THE INTERVIEW: Sifelani Tsiko
Dr David Okello’s tenure as the World Health Organisation Representative in Zimbabwe comes to an end this month after serving the country for five years. During his tenure the WHO enjoyed good working relations with the Government which saw him providing policy advice on matters of health and development, and directing the work of WHO in the country. In the report, Sifelani Tsiko (ST) our senior writer speaks to Dr Okello (DO) about his eventful stay in Zimbabwe.
ST: Your five-year tenure of office is coming to an end. How would you describe your tenure here in Zimbabwe?
DO: My tenure of office in Zimbabwe has been a very happy one, fully engaging and extremely productive. During my stay in the country, I met great people with vast talents across all professional disciplines. I appreciate the hospitality and friendship found abundant in this beautiful country. I am at a loss for words to explain my profound gratitude. When I arrived in Zimbabwe slightly over five years ago there was a UN media debate on what to do about maternal mortality figures which were frightening — Zimbabwe was losing so many women. I do remember saying pregnancy though associated with some risks, is not a disease; but a natural phenomenon that should not be a death trap.
Some Ministry of Health and Child Care (MOHCC) officials were saying women were dying because of unavailability of blood. The Health Transition Fund (HTF) had money for procurement of medicines only. My very first and rather forceful intervention was to say the same funds should be used to buy blood to stop women from dying whilst having a baby, which is the future of any country. Together with some civil society activists, we waged a campaign to ensure blood is included in commodities under HTF. Over the years the numbers of women dying during childbirth have dropped significantly which I believe I contributed towards.
ST: What would you regard as some of the major achievements you made to Zimbabwe and Africa as a whole?
DO: Achievements can be difficult to attribute to individual efforts, as my role remains to trigger actions from other players. But I remain extremely content by the story of a 10-year-old boy who attended a speech I gave at a UN Wellness Day, three years ago. At that function, I narrated my experience when I go for church service on Sundays in the middle of Harare City.
Wherever we get out of the church, all the well-to-do families drive their children to the nearby fast food stores, where they engorge themselves fully with salty and oily chicken parts, and sugar rich drinks. I told the fully packed audience at the UN function that these very popular foods and drinks are very dangerous and bad for health. I said this habit must stop.
The following Sunday, the 10-year-old boy vehemently refused his grandmother to take him to Nandos. The boy told her to adhere to WHO advise on safe foods — to avoid highly refined foods rich in saturated oils, salts and sugar. He requested instead to be taken home to eat sadza and vegetables. The grandmother was surprised, but happy to save her meagre dollar coins.
I have no means of envisaging the impact of my advice and what people take and use from my public statements in media events, workshops and from my public lectures. But I was thrilled by the story of this boy. I surely must have influenced many people out there.
I have played my role as the leader of WHO in the country in three specific areas: 1. Ensuring WHO’s effective health leadership at the national level by: ( i.) Convening national as well as international stakeholders, (ii.) Engaging effectively in partnerships to promote WHO’s health agenda of facilitating and supporting the achievement of quality health services for all, and (iii.) Enhancing WHO’s image and visibility in the country; 2. Acting as the lead technical advisor to the Ministry of Health, other related Ministries and other national and international partners on public health issues, strategies, priorities and programmes, with an emphasis on integrated, multi-sectoral approaches in order to build the capacities of national systems to address public health challenges in the country; and 3. Leading the WHO country team in ensuring the optimal use of WHO financial, technical, logistics and human resources through efficient and effective team management of the country office and country team;
We have helped the country raise funds to sustain important public health programmes. For instance, WHO led the development of Global Fund grants applications and the subsequent negotiation processes. The Global Fund is one of the key financiers of the HIV response in Zimbabwe. To date about 1 million of the estimated 1,3 million people living with HIV (PLHIV) are on ART. Cumulatively, the Global Fund has disbursed some $837 942 716 for the HIV response in Zimbabwe. As WHO we played a major role in this.
ST: What do you think were some of the challenges you faced in implementing some of the programmes in the country?
DO: The mandate of WHO is linked to the provision of technical support to health programmes, enforcing norms and standards, based on internationally established standards. Unfortunately, many health stakeholders in the country prefer WHO to be a donor, to raise funds and mobilise resources for health care. The other challenge is we have had gaps in the range of expertise needed to support country programmes, particularly in health promotion, nutrition and mental health.
ST: Zimbabwe hosted the 67th Session of the WHO Regional Committee for Africa at Victoria Falls from August 28 to September 1, 2017. What is your comment about the event? How would you describe Zimbabwe’s role in this event?
DO: The 67th Session of WHO Regional Committee for Africa was an uplifting experience to see all health leaders from Government and partners united. The leaders placed the health of the people at the centre of development endeavours not just in words, but also showed that they care.
The meeting was a resounding success with over 600 delegates, and a total of 37 Health Ministers from different countries in attendance. The coordination of efforts with the Government of Zimbabwe, at the preparation stage and during the meeting was exceptional. We commend the leadership and experts of the Ministry of Health and Child Care for exhibiting the true nature of leadership in this respect.
Zimbabwe displayed talent and experience in organising such a large meeting. Beyond the technical issues in the meeting, I believe the country marketed Victoria Falls as a solid tourist destination — with a brand new airport and excellent facilities in the environs of the Falls.
ST: Zimbabwe and most other African countries still shoulder a disproportionate share of the global disease burden for communicable and non-communicable diseases. How best can Africa fight NCDs?
DO: The new burden of NCDs comes at a time when the country is still struggling to bring infectious diseases under control. Fortunately, NCDs are largely caused by a small number of shared risk factors, including: improper diet, inadequate physical activity, tobacco use, and excessive alcohol consumption. To this extent, I would like to make a special appeal to health and social researchers in Zimbabwe to find feasible ways of confronting the risk factors to NCDs. We must pressurise industries to stop marketing dangerous products to our children.
Let me mention here a specific NCD problem of grave concern. What can we realistically do in response to the carnage we are facing on the roads? Road traffic accidents (RTAs) have reached totally unacceptable levels. We know that these accidents are largely preventable if different relevant initiatives are implemented conscientiously. The risk factors are mainly behavioural — including non-compliance with road traffic regulations and harmful use of alcohol, among others. It is about time we paid attention and got better understanding on who is actually injured on the roads; and what is the impact of the injuries on families and communities.
This remains another area of much needed research, to examine the full knock on effects of road injuries. We should not limit our concerns just on medical treatment and rehabilitation of victims of RTAs.
ST: Do you think the political will is there to fight NCDs and other infectious diseases here in Africa? Are African governments spending as much as they should on health?
DO: Besides being in charge of WHO operations in Zimbabwe, I have also been coordinating the work of WHO in the Eastern and Southern Africa sub-region. I therefore have good insight on how governments in the sub-region generally handle matters of health.
Public health is constantly fighting to gain attention and resources. Many of the mechanisms and infrastructures that safeguard public health on a daily basis go unnoticed until something dramatic goes wrong. The need to invest in health may come into view only when the food or water supply is contaminated, or when the stocks of essential medicines procured through support from partners suddenly run out, and/or when surveillance misses the start of a major outbreak. Although the consequences of such failures are costly and disruptive, public health still struggles to persuade Governments to invest in basic infrastructures and services — before something catastrophic happens.
That notwithstanding, I believe there is good political will. What is lacking is the need to walk the talk — put more resources into health.
ST: What do you think is the role of African medical researchers in finding solutions to some of the pressing health problems on the continent? Do you think they are getting the necessary support to carry out their work?
DO: Research is about finding solutions to the problems we face every day. I urge African health researchers to see the challenges in the health sector as opportunities for innovations. And in looking for answers to the challenges in the health sector, we should also actively engage well beyond the health sector, given that the solutions to some of our challenges may be found elsewhere in other sectors.
ST: Are you happy with media coverage of health matters here in Zimbabwe and the rest of Africa? How can the WHO and the media improve the coverage of health issues on the continent?
DO: Media coverage on health matters has been visible but not enough given to disease scourge and emergencies that we face. There is a need for continuous dialogue between media and the Health fraternity to nurture a consistent reporting mechanism on health matters;
ST: Do you think Africa’s specific needs are getting attention at the WHO and global level? Are our concerns being addressed as Africa?
DO: As you know, for the first time in the history of WHO, a new WHO Director General (DG) from Africa was elected into office during the last World Health Assembly in May 2017. This is an opportunity for Africa to steer the global health agenda and elevate the aspirations of Africa better. For the new DG to really pay attention to the needs of Africa, it will be most desirable if African member states and philanthropists in Africa pay their full share for the work of WHO in Africa. In that way, they will have a stronger voice advocating for issues in Africa at the global stage
ST: Some critics say there is need to reform the way UN agencies such as the WHO operate. What is your comment on this? How best can Africa’s needs receive the attention they deserve?
DO: I agree, and I think the current leadership of WHO at global and regional level want to see a change in how we do business. For that reason, there has been a deliberate effort by Dr Matshidiso MOETI, the WHO Regional Director for Africa, to transform WHO into a more transparent and results-oriented organisation. WHO/AFRO is moving in the direction of being more accountable to the people of Africa, and to show more results for the resources made available by donors. I have seen the new WHO Director General has also started working on the transformation agenda; and many reforms have been introduced. In essence, the entire UN is talking reforms.
ST: What do you intend to do after your retirement from WHO?
DO: I love writing, and I intend to put some considerable amount of time to put on record my experiences in WHO and in my other public life endeavours. I am also a teacher and I see myself going back to the academia to offer my services in training health care workers and in research to inform decision making at the local level; and as well as in collaboration with other people in Africa and beyond. I certainly see myself linking up with networks created here in Zimbabwe to do this kind of work.
ST: Zimbabwe has been your home for the last 5 years. What memories are you going to carry about Zimbabwe? How were your relations with the local health fraternity?
DO: When I arrived in this country in September 2012, I quickly set myself a goal to learn at least one local language. I immediately bought a book on “Learning Shona”, published by Hayden Eastwood and Petros Nkondo. Interestingly, the first things I learnt were songs — e.g. “Shamiso ndichakuteengera pata pata ndichakutengera slippers …”, and “Simudzai mureza wedu weZimbabwe …”
As you know learning is a continuous process. So everyday I learnt some new vocabulary and add to the body of knowledge already acquired, including other dialects. I also learnt the real meaning of “vukuzenzele”.
I love the country, the people and their professionalism, especially that of my staff in the office. Zimbabweans are very hard working and remarkably reliable. Relationships with the local health fraternity have been excellent. I almost had a floodgate of invitations to give keynote addresses in many health functions; and participated in many social cocktails, birthday parties, etc., you name it.
I have attended hilarious “lobola” functions; and joined in to offer compassion and condolences to families when there is bereavement. In other words, I had become part of the Zimbabwe community. If I was offered a chance to stay in Zimbabwe, I would gladly accept the offer and make the country my second home.