The Politics of Global Health: WHO DG Candidate Sania Nishtar’s Q&A, Part III

Sania Nishtar speaking in Ottawa 2006
Image credit
Sania Nishtar speaking in Ottawa 2006. Image Courtesy of Sania Nishtar.

Governed by member states with often differing views, WHO is still expected to lead on crucial matters of global health. For WHO Director-General, this necessitates a command of the art of politics.

“WHO is entering a new era of responsibilities, where a political role assumes great importance—and it must realign and reconfigure,” says Sania Nishtar, one of three finalists in the race for DG. The future, Nishtar says, demands that WHO deal more directly with heads of government whose decisions in finance, trade, IP [intellectual property], investment treaties, food, migration, etc. have major impacts on global health.

In this third installment of a 4-part Q&A with GHN, Nishtar discusses the need to better communicate WHO’s mission, the challenges of resolving trans-border risks, and the need for the organization to develop political clout.

The Ebola outbreak in West Africa exposed a gap between what WHO is (a consultative, technical organization) and what the world expects from it (a rapid-response health organization). How would you deal with that?
So, you know, part of what the running of organizations involves is communicating what the organization is about. And certainly, we can do much better as far as that is concerned.  Now, WHO is several things in one animal. It is the world’s leading organization, which has the exclusive stewardship mandate, which needs to come into play during infectious outbreaks and emergencies with health consequences.

It is, of course, also the norm and standard setter for health globally; in a way, the world’s global compass for health. And then, it is meant to be the technical lighthouse of the world as well. It is important to clearly communicate how it will play these roles. Especially in the case of its technical role, countries have to appreciate that WHO gives technical advice but neither is it a funding body nor does it have an implementation role.

What is more important in a Director-General: Having experience in global health or political skills?
The DG has to have both. The DG is the chief technical officer of the world’s leading agency for health charged with a standard setting role, and it is not acceptable for the DG to be reliant on others for technical decisions.

On the other hand, the DG has to play an important political role as well. We must appreciate that the global political landscape for health has changed—and so has our understanding of health—its determinants, how we deal with it as a policy issue and the sectors that need to get mobilized to address the complexity of the social, environmental and economic determinants of health. WHO is entering a new era of responsibilities, where a political role assumes great importance—and it must realign and reconfigure.

There are a number of complex trans-border risks, which call for political problem solving abilities at a global scale. Threats such as emerging and reemerging infections, AMR [antimicrobial resistance], NCDs [noncommunicable diseases] and climate change are threatening to wipe out the development gains of the last century—and as the world’s only universal membership multilateral agency in health, it is WHO’s mandate to lead on them.

There is a new context shaped by the sustainable development frame. Up until now, WHO has been attempting to lead international health work by focusing on health actors—now it must re-interpret its role in an environment where overarching decisions about health such as UHC [universal health coverage] are taken by heads of government, where decisions that impact health, go far beyond the ministries of health; where many political domains and sectors outside health shape global health—finance, trade, IP, investment treaties, food, corporate activity, migration, conflict.

The policy approaches to deal with NCDs, AMR, road safety, violence and injury prevention, the drug problem, social and environmental determinants of health are a case in point. Even achievement of UHC, which is seen to sit in the health domain necessities a massive change in employment, and economic and social policies.

This, on the one hand, means WHO must develop the political clout to influence other policy fields and shape their behaviors in such a way that the political, economic, and commercial objectives of these actors are reconciled with public health goals. On the other, it creates an imperative for holistic approaches, and partnerships where WHO becomes a force multiplier through norm setting—and that is precisely the reason why I emphasize the importance of honing WHO’s mandate and ushering in a new era of leadership, centered on partnership-building in my vision.

The new era also means WHO leads on hard issues and helps countries overcome systemic constraints, build their institutions and systems so that they can deliver on the SDGs, and agencies such as WHO can focus on where they have a comparative advantage. That is a political role, which I have done all my life.

Also, we have to be mindful political attention to global health has increased, expectations have soared, but WHO sits in a very uncertain political and financial environment. It will take astute political and communication skills to make a strong investment case, and ally concerns in the wake of reputational damage, which eclipse WHO’s strengths and its potential.

And, WHO is a member-state governed body and on the one hand, the secretariat’s role is to execute policy set by member states; but on the other hand, WHO is also the global guardian of health—which means it must take independent positions and give the right advice even if it has political implications, and that will entail political leadership.

Finally, there is a political role that has to be played internally within the organization as well. WHO’s governing bodies come from diverse positions and have a sovereign right to bring issues to the table—but this creates issues for priority setting. And because of their diverse backgrounds, they often tend to get polarized on certain matters creating an impasse—and that is where the DG’s political mediation role assumes great importance. These are roles I have played all my life. 


Read other installments of Global Health NOW’s 4-part Q&A with Sania Nishtar here

This interview has been edited for clarity and length.

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