Health related, Director-level appointments in the World Health Organization (WHO) are not front-line health workers with well-honed clinical skills. They are Senior Management/Administration. They need to understand resources, politics, and systems. They need to be able to gather, balance and weigh evidence, lead teams, provide advice, develop strategy, and monitor and evaluate performance. All this is done with the support of qualified teams. Where disease-specific knowledge is required, medicine can be useful. It is not uniquely qualifying.
A year ago I wrote that public health is not a specialisation of medicine. Sadly, no one at WHO read the blog. I know this because of the four director level (D1) positions recently advertised by the WHO African Regional Office (AFRO): (i) Regional Emergency Director; (ii) Director-Communicable and Noncommunicable Diseases; (iii) Director – Universal Health Coverage/Life Course; and (iv) Director – Universal Health Coverage/Healthier Population. Under “Required qualifications”, a medical degree with postgraduate qualifications in public health is stated to be essential for the first three positions. The requirement is marginally relaxed to “ Medical or health-related degree with postgraduate degree in Public Health or Social Sciences” for the last position.
The WHO view about the relationship between medicine as a qualification and the skills and capabilities required to fulfil the job — when you actually read the duties and responsibilities — is myopic. It is myopic because it creates a baseless, blanket exclusion for potentially excellent candidates. Why limit the pool of excellence that is available? No one is in any doubt that the health problems facing AFRO are massive. Hiring the best qualified people, not necessarily the best medically qualified people, will make tackling that problem a little easier.
Much has been written in the management and leadership literature about the need for diversity of thought at senior levels of organisations. The mantra is, do not surround yourself by cognitive clones. And yet, how much more effectively could one reduce the range of thinking than by restricting the thinkers to those who have all been trained to think in the same way? By identifying medicine as an essential qualification for jobs for which medicine is patently not uniquely qualifying, WHO entrenches particular ways of thinking about health and the delivery of its mandate. D1-Directors climb the ladder to D2-Directors. If you cannot qualify to be a D1-Director without medicine, you are excluded from climbing the ladder to a D2-Director. And thus, WHO develops a culture of thinking about health in which health equals medicine.
Who will cut that Gordian knot?