The case against WHO director-general candidate Tedros Adhanom
(OPride) — Ethiopia’s former health minister Tedros Adhanom Ghebreyesus is running for the post of WHO Director-General. Tedros, who served as a cabinet minister since 2005, most recently as the Horn of Africa’s country’s Foreign Affairs minister, is backed by the African Union. He served as Ethiopia’s Minister of Health of Ethiopia from 2005 to 2012, and a Minister of Foreign Affairs from 2012 to November 2016, when he quit during a symbolic reshuffle to focus on his WHO campaign.
But not everyone is cheering for him. In fact, the fiercest opposition to Tedros’ elevation to the head of WHO is coming from Ethiopians themselves. Tedros’ candidacy has been a subject of contentious debate, particularly on social media, for months. There is an ongoing social media campaign under the hashtag #NoTedros4WHO.
Tedros on the other hand is using a well-oiled lobbying firm to tout his accomplishment and qualifications. It helps that he is the first and only African candidate for the job. His PR machine has emphasized two key accomplishments: Reforming Ethiopia’s resource-constrained health system, and his diplomatic prowess gained during his time as Ethiopia’s top diplomat.
Tedros is now the Special Adviser to the Prime Minister of Ethiopia. He is also part of the executive committee of the dominant Tigrayan People’s Liberation Front, the kingmakers in the ruling Ethiopian People’s Revolutionary Democratic Front (EPRDF). EPRDF has been in power since 1991 and has “won” the last two elections by a margin of 100 percent.
Critics of Tedros’ candidacy have rightly pounced on Ethiopia’s dismal record on human rights, his role and complacency in those abuses, and on his membership in the Tigrayan ruling class. But in the mainstream media, little, if anything, has been done to scrutinize his less than stellar record as Ethiopia’s minister of health. We have curated four cases against Tedros’ candidacy from his time in office as follows:
- Abuse of office and politicization of foreign aid funds (h/t J. Bonsa)
Hinging arguments [against Tedros’ candidacy] on the lack of “democratic governance” in Ethiopia simply does not bite that strongly. ONE NEEDS TO BE VERY VERY SPECIFIC. In his personal capacity, Tedros has abused his offices in many many ways, and it is these abuses of office that are highly relevant to the issue at hand, they need to get dug out and presented to the rest of the world.
There are a great deal of reports that provide details on ways in which Tedros and others in the EPRDF have abused their positions. For example, in a landmark 2010 report, Development without Freedom, the Human Rights Watch found:
“…evidence that (donor) money from the Protection of Basic Services (PBS) program—which funnels $3 billion over three years into district government budgets for agriculture, roads, health, and education—is being used in some areas to encourage teachers and farmers to join the ruling party, even though these benefits should not be allocated according to political affiliation. The Productive Safety Net Programme—a cash-for-work program for vulnerable populations worth $2 billion over three years—is controlled by local officials who also can restrict its use to those who join the ruling party. Local officials even offered to “forgive” opposition members in need of food and give them access to the program if they wrote a letter of regret to the administration for aligning with the opposition. Meanwhile, the World Bank’s Public Sector Capacity Building Programme, which is used to train civil servants, is simultaneously a vehicle for government officials to indoctrinate trainees on the ruling party’s ideology, and to target opposition supporters in the name of weeding out under-performing staff.”
“PBS supports five specific service sectors—health, education, water, agricultural extension, and roads—which are delivered at the local level by civil servants, woreda and kebele officials, teachers, nurses, development agents, doctors, and Ministry of Health officials.
They did measurements of the women and children; then, those that could not pay or the opposition party members were left out. Those who are doing the assessment are government workers, working in cooperation with GOAL [an NGO] since March 2009. The poor ones have another chance to get it, next time, if they can pay, but the opposition members cannot get it at all…. There are many children whose bellies are swelling
The kebele chairman and manager are the key figures in the kebele, which is in turn the key unit of organization. Most block grants fund salaries of officials and recurrent expenditure of local governments. These local officials—teachers, agricultural and health extension workers, and kebele staff, whose salaries are paid through PBS—decide how to allocate resources, control militias, and write references for students and job seekers.Among the key material resources that PBS funds are schools, seeds, fertilizer, and other agricultural inputs.”
“A woman from Boricha said that Ministry of Health extension workers who weighed her child told her that the child was entitled to assistance, but that the kebele chairman denied her the “pink slip” necessary to attend the feeding distribution. A farmer and opposition leader from another woreda in the southern region told a similar story of women and children being required to pay for pink slips:
- Padding stats to meet bolster Ethiopia’s image and attract more aid (via J. Bonsa)
There were numerous similar reports, some specific to scandals within Ministry of Health. For instance, the Millennium Development Goal achievements were entirely based on fabrications, such as reporting constructions of bird-nest-like clinics all over Ethiopia, without any facilities. Even then, it was only a number game – if 100 were built, 500 were reported. There were times when auditors from international organizations demanded to see all clinics but the authorities refused access to all, limiting access to a few locations, as samples. Those that were actually built do not actually qualify to be called clinics. They are often manned by a couple of semi-literate locals who were rushed through mock training over a few days and the so-called clinic was handed over to them. The clinics were built for two purposes: (a) business opportunities for the crony construction contractors at inflated budgets (b) create fake success story to report to the rest of the world. Andhanom was never concerned about the health and welfare of Ethiopians.
There were times when the authorities stood firm, demanding that they could use the funds they received the way they want. The reason was they did not want to even play around with building clinics. They could divert funds away from improving access to health facilities by building clinics, towards other facilities, e.g. buying medicine for HIV AIDS. This change was often reported as “re-prioritization” but the actual motivation was that it was much easier to embezzle HIV AIDS money than clinic budgets. They could provide fake invoices for procurement, report inflated beneficiary numbers, etc.
- Widespread allegations of nepotism, corruption and lack of transparency (Keffyalew Gebremedhin)
“…by ignoring many unpleasant details that have facilitated corruption in Ethiopia’s ministry of health, when Dr. Tedros Adhanom was the minister (2005-2012) – aid money from governments and philanthropists have been lost in several millions from those that needed treatments for HIV/AIDS in a country that has claimed hugely its toll in lives.
In one instance, while Tedros’ was a minister, this resulted in 79 percent cut in US assistance to Ethiopia. In other words, some had estimated at the time, “Aid to Ethiopia’s health sector would, according to the US government-run web portal ForeignAssistance.gov fall to $171 million in 2013 from $390.6 million in 2012. A major cut would be felt in HIV/AIDS programmes, which would receive only $54.1 million, a dramatic cut from the $254.1 million allocated in 2012.”
It is the severity of the US cuts that made Amanda Glassman, Director at Global Health Policy and a senior fellow at the Center for Global Development, to lament writing on PlusNews on January 9, 2013, “There’s an AIDS spending cliff in Ethiopia, and the government is already in free fall. Next year, Ethiopia will experience a 79 percent reduction in US HIV financing from PEPFAR [the US President’s Emergency Plan For AIDS Relief]”.
Let it be clear that I am not in any form or shape accusing the minister of corruption. Nor has the US Government at the time publicly mentioned the word “corruption.” Nonetheless, there was visible movement about preparations in the United States already in February 2012 about the establishment of independent panel “to investigate the Global Fund’s fiduciary controls and oversight mechanisms after allegations of grant fraud in several recipient countries.”
In Ethiopia’s case, there were also widespread complaints by health officials, which included allegations “about unfair hiring practices, nepotism and preferential treatment to well-connected individuals.”
Lower level corruptions in Ethiopia’s health sector, when Dr. Tedros Adhanom was minister included:
(a) construction and rehabilitation of health institutions;
(b) purchase of equipment, supplies and drugs resulting in bribes, kickbacks;
(c) and political considerations influence specifications and winners of bids, bid rigging during procurement, lack of incentives to choose low cost and high-quality suppliers; and
(d) education of health professionals: bribes to gain place in medical school or other pre-service training, bribes to obtain passing grades, and political influence, nepotism in selection of candidates for training opportunities
Moreover, the reporting by the Center for Global Development in 2006 touched upon malaria prevention and treatment with funds made available by international donors being exposed to abuses. The concrete problems included the sale of unauthorized medicament, whose consequences were not either felt at the time or least anticipated due to the high financial flows from donors into the country when the candidate was minister of health.
In addition, monies were secretly siphoned off by the ruling party’s cadres to build the propaganda infrastructures of the TPLF, such as Walta Information Center (WIC) and Fana Broadcast, while weakening state institutions. These were and even more so today are the giants in Ethiopia’s tortuous and blood-tainted politics, partly built with health funds that flowed under Dr. Tedros’ tenure as minister of health.”
- Lack of concrete health outcomes and cholera outbreak cover-up (h/t Mohammed Abbajebel Tahiro)
For all the money donated by the international community, there is little improvement of health outcomes directly attributable to those funds. For instance, there are over 14 hospitals in Tigray alone. In the south, three regions have less than 14 hospitals combined. There is chronic shortage of primary care facilities; the death rate from preventable diseases is still unacceptably high. Many lakes, rivers, and creeks are polluted by farm and industrial chemicals. Al Jazeera and BBC have reported on the increasing rate of cancer and other diseases directly attributable to human activity.
In a cholera outbreak in Oromia in 2008, scores of people died; the response of the ministry of health was inadequate, to say the least.
More via Ecadforum: An investigative report published by the Society for Disaster Medicine and Public Health paints a disturbing picture of a deliberate inaction on the part of Dr. Adhanom in the face of the tragic health crisis that was rapidly claiming so many lives. Chief among the findings were:
- Despite laboratory identification of V cholerae as the cause of the acute watery diarrhea (AWD), the Government of Ethiopia decided not to declare a “cholera outbreak” for fear of economic repercussions resulting from trade embargos and decreased tourism.
- The government, in disregard of International Health Regulations, continually refused to declare a cholera epidemic and largely declined international assistance.
- The failure to acknowledge a cholera outbreak had several important implications. First, it meant that the WHO could not assume responsibility for managing the epidemic because this requires that the state declare a cholera outbreak and request assistance. Under the WHO International Health Regulations, 2005, cholera is considered a disease “with demonstrated ability to cause serious public health impact and to spread rapidly internationally.”
- As a signatory to this agreement, the Government of Ethiopia had the obligation to report the outbreak because cholera is not endemic to the country. Second, without official declaration of a cholera outbreak, there was a delay in accessing donor funds. Declaration of a cholera outbreak might have resulted in a much more vigorous international response, and resources might have been mobilized much more rapidly. Also, refusing to acknowledge a cholera epidemic weakens the chances for ongoing surveillance to recognize the potential for cholera endemicity in the region.
- The United Nations Office for the Coordination of Humanitarian Affairs reported unacceptably high case fatality rates (in 3 of the 5 affected Oromia zones (Guji, East Shewa, and Bale).
In October 2016 (when Dr. Tedros was still Foreign Minister), Ethiopia’s Ministry of Foreign Affairs posted a blog on its official website in response to Human Rights Watch’s reporting on Ethiopia. The piece accuses Human Rights Watch of baseless allegations, intentionally misleading its audience, and propagating “scare stories.” It focuses on the NGO’s response to an October stampede during an anti-government protest at an annual festival in Oromia, though addresses Human Rights Watch’s reporting in Ethiopia more generally. Yet Human Rights Watch is widely recognized to employ a gold standard of research. The above-mentioned report, for example, was based on more than 125 interviews, “court documents, photos, videos and various secondary material, including academic articles and reports from nongovernmental organizations, and information collected by other credible experts and independent human rights investigators.” All material in the report was verified by two or more independent sources.
In light of Ethiopia’s severe human rights abuses and Dr. Tedros’s prominent position within the ruling party and the government, a natural question becomes: What was his role in the country’s systematic abuses of human rights?
I do not know the answer, or the veracity of other charges that Ethiopian diaspora organizations have lodged. In his role in the TPLF and EPRDF power structures, is it possible that he tried to change things from the inside, using his position of power within the government to oppose the government’s repression?
What we do know, though, based on the independent reports of Human Rights Watch, Amnesty International, the U.S. State Department, and others, is that the human rights situation in Ethiopia is dire. And Dr. Tedros has long been an important member of the government.
Dr. Tedros has committed to an open and transparent approach to running WHO. Now is the time for him to demonstrate this commitment, publicly addressing the concerns about human rights during his time in the Ethiopian government, and his role, including as a member of the power structures of the ruling party and coalition. States should evaluate his answers carefully and in light of other evidence.
States should also consider whether regardless of Dr. Tedros’s actions within the government – perhaps unless he vigorously fought against rights-abusive policies from the inside – the mere fact of having served (particularly for a considerable length of time) in a high-level post of a government that perpetuates such severe human rights abuses should be an automatic disqualifier from any international leadership position. Would electing someone put forward by such a government, particularly someone who has long served in that government, in some way represent the international community endorsing, accepting, the legitimacy of that government and its policies, and diminish the importance we ascribe to human rights?