CONGO/B: ISSUES OF WHO COST EFFECTIVENESS

UNCLAS SECTION 01 OF 03 KINSHASA 001270

SIPDIS

FROM BRAZZAVILLE EMBASSY OFFICE

DEPT FOR AF/C, AF/RSA, IO, AND EB
IO FOR AS SILVERBERG, DAS MILLER, IO/TANN BLACKWOOD
AF FOR FRAZER
DEPT PLEASE PASS HHS FOR DR. WILLIAM STEIGER
PARIS FOR AFRICA WATCHER
GENEVA FOR HEALTH ATTACHE

E.O. 12958: N/A
TAGS: PREL EFIN AMGT OTRA OVIP CF
SUBJECT: CONGO/B: ISSUES OF WHO COST EFFECTIVENESS
IN AFRICA RAISED AFTER HHS DELEGATION VISIT

REFS: (A) State 132012, (B) Kinshasa 001172


1. This cable is a revised version of Kinshasa

1256.


2. SUMMARY: After the recent visit of a high-level
delegation from the U.S. Department of Health and
Human Services (HHS) to the World Health
Organization (WHO) Regional Office for Africa (AFRO)
in Brazzaville, a senior professional staff member
of AFRO told the Charge' d' Affaires that there is
an urgent need to examine the cost and operational
effectiveness of WHO in the entire Africa region.
He said the lack of a supportive infrastructure in
Brazzaville, the absence of a managerial focus on
cost effectiveness, high staff salaries and
benefits, and the high cost of the travel required
to manage regional programs mean that WHO/AFRO
spends most of the billions of dollars allocated to
it on administrative support requirements rather
than on health programs in the countries of the
region. Because of the influence of national and
sub-regional politics and a prevailing culture
within WHO/AFRO of strict loyalty to the boss (not
chosen by the WHO Director-General in Geneva but
elected by African member state governments to a
once-renewable five-year mandate),he concludes that
donor organizations like the U.S. Government must
strictly scrutinize how WHO/AFRO uses donated funds,
hold senior officials accountable to follow clear
budgetary guidelines and, if necessary, press for
structural reform within the WHO financial
management system. End Summary.


3. During the course of a three-day working visit
to Congo-Brazzaville July 25-27, 2005, Dr. William

R. Steiger, Special Assistant to the Secretary of
the U.S. Department of Health and Human Services
(HHS),who has served as the U.S. Government
Representative to the WHO Executive Board, and his
three-person delegation were hosted by the WHO
Regional Office for Africa and the U.S. Embassy. In
a partnership arrangement with the Embassy, Dr. Luis

G. Sambo, Director of the Regional Office, and his
staff organized the program and provided
transportation for the delegation. The Embassy
provided diplomatic and administrative support. The
members of Dr. Steiger's delegation included Dr.
Samuel Adeniyi-Jones, Director, Africa Region, HHS
Office of Global Affairs (OGHA); Mr. Joseph Grogan,
Executive Director, Presidential Advisory Council on
HIV/AIDS (PACHA); and Mr. R. J. Benn, International
Health Officer, HHS/OGHA. Charge' d' Affaires Ollie

P. Anderson, Jr. and/or Econ/Cons Officer Chelsea
Bakken accompanied the delegation during most of its
visit.


4. Upon arrival in Brazzaville on the evening of 25
July, the delegation accompanied Charge' Anderson to
a South African Embassy reception and later to
dinner hosted by the U.S. Embassy at a local
restaurant. Most of the following day was spent in
briefings given by Dr. Sambo and his senior staff at
the Brazzaville WHO Regional headquarters. Dr.
Sambo and his team outlined WHO/AFRO's ten-year
strategic plan, which included more delegation of
authority and responsibility to five teams organized
geographically at the inter-country level and
charged to work more closely with other regional
groups, national governments, and to develop public-
private partnerships. (COMMENT: In part, space
considerations in Brazzaville drive the
decentralization policy - while the planned moves
track the vision outlined by WHO Director-General J.

W. Lee to place more technical expertise at the
country level, the WHO/AFRO staff grew considerably
during its exile in Harare, Zimbabwe, and Dr. Sambo
simply does not have enough space in his nearly 60-
year-old building on the Brazzaville campus to bring
all of the WHO/AFRO professionals to the Congo. END
COMMENT.)


5. Some interesting statistical data was
interspersed within the briefings. The incidence of
HIV/AIDS infection in women between the ages of 15
and 24 is three-to-five times higher in Africa than
among their male counterparts. The infant mortality
rate in Africa is 100 to 110 per 1000 births, and an
estimated 15 percent of African children are
malnourished. Conspicuous by its absence from the
briefings was a list of significant health related
achievements in the region. During the briefings,
Dr. Steiger expressed to Charge' Anderson his
interest in the cost effectiveness of the WHO/AFRO
regional programs given the large share that goes to
Africa of the WHO's global budget (22 percent of
which comes from the United States).


6. Two days after the departure of the HHS
delegation, one of the senior staff members of
WHO/AFRO, to whom Charge' Anderson had given his
business card, made a follow-on contact with the
Charge'. A lunch meeting was arranged for Saturday,
July 30, 2005. This senior staff member, who
prefers to remain anonymous, said that donor
organizations should raise questions regarding the
cost effectiveness of WHO operations in Africa.
Brazzaville, he said, lacks the infrastructure
(roads, air travel facilities, reliable electricity,
trained personnel, etc.) to support a cost effective
operation. Air travel in the region is very
expensive, and some of the 46 countries covered by
AFRO are totally inaccessible by air from
Brazzaville. (COMMENT: As in much of West and
Central Africa, the quickest route from Brazzaville
to neighboring countries is often to fly up to
Europe and back down. (END COMMENT.) Information
technology (IT) operations, for example, would cost
less if based in South Africa. Local procurement
options are limited and expensive in Brazzaville
because everything is imported. (NOTE: As
reflected in the U.S. Government per diem rates,
international surveys perennially rate both
Brazzaville and Kinshasa as among the most expensive
cities in the world. Brazzaville is ranked the
fourth most expensive city in the world. END NOTE.)
Program materials and office supplies are often sent
by DHL to and from Brazzaville to support regional
programs. Local staff salaries are higher in
Brazzaville, he said, than in some other African
countries and the caliber of work is often
substandard. (He said about 300 of AFRO's 500 staff
members are local hires, which is a significant boon
to the Congolese economy). Staff members are
entitled to a one-week paid vacation at frequent
intervals and travel to selected destinations such
as South Africa, Kenya, or Ethiopia at WHO's
expense. During an emergency evacuation of family
members in 2002, he said WHO/AFRO paid an allowance
(DSA) of $100 per day to family members. The
emphasis, he said, is on job security, not program
effectiveness. (COMMENT: The physical location of
the campus is also precarious. Only one bridge
links the site to the rest of Brazzaville, and
cutting that link in an outbreak of civil unrest
would completely isolate the whole compound.
Because of the isolation and poor condition of
Brazzaville's infrastructure, the WHO/AFRO campus
must maintain, at great expense, its own power and
water sources, and has 46 villas and more that 70
apartments for professional staff, who live on-site.
END COMMENT.)


6. Because of national and sub-regional politics
and a prevailing culture of deference to the boss
(not chosen by the WHO Director-General in Geneva as
previously stated, but elected by African member
state governments to a once- renewable five-year
mandate),he said management at the Regional Office
has not addressed these issues. Those who raise
such issues are considered disloyal, and/or radical,
and would be forced out of the system. There is an
auditing process in place to monitor financial
transactions, he said, but there is no inspection
process in place to monitor cost and operational
effectiveness within the system. Thus, he concludes
that donor organizations like the U.S. Government
have a vital oversight role to play. They must
strictly scrutinize how WHO/AFRO uses funds, hold
senior WHO officials accountable to follow clear
budgetary and spending guidelines, and, if
necessary, press for structural reform within the
WHO financial management system.


7. COMMENT: Clearly, no one today would choose
Brazzaville for the regional headquarters of a major
international organization. In the pre-independence
1950's, however, when the French Government offered
the land and buildings outside the capital of its
West-Central African territories and the wartime
redoubt of General DeGualle, the other colonial
powers that made up the WHO/AFRO region at the time
saw no reason to refuse the generosity. Despite the
expense and inconvenience of the present site, re-
establishing the regional office somewhere else
would not be cheap (as the organization found out
when it abandoned Brazzaville for Harare during the
1997 Congolese war). The previous regional director
had an opportunity to move the office permanently,
but made the decision to return to Brazzaville.
Given the reality that the WHO has re-invested in
its Brazzaville campus at great cost, the
disclosures made in this report require further
investigation and corroboration. Post and HHS
believe this is a credible and accurate report of
the observations of a professional staff member with
many years of service with WHO/AFRO. He discussed
these matters freely without any expectation of
personal gain. Thus, this information can serve as
a reliable indicator of where some of the bones
might be buried as this issue is revisited in the
future.


8. Brazzaville Embassy Office - Anderson

MEECE