Statement by WHO Regional Director for Africa, Dr Ebrahim Samba, on the editorial in the 7 August 2004 issue of The Lancet

Brazzaville, 11 August 2004 -- An editorial in the August 7 issue of The Lancet painted a bleak picture of the work of WHO in the African Region, giving the impression that WHO is not recording any successes there. In fact, despite the challenges of poverty and ongoing instability, the opposite is true.

For example, in spite of recent political difficulties, the number of polio-endemic countries in the African Region has fallen from 20 in 1999 to just two today. Huge efforts are underway to eliminate the disease completely.

Four years after I took office, the African Region reached the goal of eliminating leprosy as a public health threat. Today, the average regional leprosy prevalence is below one case per 10,000 population.

The number of people affected by debilitating guinea worm has also continued to drop; only 9,031 cases were reported in 2003. Half of all the guinea worm endemic countries (there were only 12 in 2001) reported less than 50 cases in 2003.

Support from the Regional Office and WHO Headquarters has helped to restore some order to the health systems of hitherto war-torn countries such as Liberia and Sierra Leone. As at the end of 2003, 42 of the 46 countries in the region were implementing the WHO-recommended Directly Observed Treatment, Short Course (DOTS) for tuberculosis control. The Regional Office is collaborating with WHO Headquarters and other development partners to respond to requests by Member States to improve access to HIV/AIDS care and treatment under WHO's "3 by 5" Initiative - critical to improve the lives of millions affected by HIV/AIDS.

There is definitely hope for Africa and WHO/AFRO will continue to play its part.

To address some of the specific comments in the editorial:

The Lancet: "At the heart of the regional office's ineffectiveness is its acting as a political rather than as a technical agency. Recruitment of senior staff is rarely based on competence and qualification…appointments of country representatives …are often paybacks for political or other favours."

WHO is the only UN agency where the Regional Directors are elected by Member States. Furthermore, WHO's governance structure comprises Regional Committees, the Executive Board and the World Health Assembly. The membership of these is drawn from Member States. Therefore, a close relationship between WHO and its Member States is inevitable because WHO was established to support countries.


Recruitment at WHO/AFRO is carried out strictly in accordance with the rules and regulations of WHO. All staff are recruited strictly on the basis of qualification, experience, proven track record and competence. …/1 The WHO Representatives I have appointed over the past ten years have been a mix of senior personnel from national government ministries as well as from other sectors and institutions within and outside Africa. The majority of these had joined WHO as staff members thus allowing us time to assess their suitability for appointment as WHO Representatives. WHO is currently conducting a global review of its policy for the selection, placement and rotation of WHO Representatives, and WHO/AFRO will follow the new procedures once this has been finalized.

"There are strong arguments for decentralization of WHO/AFRO to at least four or five subregions.".

My predecessor experimented with this idea. He established three sub-regional offices but later closed them down for a number of practical reasons. Nevertheless, alternative methods should continue to be explored, including the current level of operations that we are maintaining in Harare, Zimbabwe, and Ouagadougou, Burkina Faso.

"WHO/AFRO has a very limited core budget and focuses on vertical donor-driven initiatives, almost certainly because this strategy is seen as the best way to ensure the agency survives". 

The Regular Budget of WHO (the portion funded by assessed contributions from Member States) has had zero growth for many years now. WHO appreciates the strong support by donors and partners. It is right to say that some important programmes have been donor-driven vertical initiatives. This, indeed, has been the subject of considerable discussion both within the WHO secretariat as well as in its Governing Bodies. However, in its programme budgeting, WHO globally is integrating Regular Budget with Extra Budgetary resources into a comprehensive, results-based approach. I should mention that WHO/AFRO is bringing together national Ministries, civil society, multilateral and bilateral agencies, NGOs and other development partners to ensure a coordinated approach in support of public health expenditure programmes. WHO has also developed a strategic approach for working with countries based on a Country Cooperation Strategy which we in AFRO have articulated in almost all 46 countries in the Region. Extrabudgetary resources placed at the disposal of AFRO have grown substantially from $90m in the 1994-1995 biennium when I assumed office to $350m in the 2002-2003 biennium. This, obviously, is a vote of confidence in WHO/AFRO. I would like to add that we work in close cooperation with WHO Headquarters and our relationship with Geneva has never been better. 

"Dr Samba is to step down after serving his maximum of two terms as Director of WHO's Africa Region"

Under my terms of appointment, the "maximum" two-term rule does not apply. However, I am voluntarily retiring in January 2005 in keeping with the pledge I made after my nomination for a second term during the forty-ninth session of the WHO Regional Committee for Africa held in Windhoek, Namibia, in 1999.

Nomination of a new Regional Director

The election will take place in accordance with the rules of procedure of the Regional Committee for Africa. While these are essentially the same as for other WHO regions, there is additional transparency in the case of AFRO which is the only region where each of the candidates will be interviewed for an hour by the Regional Committee (comprising Health Ministers from the 46 countries which constitute the WHO African Region). This exercise will take place on Wednesday 1 September 2004. We will keep the world appraised on the important results.

Dr Ebrahim M. Samba 

Regional Director

For further information: 

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