This record is a partial extract of the original cable. The full text of the original cable is not available.

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