Evolution rather than revolution is the name of the game as Luis Gomes Sambo takes over as WHO's Regional Director for Africa. The 52-year-old Angolan public health specialist—who became director of WHO's Regional Office for Africa (AFRO) on Feb 1, 2005, after climbing the WHO ladder for many years—knows he has his work cut out in the face of the burden of HIV/AIDS, malaria, and tuberculosis; high maternal and child mortality; and acute shortages of health workers. But rather than try to push through new health initiatives, Sambo says there is a need to scale up and implement existing programmes more effectively and involve a wider range of actors outside the health sector. And AFRO—long criticised for its bureaucracy, politicisation, and underachievement—just needs fine tuning, he maintains. “There will be no radical shakeup”, he told The Lancet. “You don't fix what works well.” But he does plan to “improve and change things where there is a need to do so”, and concedes that AFRO needs to be more effective, especially at country level. He also wants to strengthen relations with WHO headquarters and with key institutions like the African Union and donor governments. Sambo steps into the shoes of Gambia's Ebrahim Malick Samba, having spent the 6 previous years as Director of Programme Management—AFRO's second in command. Long perceived as Samba's favoured heir, he easily defeated candidates from Uganda, Swaziland, and Burundi for the nomination at last year's regional committee. Whereas Samba was charismatic—some would say confrontational—Sambo is more cautious and a team-player. Sambo worked only briefly as a medical practitioner when he graduated in 1977, 2 years after Angola gained independence from Portugal. “At the time there was a critical shortage of doctors in the country and so we had to cope with the huge demand for medical care”, he says, recalling that on some days he saw up to 100 patients, mainly suffering from ailments caused by lack of potable water supply, poor sanitation, and inadequate nutrition. “I thought that rather than looking at patients in the hospital it was better to go out into the communities and check and look at the issue in a broader view. I then made up my mind to shift from internal medicine to public health.” He became director of International Cooperation at the Ministry of Health in Luanda in 1981 and was vice minister of health from 1983 to 1988. He joined WHO the following year and became its country representative in Guinea Bissau from 1990 to 1994, when he moved to AFRO. There is some concern that he comes from the bureaucracy and is short on field experience. There are also questions of whether he will be strong enough to withstand political pressure over appointments and coax financial dues from cash-strapped governments. But generally, diplomats who met Sambo at AFRO headquarters in Brazzaville and during the Executive Board in Geneva said they were impressed by his political skills, his management style, and his openness to suggestions. “He realises that things need to be shaken up and that AFRO is among the weakest of the WHO regional offices”, said one diplomat who didn't want to be named. Sambo will oversee a total budget this year of just over US$350 million; the provisional budget for 2006–2007 is projected at US$850 million. He inherits a workforce of 2800 staff, including 450 staff members at Brazzaville headquarters and 350 at the malaria control programme in Zimbabwe. The split sites do cause organisational headaches, he admits, and he would like to try to harmonise the structure. “But we must be realistic in relation to realities”, he adds. He gives no sign that AFRO will be shifted from the Republic of Congo. Critics of President Robert Mugabe say that WHO should withdraw from Zimbabwe. “Surely it should be moved to a country that better embodies the sort of diligence to health care that it and WHO are supposed to promote” declares Amir Attaran, professor of law and international population health at the University of Ottawa and London's Royal Institute of International Affairs. Sambo has no time for such demands. “WHO is not a political organisation”, he says, his soft voice becoming more strident. “It is a technical organisation and we operate on the basis of the health and technical needs of member states and we do things according to our organisation's interests and mandate.” He says his policy priorities will focus on tackling the unacceptably high burden of communicable diseases, notably HIV/AIDS, and maternal and child mortality. Southern African health activists hope his appointment may breathe new life into malaria control and prevention. “A measure of Sambo's success could be in the way in which he promotes methods of malaria control that are working, such as indoor residual spraying with insecticides, and in challenging the elements in WHO that oppose such methods”, comments Richard Tren, director of the Johannesburg-based group, Africa Fighting Malaria. But Sambo hardly seems like a man willing to rock the institutional boat. His measured, diplomatic tones only give way to enthusiasm when asked about his hobbies: listening to music; playing the saxophone and guitar; and tennis and jogging to stay fit. Coming from a well-known family of herbalists, he says he has an interest in traditional medicines, but otherwise remains discreet about his family. “Do you really want to know?” he counters when asked how many children he has.”I have very nice daughters and very nice sons.”