Western Pacific region is diverse, not just when it comes to economic development, but also in health outcomes and coverage. For example, she said in some countries polio immunization coverage for 1-year-old children is way below the regional average of above 90 percent In Papua New Guinea, it’s only 36 percent.

The Western Pacific has never had a woman nor someone from the Pacific islands as a regional director. Since 1951, the position has been filled by a Korean or a Japanese man. This year’s elections, however, do not include candidates from either country, providing new leadership opportunities. Three out of the five candidates up for the job are women.

Dr Rodgers said Pacific leadership could ensure efficiency is a priority.

“Because we come from a perspective where we need to be innovative in order to get resources to help us to expand to grow,” he said.

While Mercado thinks it’s time for a woman to lead the regional office. “In a world where there’s so much complexity and people are hurting after the pandemic, and there is immense burnout in the health sector, I think women bring in the lens of family and relationships in all their work and therefore find it easier to create a nurturing and caring environment,” she said.