London - After acknowledging that it bungled the response to the biggest Ebola outbreak in history, the World Health Organisation is electing a new regional director for its Africa office this week. Critics say it's about time.
WHO Africa is widely acknowledged to be the UN health agency's weakest regional office. In an internal draft document obtained by the Associated Press last month, WHO blamed its staff in Africa for initially botching the response to Ebola, describing many of its regional staff as "politically-motivated appointments" and noted numerous complaints about WHO officials in West Africa.
WHO has six regional offices including Africa — all of them are largely autonomous and do not answer to the Geneva headquarters. The UN agency was intentionally set up as a fragmented organization in 1948 because it was feared existing regional health organizations wouldn't want to join WHO unless they had a high degree of independence.
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Whoever is chosen as Africa's new WHO head probably won't have a big role in ending Ebola since the UN has already taken charge of control efforts, but the new director could be key to preventing similar disasters in the future.
No radical shake-up
First, its structure must be overhauled, experts say.
"Everyone working in global health knows that if you want anything done in the African region, the last people you go to is [WHO] Africa," said Kelley Lee, an associate dean in health sciences at Simon Fraser University in Canada, who has studied the governance of public health agencies. She said the WHO Africa office is plagued by a profound lack of transparency and said many top jobs are doled out as political favors.
The outgoing director of WHO Africa, Dr Luis Sambo, rejected the need for major change when he was elected in 2005, vowing that "there will be no radical shake-up." Sambo oversaw the WHO Africa response to Ebola and has declined numerous interview requests.
Having already served two terms as regional director, he is ineligible to run again in the elections held at a committee meeting in Benin this week.
There are five candidates jostling to be the new Africa director: Jean-Marie Okwo-Bele, a Congolese doctor in charge of the vaccination programme at WHO Geneva, Mali's Dr Fatoumata Nafo Traore, director of the Roll Back Malaria partnership, Dorothee Akoko Kinde-Gazard, Benin's health minister, Therese N'Dri Yoman of Cote d'Ivoire, a past health minister, and Dr Matshidiso Moeti of Botswana, who previously ran the country's epidemiology department.
In a report on lessons learned from Ebola released ahead of this week's meeting, the WHO Africa office said the explosive spread of the lethal virus was due to issues including poor awareness and badly trained health workers. It didn't mention several problems detailed in the internal WHO document written in Geneva, which observed that WHO staff in Africa refused to help get visas for outbreak experts to fly to Guinea and were compromising Ebola containment efforts.
Lee said WHO headquarters in Geneva should have jumped in sooner to seize control of Ebola from its Africa office, but that agency politics likely complicated that.
"There were enough voices raising the alarm outside of WHO to suggest that something exceptional was going on," she said. "Serious questions need to be asked within WHO Geneva about why these other sources were ignored for so long."
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In a speech at the Benin meeting on Monday, WHO chief Dr Margaret Chan stayed away from any critical remarks and instead thanked Sambo for his "years of dedication to WHO and to the health of the African people".
Some experts doubted that whoever is elected as new WHO Africa head would do much to change the stagnant culture there.
'Completely out of touch'
"There is no appetite for reform among senior WHO leaders," said Dr Donald A Henderson, who headed the agency's smallpox eradication efforts.
He called the WHO Africa office "completely out of touch" and said it was so bereft of competent people when Ebola in Guinea was identified in March that "there was no one left to raise the alarm."
Others said the fumbled response to the Ebola epidemic has further undermined WHO's credibility.
"This Ebola outbreak should have justified WHO's existence but it has become completely sidelined and irrelevant," said Lawrence Gostin, a professor of global health law at Georgetown University. He said regional directors, including the one in Africa, should be more accountable to Geneva but couldn't see them willingly relinquishing power.
"Seeing thousands of Africans die of a preventable disease should teach us to make sure the right systems are in place to avoid a similar outbreak in the future," he said. "But if history is any guide, then crises will come and go and nothing will change."