WHO and Margaret Chan: the next 5 years

14 Jan 2012
The Lancet
WHO is in the process of appointing a Director-General whose tenure will run from June, 2012, to June, 2017. Margaret Chan, the current incumbent, is the only candidate standing. WHO's Executive Board will consider her appointment when they meet later this month, and the World Health Assembly will ratify the Board's decision in May. It is certain that Dr Chan will win a second term.

Her renewed appointment comes at a perilous moment for WHO. As a letter we publish online this week from Oxfam reveals, WHO is in crisis. Rescue is needed. But is this predicament a fair reflection of the Director-General's performance? No, it is not. When Dr Chan was elected she made a promise—namely, that she wanted her term to be judged by progress on health for Africa and for women. WHO's leadership of Every Woman, Every Child, the UN Secretary-General's Global Strategy on Women's and Children's Health, has been her great success these past 5 years. Add to that the remarkable achievement in September, 2011, of a political declaration on non-communicable diseases, together with her refashioning of a failing health systems agenda around universal coverage, and you have a record that is a surprising success for an agency in the vortex of a financial emergency.

One cannot judge Dr Chan's legacy without recalling that her first priority 5 years ago was to deliver the initiatives begun by her predecessor, Dr Lee Jong-wook, who tragically died during his first term as Director-General. The most important project left unfinished was the Commission on Social Determinants of Health. Initially sceptical, Dr Chan not only saw this important report through to completion, but also became a significant champion of the social determinants agenda. Also recall that Dr Chan deftly led communications with the media and public during the 2009 influenza A H1N1 pandemic.

None of this is to say that there have not been disappointments. Her leadership team has not been a success. Only recently have the right people been selected for crucial portfolios. Several regional offices of WHO remain lacklustre backwaters. And sometimes one wishes for a sharper message, a stronger articulation of what WHO is for in the 21st century. These matters can be addressed during a second term. But that term will depend on proper financing of WHO by its donors. And here Dr Chan faces her greatest test of all.