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Meet Dr Joy St John, Executive Board Chairman

Portrait of Dr Joy St John, Chair of the WHO Executive Board

Dr Joy St John is the Chief Medical Officer of Barbados, and Chairman of the WHO Executive Board. Following the 132nd session of the Executive Board, she talked with Gaudenz Silberschmidt, Senior Advisor, Office of the Director-General, about her work.

GS: What does the Chairman of the Executive Board do?

JSJ: The Chairman of the EB may have a role that has been defined in the past – but this Chairman of the EB is having a lot of fun! I actually enjoy chairing meetings at WHO!

“This has been an amazing, uplifting, enjoyable and downright fun experience. I so loved what I did, I loved the challenges, I loved it when there was a bit of friction ... From a global perspective what we achieved in these days is far reaching, it was not a talk shop, and much will come of this – I think we had a good foundation to press on with WHO reform and we kept it real.”

Dr Joy St John, in her closing remarks as Chairman of the 132nd Executive Board.

GS: More so than other meetings?

JSJ: Yes! And I’ll tell you why. I’m accustomed to meetings were there is frank debate – let’s put it like that - a lot of frank debate, and a lot of passion around the table. In WHO, the passion is more restrained, and the arguments are at a high technical standard. The challenge is to find consensus and reach conclusion. I had a lot of fun over that.

The EB Chairman has also had the privilege of overseeing the reform. So there have been many meetings – face to face and virtual - to advance the WHO reform agenda. It’s not new to me to be part of a reform of an organization; immediately after I was appointed as chief medical officer Barbados chaired the “PAHO in the 21st century” process – so being involved in WHO reform is like revisiting a nice memory. And another privilege as Chairman is that I’m also chairing the group looking at the evaluation of WHO’s readiness to implement reform.

I’m also a member of the expert group on NCDs. So I’ve been having a lot of interaction with the NMH cluster, most recently on the NCD action plan but in the past we also worked on the lead up to the global monitoring framework discussions and before that we had the UN high-level meeting on NCDs, so I also had a close involvement in trying to get some movement on the NCD agenda.

Another thing I’ve tried very hard to do is to ensure that the bureau - the vice-chairs and the rapporteur – are involved in the decision making, so we discussed the EB agenda and will meet shortly before the next EB in May. And the bureau is also part of the team overseeing the evaluation of WHO reform. We have had a lot of interaction, though not as much as I would have liked. But we have had a lot of interaction.

GS: What proportion of your work time is devoted to the EB?

JSJ: I can’t quantify the time – I wake up around 2.00-4.00 am my time and start to do WHO work, reviewing reports, reading papers; there was a ton of work to prepare for the January meeting. I also do a lot of my communication with WHO at that time – so my day starts early with WHO work and a few hours later I go off to the Ministry of Health to do my usual work, and then when I come home in the evening I pick up on the things that need to get done.

But it’s never felt intrusive, and it’s always been a pleasure. So it’s almost as if I run the two days simultaneously. I have not had a great deal of consistency in work, but I have kept up that rhythm throughout the year. And I have been travelling – mostly to Geneva on a regular basis – practically every month since I began to chair. So it is a good percentage – probably not as high as 50% more like 40%.

GS: What achievement as the Chairman, concerning reform, are you most proud of?

JSJ: Concerning reform? The strengthened role of the PBAC. I hadn’t experienced that many PBAC meetings, but I thought it was a massive waste of a powerful organ. And when we did reform the PBAC it saved my life. If the Chairman of the PBAC had not functioned in the way we wanted him to function as part of reform we wouldn’t have finished the January EB agenda.

The agenda of the PBAC was expanded, the decision making power of the PBAC was increased and therefore a lot of work - critical work – was done. A great achievement, and you can see the results in real time. So I’m quite pleased about that.

GS: And where would you have liked to see more results?

JSJ: I have a sense that the engagement of the staff in WHO reform still needs a little more work. At the same time as WHO is running its own business it needs a specific change management process and team – otherwise the things that need to get done can’t get done just because there are not enough hands to do the work.

But I think that the engagement of staff at all levels – with a heavy emphasis on all levels, because WHO should not be seen as just Headquarters - the engagement of staff at all levels is something that needs to fast forward, expand, perhaps with a little team specifically looking at reform – that is my sense.

GS: So we hope that this interview will also contribute to the engagement of staff!

JSJ: With an organization as complex as WHO you can’t please all the people all the time. And we know the egos in global health, we know the politics of health organizations - which far eclipse party politics – it’s such a complex issue. You won’t get it right 100% of the time, but you have do justice. Justice does not just have to be done, it has to be seen to be done.

GS: What advice would you give to your successor as the EB Chairman concerning support to reform?

JSJ: Get a good handover. I started in January 2011 – so I have seen the EB evolve during the last 2 years. There is no way that a person coming in as a new member can understand what is going on, without being active and engaged in the process. So you have to get a good understanding of what WHO is, so the best advice is to get a good handover, and do some interviews of your own, especially of the secretariat.

GS: And what advice would you give to Member States, where would you like to see their support?

JSJ: Well they need to pay attention to the process of WHO reform. The documents that have informed us and kept us abreast of progress have been very good. So they need to read them, and they also need to give input and advice – not just through the EB Sharepoint – but if they have a mission or an opportunity to visit WHO they should speak to people in the secretariat like you.

When you start a process of reform as complex as this, feedback is important – I’m sure that you are getting some of it. But there is a range of responses from a range of countries and from the three levels - I’m not sure that you are getting that . Member States needs to say a) you are doing a good job, or b) you are not, and c) this is how we would like it to be improved.

GS: You raise an interesting point, because indeed we face the challenge – both by Member States and staff - that despite our efforts it is difficult to get constructive criticism and feedback. We haven’t yet found a way to get this from people that have had time to devote to it and to put their mind into it.

JSJ: I think part of the problem is that it is happening really fast – believe it or not this process has been at lightning speed. It is difficult to divorce yourself from it and look on and give that kind of constructive criticism. And you are part of something that is happening so fast and changing around you. That is why I said I think it would be better with a change management team and process separate and apart from the running of the WHO.

There are counterparts in country offices, there are counterparts in regional committees - if you can get those people together, they may be able to share in a focus group setting – where they are bouncing off experiences and feeding off each other. I think that these mechanisms and modalities can add to the feedback and also remove the barriers.

GS: What would you like to see in WHO in 4 years’ time?

JSJ: The main thing that I would like to see happening is a greater alignment of the three levels of WHO. I would also like to see more strengthening of the regional committees. Some of the regional committees have infrastructure and resources, and there are others that have less.

I would also want to see a greater level of cross fertilization across HQ – I get the feeling that WHO HQ still works in silos. Even within clusters I think there are silos and people are not working together as teams.

And the other thing that I would like to see is a greater emphasis on human resources. I have listened to the staff association and I have seen the excellent work done by HRD. There has been a great deal of emphasis on process, there has been a great deal of emphasis on the human face, but I still believe there should be more work done.

Coming back to an earlier comment, I think that if there is better handling of staff, of their perceptions and comfort levels - if you don’t get a better handle on this, their role in WHO will be hurt from reform.

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