Health for All: WHO leads the Way

          The World Health Organization (WHO) has been playing an integrative and complementary role in health systems around the world moving towards universal health coverage. The WHO with its 193 members, has emerged as the world’s leading organization devoted to the improvement of the health of the world’s nearly seven billion people. Headquartered in Geneva, Switzerland, the WHO is affiliated with the United Nations. Thousands of health experts around the world coordinate many programmes to ensure that more people, and especially those living in dire poverty, have access to equitable, affordable health care so that they can lead healthy, happy, and productive lives.

          The World Health Organization is the successor to the Health Organization of the League of Nations, which was formed in 1921, after World War I. In the post-World War II period when the United Nations was formed, the need for a global permanent organization devoted to health was direly felt. A constitution about health was written, and the WHO was founded on April 7, 1948, as a specialized agency of the United Nations when its 26 member states ratified its Constitution.

         

          Now, every April 7th is celebrated as World Health Day. Its membership is open to all the members of the UN. The states which are not members of UN can become members of WHO after their applications is approved by the World Health Assembly. Non-sovereign states and territories can also become its associate members. It aims at securing and ensuring proper health conditions through international cooperation.

Structure of the WHO

          More than 8000 people work for the WHO’s many offices around the world. The organisation of the WHO consists of the World Health Assembly (WHA), the Executive Board (EB) and the Secretariat. The World Health Assembly (WHA), composed of representatives from all member countries, is the supreme decision making body of the WHO. The Assembly holds annual meetings and is responsible for laying down general policies. It approves the budget of the organisation and adopts necessary conventions for the promotion of its objectives. Every May, it approves the organization’s budget and its main research priorities for the year.

          The Secretariat is headed by the Director-General, who is nominated by the Executive Board and elected by Member States for a period of five years. The WHO's Secretariat is staffed by health professionals, other experts and support staff working at headquarters in Geneva, in the six regional offices and in countries. The WHO Constitution specifies provisions to create regional organizations and committees considered desirable to serve any purpose within the competence of the organization.

          The Executive Board is composed of 34 people, primarily doctors, who advise the Assembly. These members are selected by WHA from amongst persons most qualified by their technical competence in the field of health and medicine. These members are elected for three years. The Board carries out the decisions of the WHA. It takes necessary measures to deal with the epidemics and sudden calamities. The Secretariat under DG works through technical experts and committees.

          The main objectives of WHO is attainment of the highest possible level of health by all people. This goal is to be achieved through the combined efforts of the governments and people. It involves education and awareness about prevailing health problems, proper food supply and nutrition, safe water and sanitation, maternal and child health including family planning, immunisation against major infectious diseases, prevention and control of local diseases, appropriate treatment of common diseases/injuries and provisioning of essential drugs.

          It provides institutional leadership in combating non-communicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, and mental health conditions - which together with violence and injuries - are collectively responsible for more than 70% of all deaths worldwide. The WHO coordinates global endeavour to provide beter communicable diseases treatment and care for HIV, tuberculosis, malaria and neglected tropical diseases and to reduce vaccine-preventable diseases, dissemination of information, setting up health norms and providing ethical policy options to member countries. Recently, WHO played a constructive role in combating Ebola disease in western Africa. But still higher presence of HIV in Africa, growing lifestyle diseases like diabetes, heart diseases and use of tobacco products require a more proactive WHO.

          The WHO’s current priorities include fighting communicable diseases especially HIV/AIDS, polio, malaria and TB, non-communicable diseases, sexual and reproductive health and ensuring food security. One of its most important role is to lessen any possible consequences of health-related hazards on world health and reduce its economic and social implications.
WHO regularly performs world health survey and releases world health data for generating awareness and capabilities to fight future pandemics.

          To reach the highest attainable standard of health is an objective that has guided health policy nationally and internationally for over 65 years, finding voice in WHO’s “Health for All” programme which began in the 1970s and was enshrined in the Alma Ata Declaration of 1978. The Alma Ata Declaration is best known for promoting primary health care as a means to address the main health problems in communities, fostering equitable access to promotive, preventive, curative, palliative and rehabilitative health services.

          The idea that everyone should have access to the health services they need underpinned a resolution of the 2005 World Health Assembly, which urged Member States “to plan the transition to universal coverage of their citizens so as to contribute to meeting the needs of the population for health care and improving its quality, to reducing poverty, and to attaining internationally agreed development goals”.

          Chapter II, Article 2 of WHO’s Constitution lists the twenty-two functions of WHO. In addition to a continuing focus on infectious diseases, there are also functions that specifically deal with areas including research, assistance to government and addressing non-infectious disease that had previously been given little attention on the international health policy stage.

The WHO performs following functions:

          In carrying out its activities, the WHO's Secretariat focuses its work on the following core functions:

·        WHO articulates consistent, ethical and evidence-based policy and advocacy positions.

·        WHO manages information by assessing trends and comparing performance; sets the agenda for stimulating research and development.

·        WHO catalyses change through technical and policy support, in ways that stimulate cooperation and action and help to build sustainable national and inter-country capacity.

·        It negotiates and sustains national and global partnerships.

·        It sets, validates, monitors and pursues the proper implementation of norms and standards.

·        It stimulates the development and testing of new technologies, tools and guidelines for disease control, risk reduction, health care management, and service delivery.

·        It tries to prevent the spread of diseases by providing assistance to the states to check the diseases at the source and to prevent it from spreading to other countries.

·        The WHO tries to cure the disease once it has spread, by imparting scientific knowledge about the diseases and suggesting ways to combat the same. Though the actual operations for curing the disease are left to the national governments, the WHO provides necessary training to state personnel, sponsors seminars and conference for the exchange of techniques and experience.

·        The WHO provides training to personnel of different states for the prevention of diseases. It is well known that it was chiefly due to the world-wide campaign by the WHO against Malaria, polio and small pox that the diseases have been checked.

·        The WHO holds discussions with the members to improve the health administration by imparting education regarding health through seminars, conferences and training projects to deal with problems like environmental hygiene, eradication f disease, control of disease etc.

·        WHO has launched many special programmes in collaboration with UNDP and the World Bank for research and training in tropical diseases like malaria, leprosy, dengue, bird flu and Japanese encephalitis. It also launched a special programme to prevent and control AIDS through public information and education about the modes of its transmission.

The Organization’s Eleventh General Programme of Work 2006-2015 details the six core functions which include the following:

1.     Providing leadership on matters critical to health and engaging in partnerships where joint action is needed;

2.     Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;

3.     Setting norms and standards and promoting and monitoring their implementation;

4.     Articulating ethical and evidence-based policy options;

5.     Providing technical support, catalysing change, and building sustainable institutional capacity;

6.     Monitoring the health situation and addressing health trends.

          This set of functions, according to WHO, are based on an analysis of WHO’s comparative advantage as an actor in the international system. This advantage lies in the organization’s “neutral status and near universal membership, its impartiality and its strong convening power.”

Disease Control of the WHO

          A major cornerstone of the World Health Organization is the prevention, diagnosis, and treatment of disease. The WHO investigates and treats many people who suffer from polio, HIV/AIDS, malaria, tuberculosis, pneumonia, influenza, measles, cancer, and other diseases. The WHO has vaccinated millions of people against preventable diseases. The WHO achieved tremendous success when it treated and vaccinated millions against smallpox and declared that scourge eradicated from the world in 1980. In the last decade, the WHO worked to identify the cause of SARS (Severe Acute Respiratory Syndrome) in 2002 and the H1N1virus in 2009. The WHO provides antibiotics and other medications and medical supplies. The WHO ensures that more people have access to safe drinking water, better housing and sanitation systems, sterile hospitals, and trained doctors and nurses.

Promotion of Healthy and Safe Lifestyles

          The WHO reminds everyone to have healthy habits such as not smoking, avoiding drugs and excessive alcohol, exercising, and healthy eating to prevent both malnutrition and obesity. The WHO helps women during pregnancy and childbirth. They work so that more women have access to prenatal care, sterile places to deliver, and contraception. The WHO also aids in injury prevention around the world, especially traffic deaths.

Numerous Additional Health Issues

          The WHO promises to help people improve their health and safety in several additional areas. The WHO improves dental care, emergency care, mental health, and food safety. The WHO would like a cleaner environment with fewer hazards like pollution. The WHO aids victims of natural disasters and wars. They also advise people of the precautions they should take while travelling. Aided by GIS and other technology, the WHO creates detailed maps and publications about health statistics, such as the World Health Report.

          Thus, the function of the WHO has tremendously increased since its establishment. This has, however, brought forth the problem of paucity of funds. As the WHO has to operate within the available resources, it has to perforce confine its activities to only some specific programmes and projects. This has greatly hampered the efficient discharge of responsibilities by the WHO. However, it cannot be denied that the WHO has succeeded in securing international cooperation for solving health problems when national actions proved ineffective. The WHO is funded by contributions from all member countries and from donations from philanthropic foundations and trusts. The WHO and the United Nations work closely with other international organizations like the European Union, the African Union, the World Bank, and UNICEF.

          Pandemic diseases and emerging diseases such as AIDS, severe acute respiratory syndrome, and influenza continue to cause fear, economic instability, severe illness, and premature death. In the past decade, the public health community has improved preparedness for and detection of pandemic threats and is now responding more effectively than before. The 2005 International Health Regulations, which entered into force in 2007, have modernized the international legal framework to improve systematic preparedness and response to pandemic and other emerging public health threats.

          Use of the Internet and other media for public health surveillance has expanded, and the Global Public Health Information Network, Global Disease Detection Operations Centre (GDDOC), additional international influenza response networks, and other systems routinely detect and respond to clusters of unusual disease earlier than traditional surveillance. Cooperative agreements with ministries of health, regional training conducted in collaboration with WHO, other international organizations, and vital public health network to reduce transmission at the animal-human interface also have contributed to reducing the risk of influenza pandemics. WHO has helped
many countries including India in eradication polio. Recently, WHO played a major role in combating the epidemic threat of Ebola in African region. It has
mobilised funding, personnel and resources for this purpose.

          During the previous century, great progress was made in raising life expectancy and reducing mortality among infants and young children through improvements in living conditions and activities to combat major infectious causes of death. Collectively, interventions such as those described in this report have contributed to the shifts in major causes of death observed in the new century, with chronic, non-infectious causes increasingly prevalent not only in affluent countries, but also in lower-income and middle-income countries.

            Non-communicable diseases and health conditions are expected to account for an estimated 75% of all deaths worldwide by the year 2030. The WHO achievements demonstrate the capacity of public health agencies to harness and adapt the scientific, technical, legal, and political resources necessary to respond effectively to the problems at hand. This capacity will be tested in the years ahead as public health agencies continue to address communicable diseases while responding to the increasing prevalence of cardiovascular disease, diabetes, cancer, and other non-communicable conditions and injuries that will require innovative responses to ensure significant public health achievements in the future. WHO is now
emphasizing community participation as a necessary condition for achieving high standards of health instead of hospital-based healthcare is also a significant
achievement. This has translated into policy changes in a number of countries.

            However, the role of WHO has not always been unblemished. It is accused of not pushing into the vulnerable areas i.e. areas where due to lack of awareness people have antipathy and scornful attitude towards western medicines and vaccines. The prevailing high cases of polio in Pakistan can be a good illustration to this. Also, the major donors dictate the terms and conditions of aid.

          The observers have criticised the disease-specific approach as it was a top down approach with significant little accumulating in improving capacity of individual countries. Diseases like diarrhoea, polio, TB and measles are still causing significant deaths across the countries. The WHO could not take up the issue of reproductive planning in initial years due to position from church. Political interference in its functioning and appointments does not allow the competent professional and experts to serve the WHO.

          With other actors such as World Bank entering the health sector lending and programmes such as UNAIDS has created challenge before WHO’s as a premier health body. Secure funding has stagnated and financial crunch has affected its original mandate. The WB lending with condition on structural changes for cost recovery through user-fee has created health in-equality especially in developing countries.

India's role in WHO:

          India has cooperated with the WHO in various international mission as well as domestically. Being one of the leaders in generic drugs market and low cost vaccines, India is playing a constructive role in reducing health inequities among and within LDCs (least developed countries). India has been regularly contributing to the WHO contingency fund and hence providing resources which decrease the health deficit across the world. Recently, India has assumed presidency of World Health Assembly and donated $ 2.1 million to it.  India has also presided over the World Health assembly and played a significant role in global health planning.

          India has been collaborating with the WHO to fight challenges to public health since its foundation. The WHO’s participation has been critical in eradicating pandemics like small pox and Polio from India. India has gained from monetary and technical expertise provide by the WHO to achieve MDG (Millenium Development Goals) goals of reducing child and maternal mortality rates. Recently, WHO has participated in India's efforts for clean India under Swachch Bharat Mission.

          India must take the lead on enhancing access to medicines, promotion of generic medicines, implementing TRIPS flexibilities and proposals of Doha health round on TRIPS. It can also persuade more investments in R&D on developing country diseases and promote new innovation models like open source drug discovery.

          The recently agreed WHO Country Cooperation Strategy has improved health and equity in India at its heart with three key objectives - i) supporting an improved Government of India role in global health; ii) promoting access to and utilisation of affordable, efficiently networked and sustainable services for the whole population; and iii) helping to confront the new epidemiological reality of India. WHO, along with agency partners in the UN Country Team, prioritises its delivery in the nine states in India with the highest proportion of people living in poverty – Odisha, Bihar, Chattisgarh, Madhya Pradesh, Jharkhand, Uttar Pradesh, Maharashtra, Assam and Rajasthan.

Suggestions to improve WHO’s functioning and operations: 

The WHO’s core functions should explicitly provide for its work in promoting and maintaining global health security.

The WHO should provide strategic technical assistance to countries in support of its mission as a provider of global public goods. It should not seek to undertake activities that could or should be done better by others – by the host government, with or without support from other agencies.
 

The WHO should undertake a review of the skills and expertise of its staff to ensure that these fit with its core functions and leadership priorities.

The WHO should provide an internal separation between its technical departments and those dealing with governance and management by creating two posts of Deputy Director General, with one to be responsible for each.

The WHO should allow the Director General a single, seven-year term, without the possibility of re-election.

The WHO should explore new avenues for collaboration with non-governmental actors that have a concrete and specific purpose.

The WHO should be like other UN Organizations, where the need for regional (and country) offices is determined by what makes sense in terms of achieving organizational objectives.

The WHO should apply the Pan American Health Organization (PAHO) model to the other regional offices and the assessed financial contribution should be provided to regional offices directly by regional member states, rather than redistributed by headquarters in Geneva.

A comprehensive and independent review is overdue to examine how the staffing of country offices should be matched to the needs of host countries with a view to translating WHO recommendations into practice.

The WHO and its member states should examine how its effectiveness could be enhanced by reviewing, how the value added by its regional and country offices could be increased, and its administrative and management costs reduced.

The Millennium Development Goals

          It is important to understand how the Millennium Development Goals (MDGs) have come to play such a prominent role in shaping WHO’s work. The MDGs came out of the United Nations Millennium Declaration which was endorsed by 189 countries in September 2000 and resolves to work towards combating poverty, ill health, discrimination and inequality, lack of education and environmental degradation.

The MDGs are eight specific goals that the 191 United Nations (UN) states committed themselves to achieving by 2015. The MDGs are:

1.     To eradicate extreme poverty and hunger;

2.     To achieve universal primary education;

3.     To promote gender equality and empower women;

4.     To reduce child mortality;

5.     To improve maternal health;

6.     To combat HIV/AIDS, malaria and other diseases;

7.     To ensure environmental sustainability; and

8.     To develop a global partnership for development.

          These goals are interdependent, progress or lack thereof in achieving one goal will have effects on progress towards achieving the others. Likewise it is acknowledged that in order to achieve the MDGs, all sections of the UN system will be required to work together and, more importantly, that the UN alone cannot achieve the MDGs. Achieving the MDGs will require the cooperation and action of UN member states and of other international, regional and local governmental and non-governmental organizations. WHO in particular accepts this to be the case; WHO’s need to work closely with other UN bodies, states and other actors in the international system was a major theme of WHO’s Eleventh General Programme of Work 2006-2015.

          In the Eleventh General Programme of Work 2006-2015, WHO defines itself largely as an agency for providing leadership in the area of international public health and international public health policy. This is exactly the function WHO performs by working in the area of maternal health. These functions are very much geared towards providing countries, regions and international bodies with the information and expertise required to improve maternal healthcare. It does this through a number of avenues including advocacy, norm setting and the dissemination of technical knowledge and expertise.

          A large part of WHO’s work at the international, regional and national levels in the area of maternal health involves the setting of norms. WHO has been far more successful in this function than it has been in its attempts to achieve any of the MDG targets. Additionally, it is entirely possible that positioning WHO as an international normative body geared towards the achievement of long-lasting changes in maternal health through the setting of new norms and standards is both a far more realistic and in the long-term far more positive use of WHO’s finite resources than channelling all of WHO’s resources into the unrealistic achievement of the MDGs.