African academics set out what Dr Tedros needs in his toolbox to tackle health ills


By Andrew Githeko, Kenya Medical Research Institute, Bob Mash, South African Medical Research Council,  Karen Daniels, Stellenbosch University and Thumbi Mwangi, Washington State University.

Africa has the highest burden of HIV/Aids and malaria with escalating rates of non-communicable diseases. How will the World Health Organisation's Director-General Dr Tedros Adhanom Ghebreyesus deal with the mounting challenges? The Conversation Africa asked academics across the continent what impact his appointment will have, and for advice on what he needs to do, to manage the challenges.

What is the significance of his appointment?

Dr Thumbi Mwangi, Washington State University:  It's two fold. He is the first African to lead the global health body in its 70-year history. As an African he has been closely involved in the battle against neglected tropical diseases like rabies which affect 1 billion people. He was health minister in Ethiopia where neglected tropical diseases are endemic. He needs no lectures on why the WHO must remain at the forefront of fighting them. Secondly, his ownership of the agenda he set out in his campaign manifesto - to work towards "a world where everyone can lead healthy and productive lives, regardless of where they are or where they live" - should be seen and felt.

Dr Andrew Githeko, Kenya Medical Research Institute:  Dr Tedros brings a wealth of experience and skills in governance, diplomacy, advocacy and resource mobilisation. His efforts as health minister in Ethiopia produced measurable and significant outcomes. He's familiar with addressing infectious diseases like malaria as well as non infectious diseases. He also led research into effective ways of controlling malaria and greatly improved the ways in which it's prevented and controlled. On top of this, he played a momentous role in bilateral and multilateral malaria initiatives including those supported by The Roll Back Malaria Partnership and the Global Fund. As a researcher he will be sympathetic to the plight of researchers from developing countries.

Dr Karen Daniels, South African Medical Research Council:  Dr Tedros comes from The Horn of African which remains a politically fragile setting, vulnerable to the impact of conflict and natural disasters. What this means is that he's been in the health care trenches, like many of us who live and work in health settings across the continent. This is precisely where it's been shown that Africa can find African solutions to African problems. A leader like this is needed at the helm of the WHO to understand that Africans can be included in partnership rather than dominated to find solutions to the unique challenges that the continent faces. From an African health policy and systems research perspective, there are many reasons to laud his appointment. He brings the combined perspective of having been a researcher, a health systems manager, minister of health for Ethiopia, and policymaker.

Professor Bob Mash, Stellenbosch University: Dr Tedros is the first WHO director-general to have firsthand knowledge of the challenges facing African countries and health systems. One of his priority areas is "health for all" and providing universal health coverage. This implies a commitment to the strengthening of health systems, particularly primary health care. This should stimulate research on disease orientated programmes as well as cross cutting systematic issues like the primary care workforce, access to care, patient-centredness, community orientated primary care as well as continuity, coordination and comprehensiveness of care. But his experience in Ethiopia may not have sensitised him as much to the global problem of non-communicable diseases that's also becoming a problem on the African continent. One of my concerns is whether he will give sufficient attention to the epidemic of diseases such as hypertension and diabetes.

What are three biggest challenges facing him? What should he tackle first?

Dr Mwangi, Kenya Medical Research Institute: The WHO faces financial constraints to address global health challenges including outbreaks of emerging infections.  Countries that are adversely affected by neglected tropical diseases need his voice and the diplomacy of his organisation to keep them high on the global agenda, as well as top of mind in individual countries. Dr Tedros needs to make three focused commitments while he's at the helm.

The first is domestic financing: for a long time countries affected by neglected tropical diseases have been accessing external funds. He needs to urge them to commit their own budgets to this docket. Domestic budgets can help significantly. We need relatively low cost solutions such as drug tablets that are out of patent, improved hygiene for the affected populations and effective vaccines. Dr Tedros should also ask partners to keep their commitments. Secondly, there should be a deliberate effort to integrate the detection, surveillance and treatment of these diseases into the health system. Countries stand a much better chance of reducing and finally eliminating neglected tropical diseases if all the interventions are embedded in primary health care systems.

The One Health concept that brings together the human and animal health perspectives should also be considered. Dr Tedros supports this concept. His challenge will be how to break the current silos. Innovations offer important toolkits to consider. This includes mobile phones to diagnose and report diseases as well as drones to supply emergency medical care and a rabies vaccine that needs little refrigeration that can be delivered by community health workers.

Dr Githeko, Kenya Medical Research Institute: When it comes to malaria his greatest challenge will be to sustain - and increase - resources to the various control programmes, particularly in sub Saharan Africa. Resistance to malaria medicines is a global health threat. Dr Tedros should support malaria endemic countries to expand and accelerate national efforts to control and eliminate malaria.

The WHO should urge member states to improve the training of health workers so that they closely follow the protocols in the treatment and management of malaria. This will save more lives. The infrastructure in health facilities should also be improved to test for malaria, and to treat it more efficiently. This can only be achieved through concerted efforts and commitments by WHO member states. The research wings in various countries need to be supported to encourage novel research of drug and insecticide resistance. Support for research will be critical to address scientific, behavioral, and socioeconomic factors that affect malaria control.

Dr Karen Daniels, South African Medical Research Council: There is a vicious cycle in which the burden of increased communicable and non-communicable diseases weaken health systems. Dr Tedros has the challenge of strengthening these systems, something he's already committed to. This has to be supported by sound health policy and systems research, to help find solutions to the continent's health challenges. But better home grown solutions need more investment in national and Pan African centres of excellence. Dr Tedros could help by enabling greater WHO investment in health policy and systems research. These centres of excellence should be founded on close collaboration between researchers, health systems managers, health systems policymakers, as well as communities and civil society organisations.

Centres of excellence could facilitate closer collaboration between health policy, the research community and the WHO. This could help ensure that research is more closely aligned to the real challenges faced in our own countries. We will hopefully begin to reduce the "know-do gap" where research evidence exists, but isn't taken up in implementation.

Professor Mash, Stellenbosch University: One of his greatest challenges will be strengthening health systems at primary health care level. Governments need to be convinced to invest in primary health care as the hub and not the marginalised periphery where poorly trained and low level health care workers offer fragmented and poor quality care. Strong multidisciplinary teams should include a family physician. Strong primary health care is a prerequisite for providing universal health coverage. Ideally this should be through a national health insurance or systems that - at the very least - don't impoverish people or increase inequality.