Peter Pachner (WHO 1980 - 2006)
Please tell us about your youth.
I was born in Graz, the second largest city Austria, in 1946. Growing up directly after the
Second World War meant living in a socioeconomic setting of extreme scarcity. That
changed slowly towards the 60’s but here my generation was quick to criticize the, then
about to be established, waste oriented society.
The cold war marked my life to a great extent. No matter what, any intelligent person at that
time must have realized that whatever the conflict is about, it is always best to be on the side
of the winner, but I could not really make up my mind who is or who will be, the winner.
Like many young people at the end of the 60’s I dropped out of school (engineering studies)
to travel, see Asia and in particular India. I ended up studying Hindi language and Indian
culture in India at the Benares Hindu University. I was lucky to get support through an
Austrian scholarship. It was this ten years exposure to other cultures and public life which
was the main factor to make me take up an international career eventually.
So when and where did you start to work professionally?
The first attempt was in 1978, a part time job at the Deutsche-Welle. It was then also called
“The Voice of Germany” and was situated in Cologne, Germany. It was a German version
of the much better known (propaganda) radio station “The Voice of America”. I worked as
an author and speaker in Hindi language. However, in spite of being on the air in all forms
of radiofrequencies across continents I found that I was only presenting a single point of
view and not listening.
My conclusion was that I would be better off to work in an International Organization. This
led me to Geneva and WHO. From my initial engineering background I must have had some
hard-wired brain functions relating to mathematics, statistics and logic. The early 80’s was
the time when computers started to hit office desks. I would amaze everyone how well I
could handle these machines. And when talking statistics it led me to the Department of
HST (Health Situation and Trend Assessment). It took me 4 years to get a regular job as a
Statistical Assistant and another 4 years to become professional staff with a quite similar
scope of work as in my previous G6 position, but a slightly lower salary1.
I was very fortunate to have Dr Steve Sapirie as my Chief. He was an incredibly hard working
man. He also believed that giving a chance to younger staff and supporting their educational
development was an asset to the Organization. Thus I had the chance to get for 3 years a
study leave of 6 weeks each year and the study fees paid too. Having all that support, last
but not least, I obtained my MPH in 1998 in Public Health from the Geneva University. Of
course the theme of most of the papers was in the field of health information. It was not
easy to go back to school at the age of 49 but I think it was a good investment for both, the
Organization and me personally.
I am delighted by your good fortune of having Steve Sapirie as your boss. Obtaining a
Study Leave was indeed not so easy.
Why I got study leave and not so many others that would have deserved it too? The answer
probably quite simple; Dr Sapirie himself had the good fortune to get study leave. WHO
sent him (1977-78) for a Doctorate in Public Health at the University of North Carolina.
Later it was my turn to support younger staff in their career and professional development.
During my time in Indonesia (2000-2006) I had the opportunity to help young nationals
through contracts and organizing their participation in meetings and seminars. By the time I
1
By the time I left the Organization, 20 years later, it was perceived as a scandal that (young) staff had to work
for many yeas on temporary basis. I remember that in my time it was just like that.
left Indonesia one of my national collaborators became a professional in Geneva, and two of
them were working on their PhD in Australia.
Tell us what you did in WHO between 1980 and 1988
When I started in WHO, it was at the same time as computers came to change our lives. The
data collections I found in HST among others were handwritten cards of the office of
Hygiene under the Organization of the League of Nations. The data was from 1925 onwards
till the break of the 2nd World War. It went back to countries like Dahomey, German West
Africa and Tanganyika reporting tropical disease outbreaks. We also had in the early 80’s
massive amounts of data related to medically certified cause of death. All that had to be
organized, validated and either thrown away or computerized. Looking back I think what
we did was laying out the fundamentals of the role of Personal Computers in the office
which could also be called learning by making mistakes.
Then you seem to have been involved in training nationals in “developing countries”
Exactly, during the period 1988 to 2000 I had numerous assignments in West and East
African countries and Asia. The tasks were always related to the generation and use of
information for the management of health care provision. I was trained to work in a
participative style, workshops for District Team Problem Solving (DTPS), rapid assessments and evaluations. I strongly believe that the asset of my work was the combination of
workshops and fieldwork in a highly participative style.
When you say that you “were trained to work in a participative style” where and when was
that? There was of course my hard wired sense of logic, but to apply systemic thinking in
health I went myself trough a participative learning process by working with Dr Sapirie,
reading relevant literature and also doing my MPH at the Geneva “Institut de Medecine
Sociale et Preventive” (IMSP) with a Red Book at hand which was written by a certain J-J.
Guilbert. That book had as title something related to “health personnel”; but it is also a
guide on how to conduct workshops and it is a good refresher for anyone going for
fieldwork.
The period that followed Mahler’s (after 1988) modified many aspects of HQ. What was
the influence on your own work? In fact, the management of WHO changed twice. First
Dr Nakajima and than Dr Brundtland. The leadership of Dr Nakajima was somewhat low
profile. It was later criticized ‘business as usual’; however, there was little interference with
technical units. We must give some credit to the style of doing little or nothing; it
automatically does little or no harm. The big shakeup came with Dr Brundtland. It was the
end of ‘business as usual’. That is changing and fixing everything, even the things that
actually were working well. Then, around 1998 all of my colleagues of the HST Unit called
Strengthening of Country Health Information (SCI) retired. The Organization went from
data collection to data analysis.
Indeed, it seems a good idea: Once data are collected to analyze them. So what got wrong?
What happened? For example, the World Health Statistics Annual Report was just a
collection of data being printed without much data analysis. It was probably in response to
the Human Development Report of UNDP in 1990 that WHO and other Organizations
began to produce more data analysis in their reports. This was then very much the work of
Dr A. Lopez. It was one of the core subjects then the fight against the tobacco epidemic.
But with the arrival of Dr Brundtland data collection was downgraded. The support to
Information Systems was stopped. Thus, the end of the “Strengthening of Country Health
Information Unit”.
Methods of estimates were applied. Available data were massaged to the point of creating
serious controversies and negative reactions from Member states. This especially happened
with the World Health Report 2000. That report introduced the Health System Performance
Assessment (HSPA) method. While I fully agreed with the analytical work of data analysis
and that it was wrongly neglected in the earlier days of my time with WHO, I also disagreed
to abandon the support in data collection, generation and validation.
After I left HQ it ironically happened that the WHO leadership changed again and the new
leadership reversed the previous decisions. They send the HSPA promoters into the desert.
They installed a new team to establish the health metrics approach (data collection).
However, because of the new name, the old staff in data collection techniques was mostly
left out. It is a phenomenon we find on all levels in life: a new name for the old wine makes
it all happen!
You must have felt rather disappointed… You bet! Since around 1998 till 2002 data
generation and validation were seriously sidelined, thus leaving me in an office with not
much to do. It was time for me to revert to country level. In country offices, at least the
larger ones, a technical capacity is highly welcome. An effective and a balanced approach
are always welcome.
At that time HQ went a bit astray of its traditional health-leadership agenda. To put health on
top of the political agenda was then the flashy slogan. We all know by now that politics in
general is not to be confounded with health policy. The approach of “health on top of the
political agenda” had clearly no positive impact at all. In 2000 I was fortunate to find a
place in the country office of Indonesia where I could apply collection methods, validation
methods and promote also the assessment and data use. My position as a Monitoring
Officer was perfect for this kind of support to national institutions.
Please give us a concrete example of how the Indonesians utilized your support
A number of products and events had lasting impact especially in Indonesia, and I hope to
some extent for the organization. The District Team Problem Solving was institutionalized
in Indonesia to the point that the Ministry of Health staff was convinced that the method
came from Indonesia and has been developed there. All this was very encouraging for me
as I know that the only methods which work are those that are locally developed. Practically all districts use the participative planning process to develop their annual health plans in
maternal health. It has also been included in the curriculum in the Gadjah Mada University.
The other great breakthrough was the application of Health System Performance Assessment
on sub national level. The method was also used to evaluate the impact of the Tsunami and
the massive relief and reconstruction effort on health in the affected Province of Aceh. Data
from before the disaster was compared with data after. The result was a rather unfavorable
finding for the relief inputs. Infant mortality, child mortality did increase and health status
declined significantly from 2004 to 2006. For this work I got the support of the old WHO
team, Ajay Tandon, Cecilia Vidal and also Chris Murrey, then scattered across Harvard and
the World Bank. The product, a book, was appreciated by the government of Indonesia and
the scientific community. I hope it also impressed the WHO metrics team. I can’t tell if it is
related or not. But a Health System Metrics approach was developed. Again a new name,
remember my old wine remark from above.
A further methodology, which I was familiar with since my first days with WHO, is the
collection and use of data on medically certified cause of death (CoD). One of my former
colleagues, Dr A.D. Lopez, had returned to his homeland and is professor in an Institute in
Brisbane (Australia). His outstanding expertise in CoD techniques, the proximity to
Indonesia and the availability of Australian funds for Indonesia motivated me to collaborate
with his Institute. It was possible to raise considerable funds for this activity through
Australian Aid. Since then, a population of approximately 2 million is covered by complete
reporting of Medically Certified Cause of Death Certificates. The ultimate target is 30
million, so there is still some work ahead.
Peter, with all due respect for statisticians, please give me some arguments in favor of this
achievement related to death while I, as a doctor, was concerned with keeping patients
alive.
As you state the concern of medicine is life and not death. However, we all end up dead. That
is not a matter of what went wrong but a natural event in life, like many others, and worth to
be studied. Therefore it is extremely important to convince Governments to make more
efforts to establish correct Cause of Death data and statistics. The history of public health
contains convincing arguments.
The origin of vital statistics in the modern sense can be traced to an analysis of the English
bills of mortality published by John Graunt in 1662. In the nineteenth century, the industrial
revolution resulted in rapid urbanization, overcrowding of cities, and a deterioration of
social and living conditions for large sectors of the population. Public health reformers
became acutely conscious of the need for general sanitary reform as a means of controlling
epidemics of disease. These early sanitarians used the crude death statistics of the time to
arouse public awareness of the need for improved sanitation, and in the process they pressed
for more precise statistics through effective registration practices and laws. Thus, the history
of public health is largely the history of vital registration and statistics. Records of deaths by
cause shall continue to be needed for the control of epidemics and the conservation of
human life through sanitary reform. During my early years in WHO, the cause of death data
was used to identify patterns in the ever increasing incidence of cancer. Countries like
Indonesia are going through a socio-economic development and industrialization. The challenges to adapt the health system to the current developments are enormous and it is evident
that sound epidemiological data is needed to guide health policy in the right direction.
Tell us about your work during the 2004 Tsunami It was one of the dark chapters of my
work. Maybe because there is not much I could really do. It was a catastrophe of
unimaginable extent. The response in form of aid and reconstruction was claimed to have
been successful. What I saw was that the WHO response was there but the agony of getting
things done was enormous. The difficulties in organizing aid suggest that it has never been
the role of WHO to be on the forefront of Disaster Relief. Initially WHO advised some
relief agencies and the government on priorities. Other organizations just went ahead
anyway. We had a significant influx of logistic expertise to manage the huge amounts of
donations channeled through WHO. We went in one month from 50 staff to 350 staff.
So, please explain why, how from a “data specialist” you got involved as a relief operator.
My role was the organization of a Health System Performance Assessment (HSPA) survey
and to monitor and support the information activities of our Aceh offices. Again, in the
reconstruction effort District Team Problem Solving method was applied and appreciated.
But it was also imperative then to attend all meetings related to Tsunami matters which were
practically all matters at that time. It was obvious that we had to be there when something
happened. The whole world watched. The top WHO leadership was extremely nervous
about ensuring WHO had its share in the news and that they had better be positive.
All that is very understandable but when we talk about media circus we do mean circus. To be
more explicit, this circus motivated persons from all levels and also Organizations,
including WHO, trying to get a better and visible profile by surfing the Tsunami. The news
of their success was often fabricated. The suffering of the population is a totally different
story. The WR Dr G. Petersen was somewhat sidelined2 while Tsunami “heroes” became
famous on world TV.
2
I think the then WR Dr G. Petersen would be a perfect person to give an overview on that critical event for the
country office in Jakarta. However, it would be probably worthwhile to have a review of a greater number of
staff which were posted then in Jakarta to come to a balanced review.
Last event, the H5N1, was the Avian doomsday for the so far cordial relations between
WHO and the Ministry of Health of Indonesia.
The Bird Flu was announced as the coming of the new scourge of humanity, wiping out
millions of humans like chickens. And as we just calmed down and sized down after the
Tsunami the media circus started again. Being in the forefront on the TV Screens was the
thing. This time the disaster was the deterioration of the relation of WHO with the Ministry
of Health of Indonesia. This all happened in the last days of my service, while also WR
Dr Petersen retired and a new Health Minister was nominated as well as a new Regional
Director. It is unimaginable, but we had copyright disputes over virus samples. I am aware
that it is difficult to manage emerging infections and to predict their epidemiological future,
but a bit of modesty on the part of WHO would be helpful for keeping a good reputation.
Tell us about people that you do remember well
Dr Petersen was my last boss and was truly a remarkable WR, but I met and worked with
many other remarkable people.
Dr A. D. Lopez was a young man when he joined, almost the same day as me. He astonished
me how much a demographer can do to influence health policy. Just type ‘Lopez AD
Tobacco’ in a search engine. The Web will illustrate that cause of death data and a good
demographer can start a serious challenge to unhealthy life styles.
Dr S. Sapirie always astonished me about how much a man can be working, remain simple
and clear in expression and in his approach to health systems and propose useful solutions.
Dr J. Frenk was a great person to listen to and to work with. I am sure he still is inspiring his
staff in Mexico as Minister of Health.
The regional Director Dr Uton (SEAR) and the Minister of Health of Indonesia Dr Sujudi
were Asian Gentlemen who knew how to run big organizations smoothly, to deliver and at
the same time avoid any International/ National/Regional controversy.
Dr Soeharsono, my ever smiling counterpart from the Ministry of Health in Indonesia, was
always helpful and highly appreciated by his countryman and by all of WHO for having
been the most knowledgeable person in the area of health surveys in Indonesia. Surveys are
the most reliable information in that country.
Your sharp vision of the functioning of WHO is fascinating. Please tell us more.
There were many others which were remarkable, not always in a positive way and many have
been remarkable how unremarkable one can be. I have never counted but I am sure that it is
safe to state that the positive remarkable colleagues and collaborators in the Organization
and in countries constitute the large majority of persons I had to work with.
The role of the Director General used to be in the domain of health policy and has during my
career unfortunately shifted to the position of a top business manager.
The Regional Directors and their dependence to regional politics are often perceived as a
problem. However that can also be perceived as a solution. The more we have nominated
civil servants the more we have to face popular mistrust. The EU Commission and it’s
relation to the EU population is a good example for this concept.
The complex organization of WHO reflects the complex situation in the World. It could be
possible to reorganize, strengthen the Executive Board, reduce WHO HQ dramatically and
have regional competence centers.
When being part of WHO I had quick and ready solutions for all structural problems. Now
that I am not part of it any more it seems to be more difficult to come up with one of those
golden bullets. There have always been solutions and re-organizations in the air in WHO.
But why changing one piece when the rest is not re-organized? But who will and can do
such a gigantic task?
You clearly point out a schism between an “HQ problem” and a solution linked to “work in
countries”. Yes, there was increased firing and hiring, especially hiring in HQ as they went
from 800 to 2500 staff. In my opinion that was a wrong trend. It has led to shifts of doing
one thing and not another in the domain of public health where a broad range of problems is
globally present. It has also led to a huge number of HQ staff unwilling to work in
countries. Mobility has always been a problem. Some staffs are stuck in a country office for
10 years because HQ staffs avoid the discomfort of some duty stations.
Let’s consider the mobility issue. It would surely be detrimental to Directors and Chiefs in
HQ as they would most likely loose their staff and probably their position. But would it not
be beneficial to the Organization as there are too many of them?
During my HQ work I had no major problems with the administration. If something went
wrong it was at the Director and Chief level, two positions which like to speak up in the
name of WHO and sometimes confuse their own ambitions with those of WHO. The
relation with other Organizations comes out very strong at country level. It is usually
excellent and respectful. But I would not say that we really work together. That could
certainly be improved. Again, here we have a limitation due to the complexity of the UN
system and it is difficult to fix one or another part without looking at the whole UN System.
I would not dare to say that I have an in depth knowledge of it as a whole.
WHO had also some positive achievement, no? Yes of course, but most of WHO’s
worldwide remarkable achievements are from my early days in WHO such as Primary
Health Care and Smallpox eradication, during Dr Mahler’s time. These concepts and
activities are recognized universally and constitute the backbone of the respect WHO has
earned globally.
On a whole it was a great experience to work for WHO. I do not regret a minute of it and the
good days and the bad days are part of that experience. Being with people from all
countries, working in many countries and many languages is exactly what I wanted and
what I got.
How much did your travelling life have an impact on your family life? My family in Austria
never thought it was a good idea to leave home for such a long time. I guess it is not
everyone’s desire to be international. For those who want to be international it is like
finding a new family, the international one. It is too soon to retire at 60, like loosing a
family and going back to a home which meanwhile is as strange as any other country. Again
I am in a different situation than most people here, as they want to stop working and
complain about their job.
Like me, I suppose most colleagues from WHO, liked the job and would like to work longer.
The task was to find something to do. I am happy to still have
young daughters, Aquila and Sofia. There I have a meaningful
occupation by taking care of them.
Thank you very much Peter for this stimulating exchange.
This document is not a formal publication of the
World Health Organization
nor of the Association of Former WHO staff.
The views expressed by interviewees are solely their
responsibility.