By Getahun Assefa G/Yesus

“A chicken that will grow into a cock can be spotted the very day it hatches”, African proverb; African wisdom.

This article argues against Dr Tedros Adhanom’s candidacy to the top post of the World Health Organization. The tenet of the argument is that the criteria to nominate head of global institutions such as the WHO should include sound or relevant professionalism, proven leadership skills, good governance and good government practices. Governments that are riddled with brut dictatorship, cronyism, rot corruption, ethnocentrism and overall maladministration should not file candidacy to top posts in global governance structures. Failed states such as Ethiopia will advance their candidature based on characteristic features that define them. In other words, potential candidates for top posts in international organizations such as the WHO, need specific leadership skills, relevant profession and proven technical qualities. Such skills should go beyond political acumen but include proven capacity to strategically think to mobilize global action to realize the vision and mission of international organizations. Ability to think strategically, proven technical capability, professionalism, excellence in leadership and specific risk management or problem solving skills should be part of the composite criteria to determine the right candidates for the top post in global institutions.  Candidates that lack the trust and confidence of their own people and the international community at large will dismally fail, if given open cart to lead organizations such as the WHO.

The article has five parts: Part I responds to a question: why will Adhanom be a bad omen to the WHO if nominated? This is a timely question, given that the organization needs public trust and confidence more today than ever before. This part will also compare arguments with relevant provisions and principles contained in the WHO constitution that established the global health body in 1948.  Part II discusses the underlying reasons for arguments against Tedros Adhanom’s candidacy to the WHO’s top post. Part III deals with the moral authority (or moral bankruptcy) of the developed countries should they allow Adhanom- the spin-doctor and henchman of the Ethiopian regime known for its brut dictatorship – to head global institutions. This part will also reflect on the wider implications of the behavior of some developed countries and their philanthropies in rallying behind dictators to head global institutions. Their tacit node or support to megalomaniac dictators and authoritarians will damage the relationship of trust and confidence between the international community, particularly the Ethiopian people and the WHO. Part IV exposes how the Ethiopian regime,  spin-doctored by Adhanom,  uses “starvation as  mass weapon of war” against the Ethiopian people for its political expediency and how this contravenes the WHO constitution and its basic documents.  Finally, part V reflects on glaring professional failures of Tedros Adhanom and his government in pushing the Ethiopian people into perilous social and economic hardships in all areas of available indicators. This part also provides concluding elements and addresses why Tedros Adhanom should not be elected/ or selected to the post of Director General of the World Health Organization. The arguments are based on evidence and they are free from hate or malice.

The main objective of the article is to expose the professional incompetency and political wrongdoings of Tedors Adhanom and the Ethiopian regime spin-doctored by him. The candidacy of Adhanom to head the WHO will be disastrous to the organization, given the crime he has been committing against the Ethiopian people and the dismal professional records he carries on his back. Ethiopians of all walks of life and diverse ethnic backgrounds should join hands and exert pressure to prevent Adhanom from pursing his interest of greed, this time, at the international level. If the Ethiopian government intends to file candidates for any global top posts such candidates should be free from the politics of the government. Their nomination should be solely based on proven leadership capacities, ability to strategically think, technical capability, professionalism and managerial skills to lead institutionally complex, financially robust and operationally intricate global institutions such as the WHO.

The key messages from the five-series of the article area: (a) Tedros Adhanom abused, misused and mismanaged public funds disbursed by the Global Fund to improve the deplorable health conditions of the people of Ethiopia during his reign as Minister of Health (see details and concrete examples further  below); (b) he has no relevant and proven expertise in key technical and operational areas within the mandates of the WHO; (c) WHO’s field, regional and global operations will pose significant challenges to Adhanom whose experience was only to briefly head the Ethiopian Ministry of Health, which itself is underfunded and was not capable of preventing health crisis in the country. For instance, in 2011 when Adhanom was the minister of health (Minister of Death), 75% of the land and 60% of the population is exposed to malaria in Ethiopia. The audit report by the Global Fund heavily criticized the administration of Adhanom (the then Minister of Health) that “none of the medical doctors and clinical nurses in the health facilities visited was trained in malaria case management as per national guidelines”. Moreover, the main infectious diseases that are top killers in Ethiopia are: respiratory infection (10%), Diarrheal Diseases (8%), HIV/AIDS (7%), Tuberculosis (7%), Stroke (7%), Cancer (6%), Ischemic Heart Disease (4%), and Preterm Birth Complications (3%).  (d) Ethiopia’s regime, spine-doctored by Adhanom is among the most corrupt regimes in Africa. The recent report released by Global Financial Intelligence in January (2016) revealed that $26 billion left the country unlawfully in many forms between 2004 and 2013 “with Ethiopia continuing to bleed an average of $2 billion every year”. And finally,  (e) Tedros Adhanom is the spine-doctor, external  face and protector of the government of Ethiopia riddled by arch dictatorship, totalitarianism, nepotism, lawlessness and all attributes of bad governance- all of which are in sharp contradiction with the constitution and ideals of the WHO.

Part I

The candidacy of Dr. Tedros Adhanom of Ethiopia to the top post of the world’s body on global health is viewed by many as contempt to the international institutions. For Ethiopians particularly in the country’s Diaspora community, the audacity of Adhanom is considered as a travesty of justice. Still for academics, experts and intellectuals in the public health arena   his candidacy is projected as a self- inflicted wound or simply suicidal idiocy. Ignorance of the regime has been tolerated for long. This time, however, such an idiocy and ignorance stand side by side with necked arrogance and ineptitude.

Adhanom, a biology student, turned malaria expert has no medical background nor has he proven expertise in public health. While his candidature tantamount to an insult to the intelligence of the global community, his mischievous behavior will be perilous to the World Health Organization if nominated. The Organization has already become lame duck in dealing with public health crisis. In the recent years, the Geneva-based health body is totally marginalized and riddled with crisis of public confidence. It has been under scathing attacks for its sluggish response to the crises over the recent Ebola epidemic in West Africa.  Independent panel of world class experts concluded that “WHO doesn’t have a robust emergency operations capacity or culture”

(http://america.aljazeera.com/articles/2015/11/23/health-experts-who-egregious-failure-on-ebola.html). Only a year earlier the Organization had been under scrutiny and series of investigations for the alleged wrongdoings with regard to H1N1 vaccine. The key accusations leveled against the Organization were linked to: (1)the apparent conflict of interest in its dealings with the virus,  (2) exaggerating the danger of the virus and thereby  (3) boosting the profits of pharmaceutical companies at the expense of public health. The organization was accused of “overplaying the severity of the illness-even announcing a fake pandemic and thereby boosting the fortunes of the pharmaceutical industry” (for details see www.dw.com/en/who-examines-claimes-over-exaggerateing.swine-flu).

For experts and close observers of the work of the WHO, this is the time when the organization needs specific and technically and professionally proven leadership skills. Such skills should go beyond political acumen but build on the culture of transparent and accountable governance, democratic principles and overall good governance as well as good government practices. Such qualities should also comprise the capacity to strategically think in realizing the vision and mission of the organization. Ability to think strategically combined with proven capacity to mobilize global action for the cause as well as specific risk management (and problem solving skills) should be important traits of global leadership qualities. Only such qualities can save the global body in the field of public health and reverse its perpetual decline and perils. Political acumen without proven and internationally recognized leadership qualities will not help to pull the WHO out of the quagmire in which it finds itself.  Experts agree that, if nominated (although there is an overall consensus that this would less likely be the case), Tedros Adhanom will be a disaster to lead the WHO and to turnaround the Organization to its fame and expertise in global public health issues, which is fast-fading.

Furthermore, the World Health Organization is one of the most complex, intricate and globally important (vital) organizations in the field of public health. It has an annual budget of nearly US$ 4.5 billion of which Country Offices account for 40 per cent, Regional Offices 23 per cent and Headquarters Operation 37 per cent. Simply put, the total budget of the Organization is equivalent to 10 per cent of the Ethiopian Gross Domestic Product or GDP (US$46 billion in 2015) and 15 times bigger than the country’s total healthcare budget. For the concluded biennium (20014-2015), the healthcare budget of Ethiopia was about US$ 600, 0000, 0000 (about US$ 300million a year)  of which 21 per cent comes from direct government allocations, 39 per cent from bilateral and multilateral sources, 37 per cent from households and the remaining,  3 per cent, from remittances and philanthropic sources (note to the readers: even household healthcare contributions are by far larger than the government’s direct expenditure on healthcare). For more details please see the government’s own document on (https://www.hfgproject.org/wp-content/uploads/2014/04/Ethiopia-NHA-Findings-Briefing-Notes.pdf)

The same document describes Ethiopia as one of the poorest countries in the world with a per capita healthcare “spending of US$16.10 in 2007/08 (Ethiopian Calendar) which is well below the $34 per capita health expenditure that the World Health Organization (WHO) Commission on Macroeconomics and Health recommended should be spent in low-income countries to deliver essential health care services in 2001, an amount that has been revised upward to US$60 by 2015″.

Tedros Adhanom’s era as Minister of Health was castigated for abuse, mismanagement and misuse of Global Fund Grants to Ethiopia. The Office of Inspector General (OIG) that audited the use of Global Fund Grants in Ethiopia published a damning report on 20 April 2012 when Tedros Adhanom was a Minister of Health. The report reveals serious abuse, misuse and mismanagement of funds meant to improve the health condition of the Ethiopian people. According to the report, allocations for Round 4 HIV interventions, in the amount of  ” USD 5.5 million was not used for the intended purposes and was still outstanding or unaccounted for by February 2011, although the grant expired in August 2010″. Similarly, “an advance of USD 6.3 million of major healthcare operations was still outstanding or unaccounted for in November 2010, after the grant period expired”.  The most disturbing evidences which the report uncovers relate to the fact that significant amounts of funds were “wrongly included in statements of expenditure reported by the Ministry of Health” during the year when Mr. Adhanom was a minister of Health. This includes “an amount of USD 11 million, which was transferred to implementing departments but that had not yet been liquidated or accounted for”. Another amount with the magnitude of “USD 4.7 million of VAT was included in construction payments”, despite the fact that Grants are exempt from Value Added Tax (VAT). Further shocking revelations by the Office of the Inspector General (OIG) relate to the newly constructed Health Centers (HC) with Grants from Global Fund. The report states that “the OIG visited 77 sites of newly constructed HCs and observed significant deficiencies, 71% of the sites visited did not have access to water; 32% did not have functioning toilet facilities; 53% had major cracks in the floors; and 19% had leaking roofs”. Overall the report recommended series of urgent actions to remedy the glaring abuse, misuse and mismanagement of public resources in Ethiopia. The recommendations include that the “Global Fund recovers from the Government of Ethiopia a total of USD 7, 026, 929 which was reported as ineligible and or unaccounted for during the audit period”. Therefore, Tedros Adhanom is corrupt and incapable (with no proven experience) of leading institutionally complex, financially robust and operationally intricate international institutions. Being a minster in one of the poorest countries and poorly funded institutions should not be taken as a yardstick to assume leadership positions in globally vital institutions such as the WHO.  (Note to the readers: The report of the Office of the Inspector General, titled as “Audit Reports and Diagnostic Review issued by the Global Fund’s Office of the Inspector General on 20 April 2012 on Ethiopia” has now been removed from the web. However, the I have the pdf version of  said report for anyone interested to consult).

• ty (GFI), a Washington-based research and advocacy think-thank, “corruption, kickbacks and bribery are on the rise in Ethiopia”. The recently published report of the GFI reveals that illicit financial flows out of Ethiopia ( one of the poorest African nations) nearly doubled to US$3.26 Billion in 2009 over the previous year with corruption, kickbacks and bribery accounting for the vast majority of that increase. The findings of the think- thank are more troubling  that “Ethiopia, which has a per-capita GDP of just US$365, lost US$11.7 billion to illicit financial outflows between 2000 and 2009”.  http://www.gfintegrity.org/press-release/illicit-financial-outflows-ethiopia-nearly-doubled-2009-us3-26-bln-says-new-gfi-report/. The most recent report released by Global Financial Intelligence last January (2016) revealed that $26 billion left the country unlawfully in many forms  between 2004 and 2013  “with Ethiopia continuing to bleed an average of $2 billion every year”. The main culprits and offenders are the ruling party (TPLF) owned parastatals that are run by unhinged dictators in Addis Ababa where Adhanom is spin-doctor and henchman.

• According to the World Bank’s Development Indicators (WBI), Ethiopia is among the the worst performers in literacy rate (with  only 29% literate out of 95 million population), life expectancy (52 for men and 56 for women) and 68% infant mortality rate out of 1000 live births. In a country riddled with massive corruption such a dismal social performance is inevitable.

• According to the WHO’S Africa office (WHO-AFRO), in 2011 when Adhanom was the minister of health (Minister of Death),  75% of the land and 60% of the population is exposed to malaria in Ethiopia, although malaria admissions and deaths  marginally fell in the recent years (afro.who.int/en/ethiopia/country-programmes/topics/480-ethiopia-malaria.html)

• The National Malaria Guideline (3rd Edition) prepared b the Ministry of Health of Ethiopia in 2012, before the departure of Adhanom to the Ministry of Foreign Affairs, states that “52 million people (68%) live in Malaria-risk areas”. The document further reveals that “Ethiopia is one of the most malaria- prone countries in Africa, with rates of morbidity and mortality increasing dramatically (i.e. 3.5 fold) during epidemics” (page 15) (for details see malariaconsortium.org. The same document alleges serious policy failures of the Government of Adhanom who was the Minister of Health (Minster of Death) until 2013. It argues “Ethiopia faces many challenges related to human resources for healthcare, including the shortage of skilled health workers, high turnover and lack of retention of health professionals” (page 64). In addition to these challenges, the National Malaria Guideline stresses once again, “serious problems in coordinating health interventions and implementing partners” (page 65)

• Another document, assessing the country’s malaria epidemic, prepared by Aynalem Adugna accessible on EthioDemographyAndHealth.org reveals that “malaria is the number one health problem in Ethiopia with an average of 5 million cases a year and 9.5 million cases per year during 2001-2005 period”. The document further indicates that “the disease causes 70,000 deaths each year and accounts for 17% of outpatient visits, 15% of admissions and 29% of inpatient deaths” (page 3).

• Center for Disease Control (CDC) of the USA claims that the main infectious diseases that are top killers in Ethiopia are: lower respirator infection (10%), Diarrheal Diseases (8%), HIV/AIDS (7%), Tuberculosis (7%), Stroke (7%), Cancer (6%) , Ischemic Heart Disease (4%), and Preterm Birth Complications (3%)  (http://www.cdc.gov/globalhealth/countries/ethiopia/. The remainder percentage of people are killed by  either by the regime or by injuries  and accidents including car accident where Ethiopia is ranked number one in the world.

From the above publicly recorded evidence and revelations by respected institutions, it is difficult to find out as to why Adhanom should be nominated to head the World Health Organizations. Where are the results which Mr Adhanom and his Government claim  as have been recorded in Ethiopia over the past 25 years? Why is he gambling to assume global offices at the cost of public health disasters in Ethiopia? Why is he using the suffering of the Ethiopian people as a springboard to assuming the post of Director-General of the World Health Body? When will the mockery and idiocy of such individuals stop?  The authoritarian government of Ethiopia and Africa’s arch dictators such as Robert Mugabe or Idris Deby should provide justifications why they think that Adhanom is the man to represent Ethiopia and Africa as head of the World Health Organizations.

Meanwhile, Ethiopians at home and aboard should brace-up to consistently campaign against the nomination of Tedors Adhanom to the post of Director-General of WHO. Their spilled blood, suffering, mass starvation, destitution and depravation should not be used as springboard to assume higher authorities in the global governance structure. Adhanom should be told in unambiguous terms that he should not be allowed to escape justices for the injustice and atrocities he and his government have been committing against the Ethiopian population for the last 25 years. The Governments of Sweden and the United Kingdom whose nationals have been languishing in the Ethiopian prisons under the regime spin-doctored by Adhanom bear huge burden of ethical and moral responsibility in undoing Adhanom’s campaign to the top post in WHO.