World Health Organization History Essay Rubric

What are the main functions of the World Health Organization? How effectively has it performed these functions when dealing with maternal health?

The World Health Organization (WHO) is the body of the United Nations (UN) responsible for directing and coordinating health. As such WHO has come to play a vital role as an actor in the field of international public health and international public health policy. Since its inception in 1947 WHO has been at the forefront of many breakthroughs in the field including, most notably, what has come to be described as one of the greatest humanitarian achievements of the 20th century, the elimination of Smallpox in 1979. However WHO’s inability to control the spread of HIV/AIDS, particularly in Africa has cast doubt on its effectiveness. Though much of the media attention given to WHO concentrates on its role in controlling and ultimately eliminating infectious disease, WHO’s mandate is far broader. The details of WHO’s mandate will be examined in detail throughout this paper but put simply this mandate is to ensure the attainment of the highest possible level of all forms of health by all human beings. This paper will focus on the area of maternal health. Maternal health is an important indicator, alongside life expectancy, of development. This is reflected by the inclusion of maternal health in the Millennium Development Goals (MDGs) however the area of maternal health is often ignored by international relations (IR) scholars who tend to focus analysis of WHO on its role in dealing with infectious disease. This focus on infectious disease by IR scholars is understandable in light of globalization. Due to globalization and the related transport revolution of the 20th century it is now possible for infectious diseases to spread around the globe in a matter of days. The threat of infectious disease brings with it a number of traditional, hard security issues that put bluntly other health issues do not. However in light of the development of the human security paradigm from the late 1990s onwards it is now becoming increasingly apparent that IR scholars will need to expand their examination of the ways in which WHO functions beyond the realm of infectious disease.

This paper will examine the ways in which WHO functions in relation to maternal health. It will do this by first examining the history, structure  and functions of WHO and the role that the MDGs have come to play in influencing WHO’s operations. The paper will then focus on maternal health as a concept before detailing what role WHO plays in the field of maternal heath at an international, regional and national level. The final section of the paper will critique WHO’s functioning in the area of maternal health with a focus on WHO’s operations at the international level. The paper will conclude by asking if it is fair or even possible to pass judgement on the functioning of an organization as complex and multifaceted as WHO by focusing on only one, narrow section of its overall mandate.

The History, Functions and Structures of the World Health Organization

In order to understand how WHO functions when dealing with the area of maternal health it is first necessary to understand something of the history, functions and structures of WHO. These three areas are closely interrelated. It is important to examine all three in order to paint a complete picture of WHO’s functioning in relation to maternal Health.

The constitution of the World Health Organization entered into force on the 7th April 1948; however the idea of an international (or at least transnational) approach to dealing with matters of health had existed since the middle of the 19th century with efforts centred on combating infectious disease[1]. As the 20th century progressed, the focus of international health policy broadened[2].

The constitution of WHO indicates that, by the middle of the 20th century nations were willing to cooperate in a broad range of health-related policy matters. Chapter II, Article 2 of WHO’s constitution lists the twenty-two functions of WHO[3]. In addition to a continuing focus on infectious disease 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 constitution of the World Health Organization also addresses its structures. These structures are complex, with three levels of organization at an international level, the World Health Assembly (WHA), comprising representatives of every WHO member state[4], The Executive board, which comprises members elected by the WHA[5] and The Secretariat[6] comprised of WHO’s Director-General and technical and administrative staff[7]. The constitution also specifies provisions to create regional organizations[8] and “committees considered desirable to serve any purpose within the competence of the organization[9]”.

The focus of WHO’s work has shifted over time. This is not surprising, considering the broad scope of WHO’s mandate that the organization tends to focus its work around only some of its functions at any given time. The organization’s Eleventh General Programme of Work 2006-2015 details the six core functions it is focusing on between 2006 and 2015[10]. These functions are:

  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[11].

This set of functions, according to WHO are based on an analysis of WHO’s comparative advantage as an actor in the international system[12]. This advantage WHO believes, lies in the organization’s “neutral status and near universal membership, its impartiality and its strong convening power[13].” This set of functions and WHO’s claims about its comparative advantage will be examined in greater detail later in this paper.

Two points become apparent from reading WHO’s Eleventh General Programme of Work 2006-2015, the first is that WHO is acutely aware of the challenges it faces if it is to remain a relevant actor in international health[14] (a topic that will be returned to later in this paper) and second, the direction of WHO’s work for this period is geared towards meeting the health related Millennium Development Goals. Both these points indicate that WHO is aware of the fact that it cannot function as an independent actor in the international system. Any action WHO takes must be informed by the actions of other actors in the international system and likewise WHO’s actions impact upon the actions of other actors in the international system.

The Millennium Development Goals

Before examining WHO’s role in maternal health 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[15] and resolves to work towards combating poverty, ill health, discrimination and inequality, lack of education and environmental degradation[16].

The MDGs are eight specific goals that the 191 United Nations (UN) states have 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[17].

These goals are interdependent[18], 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 is a major theme of WHO’s Eleventh General Programme of Work 2006-2015.

The MDGs are unique in that they have broad support across the international system. The constituent bodies of the UN and all 191 UN member states are committed to achieving the MDGs. Regional organizations including the European Union[19] and the Association of Southeast Asian Nations[20] (ASEAN) frame, to varying extents, their policies in a variety of areas around the achievement of the MDGs. Many major international charities such as the Red Cross[21] and OXFAM[22] are focusing their work, again to varying degrees, on achieving the MDGs. There are also many civil society organizations, operating at local, national, regional and international levels that are engaged with the MDGs[23]. Considering this broad support it is little wonder that WHO have chosen to focus so heavily on the achievement of the MDGs in the Eleventh General Programme of Work 2006-2015.

WHO and Maternal Health

Following the preceding discussion of WHO’s functions and Millennium Development Goals it is now possible to examine how WHO functions in the area of maternal health. This discussion will be framed around WHO’s contribution to achieving MDG 5 which concerns improving maternal health. It will first examine exactly what maternal health is, before looking at how WHO functions in relation to maternal health at the international, regional and national levels.

Defining Maternal Health

The World Health Organization defines maternal health as referring to “the health of women during pregnancy, childbirth and the postpartum period[24].” Maternal health is complex. There are a broad range of conditions, complications and circumstances that can negatively impact upon maternal health. Some of these are specific to pregnancy, childbirth and the postpartum period[25] (the period immediately following pregnancy or childbirth, defined as being 42 days in length by the International Statistical Classification of Diseases and Related Health Problems (ICD)[26]). Others are either pre-existing conditions or conditions that are contracted during pregnancy, childbirth and the postpartum period that are exacerbated or complicated by pregnancy, childbirth or the postpartum period[27]. Some conditions and complications are acute in nature and others chronic[28]. Conditions and complications can affect physical health, mental health or both[29]. Many conditions and complications are universal, affecting women worldwide[30]. Others are common in the developing world and almost unheard of in the developed world[31]. Certain conditions and complications of pregnancy are strongly associated with cultural practices[32]. The one fact that links all these conditions, complications and circumstances is that they are, almost without exception, preventable and/or treatable[33].

WHO and Maternal Health: The International Picture

The goal of MDG 5 is to improve maternal health. This goal was translated into two targets to be achieved by 2015[34]. These two targets are:

1.     to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio; and

2.     to achieve by 2010, universal access to reproductive health[35].

The second of these targets is the major goal of the International Conference on Population and Development and was incorporated into the MDGs in 2005[36]. The first is one of the original MDG targets. Progress towards these goals is measured by a number of indicators. The indicators related to the first target are:

a)     the maternal mortality ratio; and

b)     the proportion of births attended by skilled health personnel[37].

The indicators related to the second target are:

a)     the contraceptive prevalence rate;

b)     the adolescent birth rate;

c)     antenatal care coverage; and

d)     the unmet need for family planning[38].

It is clear from examining these goals that WHO must address a number of challenges if it is to succeed in meeting these goals by 2015. These challenges are multifaceted. They relate not only to health but to culture[39], economics[40] and gender[41] amongst other factors.

At an international level WHO coordinates much of its policy related to maternal health through the Department of Making Pregnancy Safer (MPS). MPS was formed in 2005[42] and works “to strengthen WHO’s role in providing technical, intellectual, and political leadership in the field of health and human rights[43].” The department aims to “strengthen WHO’s capacity to support countries in their endeavour to improve maternal and newborn health[44].” MPS evolved out of WHO’s Safe Motherhood Initiative[45] and focuses its work on 75 priority countries. These countries, located mostly in sub-Saharan Africa and south and central Asia[46] account for 97% of maternal mortality[47].

MPS primarily focuses on four key working areas:

1.     strengthening national capacity by assessing the technical capacity of health systems and health policy within countries;

2.     building partnerships with governments and other actors in order to build upon existing strategies for poverty reduction and cost-effective interventions;

3.     monitoring progress towards achievement of the MDGs through global surveys and data analysis; and

4.     advocacy, particularly mobilizing resources at national, regional and international levels in order to increase investment in maternal health, advocate continuum of care approaches in the area of maternal and newborn health and work towards achieving universal maternal health coverage and skilled care at all births[48].

The most recent MPS annual report published in 2008 continues with these themes detailing achievements such as the development and enhancement of partnerships with other UN organizations, academic and professional organizations[49], capacity building workshops[50] and the development of major advocacy projects[51].

MPS also publishes recommendations for preventing, managing and treating a variety of common conditions and complications of pregnancy[52] and on what care should be provided as standard to all women before, during and after pregnancy, childbirth and the postpartum period[53].

Regional Strategies

With the exception of the Pan-American Health Organization (PAHO) (which serves as WHO’s regional office for the Americas (AMRO)[54]) which includes maternal health in its general report on health in the region[55], each WHO regional office, the Regional Office for The Eastern Mediterranean (EMRO), the Regional Office for Africa (AFRO), the Regional Office for Europe (EURO), the Regional Office for South-East Asia (SEARO) and the Regional Office for the Western Pacific (WPRO) publishes reports dealing specifically with maternal health[56][57][58][59][60].

These reports all take on a similar form. All are focused on one or more of the MDG targets and all follow roughly the same structure. This structure looks at the current situation in each region, strategic directions for the region, and implementation frameworks. What becomes apparent from reading these reports is that all WHO regions face a number of similar difficulties in making progress in the area of maternal health. These difficulties mostly stem from deep and in many cases deepening inequalities within regions. Economic capacity of states and individuals, pre-exisiting health problems including infection and malnutrition, cultural values including gender discrimination and religion and political instability are some of the root causes of inequalities in the area of maternal health[61][62][63][64][65][66].

In addition to the common problems that all WHO regions face there are a number of issues that are specific to particular regions. These problems, like those which all WHO regions face are rooted in a complicated web of economic capacity, health, culture and politics. One well-known example of a maternal health issue that exists almost entirely at a regional level is obstetric fistula in Africa[67].

Each WHO regional office believes that if the maternal health situation is to improve they must work to overcome these difficulties at a regional level. For example EURO states that “a regional strategy for Making Pregnancy Safer (MPS) provides the opportunity to call attention to the maternal and perinatal ill-health situation in the region and creates a means to unite efforts to accelerate actions needed to improve maternal and perinatal health in the European region. This strategy was developed in response to requests from some of the 53 European Members States based on their needs[68].” Similarly AFRO states that its regional roadmap for improving maternal health “provides a framework for building strategic partnerships for increased investment in maternal and newborn health at institutional and programme levels. Consensus amongst the major stakeholders at African regional level to support countries over the next eleven years using this Road Map is a breakthrough in maternal and newborn mortality reduction efforts[69].”

It is clear to see that the regional level of WHO plays a significant role in improving maternal health and in achieving MDG 5 not only because WHO regional offices are equipped to deal with problems that are specific to particular regions but also because they play an important role in coordinating international policy. WHO regional offices are not merely concerned with issues that affect their own regions, they are also deeply involved with attempting to tailor regional solutions to global problems in the area of maternal health.

WHO and National Policy

WHO’s major contribution to the health policy of individual nations is normative in nature. One of WHO’s major functions, as discussed above, in the area of maternal health at an international level is to publish recommendations on how to care for women before during and after pregnancy, childbirth and the postpartum period and how to prevent, manage and treat many of the complications that can arise during this period.

WHO produces a range of literature designed to fulfil this normative function. Some of it is technical in nature, designed largely as a teaching aid to those working in the field. An example of this type of literature is Care in Normal Birth: a practical guide which is a detailed and systematic guide to care providing information on such matters as diagnosing when labour has started, how to monitor the progress of labour, how to prevent prolonged labour etc[70]. Other literature is directed at policymakers. An example of this form of literature is Standards for Maternal and Neonatal Care. This document discusses standards for maternal and newborn care. Each standard is presented in a uniform manner[71] and details the evidence and rationale used in developing the standard[72]. WHO states that the purpose of this document is to help policymakers develop and implement policy at national, sub-national and facility levels for providing effective maternal and newborn health services and improve to the uptake of these services by communities[73]. Other documents are a combination of technical and policy considerations.

WHO’s regional bodies also play a normative function in relation to national health policy. An example of this can be found in EURO’s Assessment Tool for the Quality of Hospital Care for Mothers and Newborn Babies which is an exhaustive survey assessing everything from drug availability to foetal monitoring[74].

How effective is WHO in the area of maternal health?

The role WHO plays as an actor in maternal health is a complex one. Now that some insight as to how WHO functions in relation to maternal health has been gained it is possible to assess how effective it has been.

Assessing the effectiveness of WHO in the area of maternal health is not as easy as it may first appear. This is the case for a number of reasons. First is the question of exactly how to measure the effectiveness of WHO. Should WHO’s effectiveness be measured against the MDGs, against the WHO constitution or against the functions outlined in Eleventh General Programme of Work 2006-2015? Second is the question of which level any assessment should focus on. Should assessment of WHO’s effectiveness be focused on the international, regional or national levels or should any accurate assessment of WHO’s functionality take in all three? Complicating the situation further is the fact that WHO itself admits that acquiring accurate data in relation to maternal morbidity and mortality is difficult[75], though the acquisition of data is improving[76] it is still the case that any judgment passed on WHO’s effectiveness as an actor has the potential to be grossly inaccurate.

This paper will assess WHO’s performance in relation to maternal health using two frameworks. These frameworks will both focus on WHO at an international level. The reason for this is simple, as a scholar of international relations the international level is the most relevant. One framework will focus on the MDGs and the other will focus on WHO’s Eleventh General Programme of Work 2006-2015 and the functions WHO has defined for itself in this report. These two approaches whilst by no means exhaustive serve to illustrate the difficulties in accurately assessing the performance of an organization as multidimensional as WHO.

WHO, Maternal Health and the Achievement of the MDGs

Assessing WHO’s performance using the achievement of the MDG 5 targets discussed above as a benchmark does not paint a pretty picture. Put bluntly WHO will fail to achieve these targets. Data published in 2005 indicates that few low and middle income countries will achieve the 75 percent reduction in the maternal mortality ratio that the first target of MDG 5 demands[77]. Worse still, the African region has gone backwards with the maternal mortality ratio widening from 870 deaths per 100,000 live births in 1990 to 1,000 deaths per 100,000 live births in 2001[78]. However there is still cause for cautious optimism. Though, at a regional level, none of the regions have achieved the yearly percentage decline in the maternal mortality ratio required to achieve the 75 percent target, some, most notably East Asia are close to doing so[79]. Moreover the global maternal mortality ratio is slowly declining[80]. Another point of progress is the increase in number of births attended by a skilled assistant with the percentage of births attended worldwide increasing by 14 percent in the 16 year period from 1990 to 2006.

Data related to the second MDG target of achieving universal reproductive health and its indicators is far more difficult to come by which in itself suggests that it is unlikely that this target will be met. The available data indicates that some progress has been made particularly in the area of access to and use of contraception however this progress is patchy at both the international level and within states[81]. Progress in this area, especially within states is tightly linked to socio-economic status and other markers of development[82].

As noted above it is difficult, if not impossible to assess progress towards the achievement of any one of the eight MDGs in isolation. Progress or lack thereof in achieving any one of the eight goals has effects on progression towards achieving the others. This is especially true of MDG 5. Perhaps more than any of the other goals the achievement of MDG 5 will require progress towards achieving at least some of the targets and indicators of almost every other MDG. This is because the improvement of maternal health is so closely interlinked with other aspects of development. The eradication of extreme poverty and hunger will mean that women’s bodies will be better able to tolerate the physiological stress that even uncomplicated pregnancy causes[83]. Improved education and gender equality will result in fewer pregnancies in the very young and fewer unwanted pregnancies among women of all ages[84]. Uncontrolled HIV/AIDS, Malaria and other infectious diseases are in large part responsible for the increasing maternity mortality ratios in Africa[85] as such it stands to reason that combating these diseases will result in a fall in the maternal mortality ratio in the region. It also stands to reason that the development of global partnerships for development will undoubtedly have positive consequences for maternal health.

WHO recognizes this. The World Health Report 2005 titled Making Every Child and Mother Count reflects this recognition. Several case studies featured in the report focus on the links between maternal health and other areas of development. One looks at the situation in Africa with a focus on Malawi[86], another links economic crisis and political instability in Mongolia to a cascading sequence of events that ultimately resulted in the death of a mother[87] and yet another examines the direct effects of HIV/AIDS on pregnant women[88]. However much of WHO’s policy regarding the achievement of MDG 5 is narrow in focus. Areas of focus include promoting evidence-based clinical and programmatic guidance, promoting skilled care at every birth and developing educational tools for health professionals[89]. In light of WHO’s recognition that improving maternal health is much more complicated than simply providing technical support to healthcare workers WHO’s narrow focus is disappointing especially considering that so many of the concurrent improvements required to improve maternal health, such as those related to HIV/AIDS and other infections are unambiguously part of WHO’s mandate.

Assessing WHO’s progress: an Alternative View

Assessing WHO’s performance against the MDG’s paints a bleak picture however if WHO’s achievements in the area of maternal health are measured against WHO’s functions as outlined in the Eleventh General Programme of Work 2006-2015 quite a different picture emerges.

Looking at the functions of MPS outlined above and comparing these functions to the functions that WHO sets itself in its Eleventh General Programme of Work 2006-2015 also discussed above one can see that on this measure WHO is performing quite well.

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 through MPS in the area of maternal health. MPS’s 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.

As argued above 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.

Conclusion

This paper has looked at two questions. The first concerns the functioning of WHO and the second concerns how well WHO functions in relation to a specific area of its mandate. The specific area of WHO’s mandate this paper has addressed is the area of maternal health, an area often ignored by IR scholars in favour of areas of WHO’s functioning that present traditional, hard security threats, particularly infectious disease. The choice to focus on maternal health came out of an interest in the human security paradigm and the belief that because of the emergence of this paradigm IR scholars need to broaden their interest in WHO beyond the traditional interest in infectious disease.

The first section of this paper examined WHO’s functioning on a general level and discovered that WHO’s mandate is far broader than the control of infectious disease. Put succinctly WHO’s role in the international system is nothing short of ensuring the attainment of the highest level of all forms of health, physical, mental and emotional by all human beings.

The paper then turned its attention to maternal health, examining what maternal health is and what WHO’s role in ensuring the improvement of maternal health is. It was discovered that maternal health is an important indicator of overall development. More importantly however it was discovered that maternal health is an incredibly multifaceted idea, taking in physical, mental and emotional health and complicated by a great many issues linked into larger questions of development. It was also shown that WHO’s operations are complex. WHO functions not only at the international level but at regional and national levels as well.

The final section of the paper examined two alternative critiques of WHO’s functioning in relation to maternal health. One was focused on WHO’s functioning in relation to the MDGs. By this account WHO had made little progress in the area of maternal health and by some measures had gone backwards. This account is important because so much of WHO’s energy over the course of the last decade has been placed into achieving the MDGs. However the other account which focused on WHO’s functions as defined by the Eleventh General Programme of Work 2006-2015 presented a brighter prognosis. It argued that instead of focusing on the achievement of the MDGs WHO should place its energy into becoming a catalyst for long-term improvement in the field of maternal health by acting as a setter of norms for international health and international health policy.

One of the questions this paper set out to answer is whether or not it is possible to assess the functioning of an international body with a mandate as broad as the one WHO is required to fulfil by focusing on only a small area of its functioning. After only a brief assessment of WHO’s functioning in the relatively narrow area of maternal health the only conclusion that can be drawn is that it is not possible. In assessing WHO’s functioning in the area of maternal health this paper came to two entirely different conclusions regarding WHO’s effectiveness. Considering this it could be strongly argued that it is impossible to objectively and fairly assess the functioning of WHO as a whole. It may in fact be impossible to assess WHO’s functioning in individual policy areas in a manner that is objective, fair and just.


[1] Mark W. Zacher and Tania J. Keefe, The Politics of Global Health Governance: United by Contagion (New York: Palgrave McMillan, 2008) p. 26.

[2] Ibid, p. 37.

[3] WHO Constitution, pp. 2-3.

[4] Ibid, p.5.

[5] Ibid, p. 8.

[6] Ibid, p. 4.

[7] Ibid, p. 9.

[8] Ibid, pp. 11-12

[9] Ibid, p. 10.

[10] Eleventh General Programme of Work, p. iii

[11] Ibid, p. iii.

[12] Ibid, p. 25.

[13] Ibid, p. ii.

[14] Ibid, pp. 32-33.

[15] MDG 5 Fact Sheet

[16] WHO MDG website

[17] Ibid.

[18] Ibid.

[19]http://europa.eu/pol/dev/index_en.htm (EU)

[20]http://www.aseansec.org/21918.pdf (ASEAN)

[21]http://www.ifrc.org/docs/news/speech10/bg220910.asp (Red Cross)

[22]http://www.oxfam.org/en/campaigns/health-education/millennium-development-goals (OXFAM)

[23]http://www.un-ngls.org/orf/MDG/civilsocietyaction.htm (Civil Society)

[24] http://www.who.int/topics/maternal_health/en/

[25] ???

[26]Beyond The Numbers, p. 23.

[27] ???

[28] ???

[29] ???

[30] ???

[31] ???

[32] ???

[33] MDGs Report 2010, p. 31..

[34] MDG 5 factsheet

[35] Ibid.

[36] Ibid.

[37] Ibid.

[38] Ibid.

[39] WHR 2005, p. 26

[40] Ibid, p. 23

[41] Ibid, p. 26.

[42] MPS Annual Report 2005, p. 5.

[43] Ibid, p. 5.

[44] Ibid, p. 7.

[45] MPS Annual Report 2005, p. 9.

[46] Ibid, p. 9.

[47] WHO MPS Website.

[48] MPS Annual Report 2005, p. 8.

[49] MPS Annual Report 2008, p. 13.

[50] Ibid, p. 13.

[51] Ibid, p. 15.

[52] http://www.who.int/making_pregnancy_safer/documents/en/

[53] WHO recommended Interventions

[54] MPS Regional Highlights 2009, p. 9.

[55] PAHO Health Report.

[56] Roadmap for Africa.

[57] Strategic Directions EMRO.

[58] MPS Regional Strategy WPRO.

[59] Euro strategic Approach MPS.

[60] Improving Maternal Health SEARO.

[61] PAHO Health Report, p. 14.

[62] SEARO, p.2

[63] WPRO, p.2

[64] Euro, pp. 12-13.

[65] EMRO pp. 11-14.

[66] Africa Roadmap, p. 4.

[67] Ibid, p. 3.

[68] EURO, p. 8

[69] AFRO, p. 5.

[70] Care in Normal Birth

[71] Standards, p. 2.

[72] Ibid, p. 2.

[73] Ibid, p. 1.

[74] Assessment Tool EURO.

[75] WHR 2005, p. 11.

[76] Ibid, p. 11.

[77] MDG 5 Factsheet

[78] AFRO Road Map, p. 3.

[79] MDG 5 Factsheet

[80] Ibid.

[81] Ibid.

[82] Ibid.

[83] ???

[84] ???

[85] Africa Roadmap, p. 4.

[86] WHR 2005, p. 11.

[87] Ibid, p. 22.

[88] Ibid, p. 23.

[89] MDG 5 Factsheet.

Written by: Jacqueline Hope
Written at: La Trobe University
Written for: Joseph Camilleri
Date: October 2010

"WHO" redirects here. For other uses, see Who (disambiguation).

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948 headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

The constitution of the World Health Organization had been signed by 61 countries on 7 April 1948, with the first meeting of the World Health Assembly finishing on 24 July 1948. It incorporated the Office International d'Hygiène Publique and the League of Nations Health Organization. Since its creation, it has played a leading role in the eradication of smallpox. Its current priorities include communicable diseases, in particular HIV/AIDS, Ebola, malaria and tuberculosis; the mitigation of the effects of non-communicable diseases; sexual and reproductive health, development, and ageing; nutrition, food security and healthy eating; occupational health; substance abuse; and driving the development of reporting, publications, and networking.

The WHO is responsible for the World Health Report, the worldwide World Health Survey, and World Health Day. The Director-General of WHO is Tedros Adhanom who started his five-year term on 1 July 2017.[1]

History[edit]

Origins[edit]

The International Sanitary Conferences, originally held on 23 June 1851, were the first predecessors of the WHO. A series of 14 conferences that lasted from 1851 to 1938, the International Sanitary Conferences worked to combat many diseases, chief among them cholera, yellow fever, and the bubonic plague. The conferences were largely ineffective until the seventh, in 1892; when an International Sanitary Convention that dealt with cholera was passed. Five years later, a convention for the plague was signed.[2] In part as a result of the successes of the Conferences, the Pan-American Sanitary Bureau, and the Office International d'Hygiène Publique were soon founded in 1902 and 1907, respectively. When the League of Nations was formed in 1920, they established the Health Organization of the League of Nations. After World War II, the United Nations absorbed all the other health organizations, to form the WHO.[3]

Establishment[edit]

During the 1945 United Nations Conference on International Organization, Szeming Sze, a delegate from China, conferred with Norwegian and Brazilian delegates on creating an international health organization under the auspices of the new United Nations. After failing to get a resolution passed on the subject, Alger Hiss, the Secretary General of the conference, recommended using a declaration to establish such an organization. Sze and other delegates lobbied and a declaration passed calling for an international conference on health.[4] The use of the word "world", rather than "international", emphasized the truly global nature of what the organization was seeking to achieve.[5] The constitution of the World Health Organization was signed by all 51 countries of the United Nations, and by 10 other countries, on 22 July 1946.[6] It thus became the first specialized agency of the United Nations to which every member subscribed.[7] Its constitution formally came into force on the first World Health Day on 7 April 1948, when it was ratified by the 26th member state.[6] The first meeting of the World Health Assembly finished on 24 July 1948, having secured a budget of US$5 million (then GB£1,250,000) for the 1949 year. Andrija Stampar was the Assembly's first president, and G. Brock Chisholm was appointed Director-General of WHO, having served as Executive Secretary during the planning stages.[5] Its first priorities were to control the spread of malaria, tuberculosis and sexually transmitted infections, and to improve maternal and child health, nutrition and environmental hygiene.[8] Its first legislative act was concerning the compilation of accurate statistics on the spread and morbidity of disease.[5] The logo of the World Health Organization features the Rod of Asclepius as a symbol for healing.[9]

Operational history[edit]

In 1947 the WHO established an epidemiological information service via telex, and by 1950 a mass tuberculosis inoculation drive using the BCG vaccine was under way. In 1955, the malaria eradication programme was launched, although it was later altered in objective. 1965 saw the first report on diabetes mellitus and the creation of the International Agency for Research on Cancer.[10]

In 1958, Viktor Zhdanov, Deputy Minister of Health for the USSR, called on the World Health Assembly to undertake a global initiative to eradicate smallpox, resulting in Resolution WHA11.54.[11] At this point, 2 million people were dying from smallpox every year.[citation needed]

In 1966, WHO moved into its headquarters building.[10]

In 1967, the World Health Organization intensified the global smallpox eradication by contributing $2.4 million annually to the effort and adopted a new disease surveillance method.[12][13] The initial problem the WHO team faced was inadequate reporting of smallpox cases. WHO established a network of consultants who assisted countries in setting up surveillance and containment activities.[14] The WHO also helped contain the last European outbreak in Yugoslavia in 1972.[15] After over two decades of fighting smallpox, the WHO declared in 1979 that the disease had been eradicated – the first disease in history to be eliminated by human effort.[16] In 1974, the Expanded Programme on Immunization and the control programme of onchocerciasis was started, an important partnership between the Food and Agriculture Organization (FAO), the United Nations Development Programme (UNDP), and World Bank. In 1967 the Special Programme for Research and Training in Tropical Diseases was also launched. In 1976, the World Health Assembly voted to enact a resolution on Disability Prevention and Rehabilitation, with a focus on community-driven care. In 1977, the first list of essential medicines was drawn up, and a year later the ambitious goal of "health for all" was declared. In 1986, WHO started its global programme on HIV/AIDS. Two years later preventing discrimination against sufferers was attended to and in 1996 UNAIDS was formed. In 1988, the Global Polio Eradication Initiative was established.[10] In 1998, WHO's Director-General highlighted gains in child survival, reduced infant mortality, increased life expectancy and reduced rates of "scourges" such as smallpox and polio on the fiftieth anniversary of WHO's founding. He, did, however, accept that more had to be done to assist maternal health and that progress in this area had been slow.[17]

In 2000, the Stop TB Partnership was created along with the UN's formulation of the Millennium Development Goals. In 2001 the measles initiative was formed, and credited with reducing global deaths from the disease by 68% by 2007. In 2002, The Global Fund to Fight AIDS, Tuberculosis and Malaria was drawn up to improve the resources available.[10] In 2006, the organization endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe, which formed the basis for a global prevention, treatment and support plan to fight the AIDS pandemic.[18]

Overall focus[edit]

The WHO's Constitution states that its objective "is the attainment by all people of the highest possible level of health".[19]

WHO fulfills its objective through its functions as defined in its Constitution: (a) to act as the directing and coordinating authority on international health work (b) to establish and maintain effective collaboration with the United Nations, specialized agencies, governmental health administrations, professional groups and such other organizations as may be deemed appropriate (c) to assist Governments, upon request, in strengthening health services (d) to furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of Governments (e) to provide or assist in providing, upon the request of the United Nations, health services and facilities to special groups, such as the peoples of trust territories (f) to establish and maintain such administrative and technical services as may be required, including epidemiological and statistical services (g) to stimulate and advance work to eradicate epidemic, endemic and other diseases (h) to promote, in co-operation with other specialized agencies where necessary, the prevention of accidental injuries (i) to promote, in co-operation with other specialized agencies where necessary, the improvement of nutrition, housing, sanitation, recreation, economic or working conditions and other aspects of environmental hygiene (j) to promote co-operation among scientific and professional groups which contribute to the advancement of health (k) to propose conventions, agreements and regulations, and make recommendations with respect to international health matters and to perform.

As of 2012[update] WHO has defined its role in public health as follows:[20]

  • providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
  • shaping the research agenda and stimulating the generation, translation, and dissemination of valuable knowledge;[21]
  • setting norms and standards and promoting and monitoring their implementation;
  • articulating ethical and evidence-based policy options;
  • providing technical support, catalysing change, and building sustainable institutional capacity; and
  • monitoring the health situation and assessing health trends.

Communicable diseases[edit]

The 2012–2013 WHO budget identified 5 areas among which funding was distributed.[22] Two of those five areas related to communicable diseases: the first, to reduce the "health, social and economic burden" of communicable diseases in general; the second to combat HIV/AIDS, malaria and tuberculosis in particular.[22]

As of 2015 WHO has worked within the UNAIDS network and strived to involve sections of society other than health to help deal with the economic and social effects of HIV/AIDS.[23] In line with UNAIDS, WHO has set itself the interim task between 2009 and 2015 of reducing the number of those aged 15–24 years who are infected by 50%; reducing new HIV infections in children by 90%; and reducing HIV-related deaths by 25%.[24]

During the 1970s, WHO had dropped its commitment to a global malaria eradication campaign as too ambitious, it retained a strong commitment to malaria control. WHO's Global Malaria Programme works to keep track of malaria cases, and future problems in malaria control schemes. As of 2012 WHO was to report, as to whether RTS,S/AS01, were a viable malaria vaccine. For the time being, insecticide-treated mosquito nets and insecticide sprays are used to prevent the spread of malaria, as are antimalarial drugs – particularly to vulnerable people such as pregnant women and young children.[25]

Between 1990 and 2010, WHO's help has contributed to a 40% decline in the number of deaths from tuberculosis, and since 2005, over 46 million people have been treated and an estimated 7 million lives saved through practices advocated by WHO. These include engaging national governments and their financing, early diagnosis, standardizing treatment, monitoring of the spread and effect of tuberculosis and stabilising the drug supply. It has also recognized the vulnerability of victims of HIV/AIDS to tuberculosis.[26]

In 1988, WHO launched the Global Polio Eradication Initiative to eradicate polio. It has also been successful in helping to reduce cases by 99% since which partnered WHO with Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children's Fund (UNICEF), and smaller organizations. As of 2011[update] it has been working to immunize young children and prevent the re-emergence of cases in countries declared "polio-free".[27] Recently, a study is conducted (2017) where researchers explain why Polio Vaccines may not be enough to eradicate the Virus & conduct new technology. Polio is on the verge of extinction, thanks to a Global Vaccination Drive. World Health Organization (WHO) stated the eradication programme has saved millions from deadly disease.

Non-communicable diseases[edit]

Another of the thirteen WHO priority areas is aimed at the prevention and reduction of "disease, disability and premature deaths from chronic noncommunicable diseases, mental disorders, violence and injuries, and visual impairment".[22][28] The Division of Noncommunicable Diseases for Promoting Health through the Life-course Sexual and Reproductive Health has published the magazine, Entre Nous, across Europe since 1983.[29]

Environmental health[edit]

The WHO estimates that 12.6 million people died as a result of living or working in an unhealthy environment in 2012 – this accounts for nearly 1 in 4 of total global deaths. Environmental risk factors, such as air, water and soil pollution, chemical exposures, climate change, and ultraviolet radiation, contribute to more than 100 diseases and injuries. This can result in a number of pollution-related diseases.[30]

Life course and life style[edit]

WHO works to "reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy aging for all individuals".[22][31]

It also tries to prevent or reduce risk factors for "health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets and physical inactivity and unsafe sex".[22][32][33]

WHO works to improve nutrition, food safety and food security and to ensure this has a positive effect on public health and sustainable development.[22]

Surgery and trauma care[edit]

The WHO promotes road safety as a means to reduce traffic-related injuries.[34]

WHO has also worked on global initiatives in surgery, including emergency and essential surgical care,[35] trauma care,[36] and safe surgery.[37] The WHO Surgical Safety Checklist is in current use worldwide in the effort to improve patient safety.[38]

Emergency work[edit]

The World Health Organization's primary objective in natural and man-made emergencies is to coordinate with member states and other stakeholders to "reduce avoidable loss of life and the burden of disease and disability."[22]

On 5 May 2014, WHO announced that the spread of polio was a world health emergency – outbreaks of the disease in Asia, Africa, and the Middle East were considered "extraordinary".[39][40]

On 8 August 2014, WHO declared that the spread of Ebola was a public health emergency; an outbreak which was believed to have started in Guinea had spread to other nearby countries such as Liberia and Sierra Leone. The situation in West Africa was considered very serious.[41]

Health policy[edit]

WHO addresses government health policy with two aims: firstly, "to address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches" and secondly "to promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health".[22]

The organization develops and promotes the use of evidence-based tools, norms and standards to support member states to inform health policy options. It oversees the implementation of the International Health Regulations, and publishes a series of medical classifications; of these, three are over-reaching "reference classifications": the International Statistical Classification of Diseases (ICD), the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Interventions (ICHI).[42] Other international policy frameworks produced by WHO include the International Code of Marketing of Breast-milk Substitutes (adopted in 1981),[43]Framework Convention on Tobacco Control (adopted in 2003)[44] and the Global Code of Practice on the International Recruitment of Health Personnel (adopted in 2010).[45]

In terms of health services, WHO looks to improve "governance, financing, staffing and management" and the availability and quality of evidence and research to guide policy. It also strives to "ensure improved access, quality and use of medical products and technologies".[22] WHO – working with donor agencies and national governments – can improve their use of and their reporting about their use of research evidence.[46]

Governance and support[edit]

The remaining two of WHO's thirteen identified policy areas relate to the role of WHO itself:[22]

  • "to provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfill the mandate of WHO in advancing the global health agenda"; and
  • "to develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively".

Partnerships[edit]

The WHO along with the World Bank constitute the core team responsible for administering the International Health Partnership (IHP+). The IHP+ is a group of partner governments, development agencies, civil society and others committed to improving the health of citizens in developing countries. Partners work together to put international principles for aid effectiveness and development co-operation into practice in the health sector.[47]

The organization relies on contributions from renowned scientists and professionals to inform its work, such as the WHO Expert Committee on Biological Standardization,[48] the WHO Expert Committee on Leprosy,[49] and the WHO Study Group on Interprofessional Education & Collaborative Practice.[50]

WHO runs the Alliance for Health Policy and Systems Research, targeted at improving health policy and systems.[51]

WHO also aims to improve access to health research and literature in developing countries such as through the HINARI network.[52]

Public health education and action[edit]

Each year, the organization marks World Health Day and other observances focusing on a specific health promotion topic. World Health Day falls on 7 April each year, timed to match the anniversary of WHO's founding. Recent themes have been vector-borne diseases (2014), healthy ageing (2012) and drug resistance (2011).[53]

The other official global public health campaigns marked by WHO are World Tuberculosis Day, World Immunization Week, World Malaria Day, World No Tobacco Day, World Blood Donor Day, World Hepatitis Day, and World AIDS Day.

As part of the United Nations, the World Health Organization supports work towards the Millennium Development Goals.[54] Of the eight Millennium Development Goals, three – reducing child mortality by two-thirds, to reduce maternal deaths by three-quarters, and to halt and begin to reduce the spread of HIV/AIDS – relate directly to WHO's scope; the other five inter-relate and affect world health.[55]

Data handling and publications[edit]

The World Health Organization works to provide the needed health and well-being evidence through a variety of data collection platforms, including the World Health Survey covering almost 400,000 respondents from 70 countries,[56] and the Study on Global Ageing and Adult Health (SAGE) covering over 50,000 persons over 50 years old in 23 countries.[57] The Country Health Intelligence Portal (CHIP), has also been developed to provide an access point to information about the health services that are available in different countries.[58] The information gathered in this portal is used by the countries to set priorities for future strategies or plans, implement, monitor, and evaluate it.

The WHO has published various tools for measuring and monitoring the capacity of national health systems[59] and health workforces.[60] The Global Health Observatory (GHO) has been the WHO's main portal which provides access to data and analyses for key health themes by monitoring health situations around the globe.[61]

The WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the WHO Quality of Life Instrument (WHOQOL), and the Service Availability and Readiness Assessment (SARA) provide guidance for data collection.[62] Collaborative efforts between WHO and other agencies, such as through the Health Metrics Network, also aim to provide sufficient high-quality information to assist governmental decision making.[63] WHO promotes the development of capacities in member states to use and produce research that addresses their national needs, including through the Evidence-Informed Policy Network (EVIPNet).[64] The Pan American Health Organization (PAHO/AMRO) became the first region to develop and pass a policy on research for health approved in September 2009.[65]

On 10 December 2013, a new WHO database, known as MiNDbank, went online. The database was launched on Human Rights Day, and is part of WHO's QualityRights initiative, which aims to end human rights violations against people with mental health conditions. The new database presents a great deal of information about mental health, substance abuse, disability, human rights, and the different policies, strategies, laws, and service standards being implemented in different countries.[66] It also contains important international documents and information. The database allows visitors to access the health information of WHO member states and other partners. Users can review policies, laws, and strategies and search for the best practices and success stories in the field of mental health.[66]

The WHO regularly publishes a World Health Report, its leading publication, including an expert assessment of a specific global health topic.[67] Other publications of WHO include the Bulletin of the World Health Organization,[68] the Eastern Mediterranean Health Journal (overseen by EMRO),[69] the Human Resources for Health (published in collaboration with BioMed Central),[70] and the Pan American Journal of Public Health (overseen by PAHO/AMRO).[71]

Structure[edit]

The World Health Organization is a member of the United Nations Development Group.[72]

Membership[edit]

As of 2016[update], the WHO has 194 member states: all of them Member States of the United Nations except for the Cook Islands and Niue.[73] (A state becomes a full member of WHO by ratifying the treaty known as the Constitution of the World Health Organization.) As of 2013[update], it also had two associate members, Puerto Rico and Tokelau.[74] Several other countries have been granted observer status. Palestine is an observer as a "national liberation movement" recognized by the League of Arab States under United Nations Resolution 3118. The Holy See also attends as an observer, as does the Order of Malta.[75] In 2010, Taiwan was invited under the name of "Chinese Taipei".[76]

WHO Member States appoint delegations to the World Health Assembly, WHO's supreme decision-making body. All UN Member States are eligible for WHO membership, and, according to the WHO website, "other countries may be admitted as members when their application has been approved by a simple majority vote of the World Health Assembly".[73] Liechtenstein is currently the only UN member not in the WHO membership.

In addition, the UN observer organizations International Committee of the Red Cross and International Federation of Red Cross and Red Crescent Societies have entered into "official relations" with WHO and are invited as observers. In the World Health Assembly they are seated alongside the other NGOs.[75]

Assembly and Executive Board[edit]

The World Health Assembly is the legislative and supreme body of WHO. Based in Geneva, it typically meets yearly in May. It appoints the Director-General every five years and votes on matters of policy and finance of WHO, including the proposed budget. It also reviews reports of the Executive Board and decides whether there are areas of work requiring further examination. The Assembly elects 34 members, technically qualified in the field of health, to the Executive Board for three-year terms. The main functions of the Board are to carry out the decisions and policies of the Assembly, to advise it and to facilitate its work.[77] The current Director General of the WHO is Dr. Tedros Adhanom Ghebreyesus, an Ethiopian national. The current chairman of the executive board is Dr. Assad Hafeez.

Regional offices[edit]

The regional divisions of WHO were created between 1949 and 1952, and are based on article 44 of WHO's constitution, which allowed the WHO to "establish a [single] regional organization to meet the special needs of [each defined] area". Many decisions are made at regional level, including important discussions over WHO's budget, and in deciding the members of the next assembly, which are designated by the regions.[78]

Each region has a Regional Committee, which generally meets once a year, normally in the autumn. Representatives attend from each member or associative member in each region, including those states that are not fully recognized. For example, Palestine attends meetings of the Eastern Mediterranean Regional office. Each region also has a regional office.[78] Each Regional Office is headed by a Regional Director, who is elected by the Regional Committee. The Board must approve such appointments, although as of 2004, it had never over-ruled the preference of a regional committee. The exact role of the board in the process has been a subject of debate, but the practical effect has always been small.[78] Since 1999, Regional Directors serve for a once-renewable five-year term.[79]

Each Regional Committee of the WHO consists of all the Health Department heads, in all the governments of the countries that constitute the Region. Aside from electing the Regional Director, the Regional Committee is also in charge of setting the guidelines for the implementation, within the region, of the health and other policies adopted by the World Health Assembly. The Regional Committee also serves as a progress review board for the actions of WHO within the Region.

The Regional Director is effectively the head of WHO for his or her Region. The RD manages and/or supervises a staff of health and other experts at the regional offices and in specialized centres. The RD is also the direct supervising authority—concomitantly with the WHO Director-General—of all the heads of WHO country offices, known as WHO Representatives, within the Region.

RegionHeadquartersNotesWebsite
AfricaBrazzaville, Republic of CongoAFRO includes most of Africa, with the exception of Egypt, Sudan, Djibouti, Tunisia, Libya, Somalia and Morocco (all fall under EMRO).[80][81] The Regional Director is Matshidiso Moeti.AFRO
EuropeCopenhagen, Denmark.EURO includes Europe, Israel, and former USSR, except Liechtenstein.[81]EURO
South-East AsiaNew Delhi, IndiaNorth Korea is served by SEARO.[82]SEARO
Eastern MediterraneanCairo, EgyptEastern Mediterranean Regional office includes the countries of Africa that are not included in AFRO, as well as the countries of the Middle East, except for Israel. Pakistan is served by EMRO.[83]EMRO
Western PacificManila, Philippines.WPRO covers all the Asian countries not served by SEARO and EMRO, and all the countries in Oceania. South Korea is served by WPRO.[84]WPRO
The AmericasWashington D.C., USA.Also known as the Pan American Health Organization (PAHO), and covers the Americas.[85] The Regional Director is Carissa F. Etienne.AMRO

People[edit]

The head of the organization is the Director-General, elected by the World Health Assembly[87]. The current Director-General is Tedros Adhanom, who was appointed on 1 July 2017[88]. WHO employs 8,500 people in 147 countries.[89] In support of the principle of a tobacco-free work environment the WHO does not recruit cigarette smokers.[90] The organization has previously instigated the Framework Convention on Tobacco Control in 2003.[91]

The WHO operates "Goodwill Ambassadors", members of the arts, sport or other fields of public life aimed at drawing attention to WHO's initiatives and projects. There are currently five Goodwill Ambassadors (Jet Li, Nancy Brinker, Peng Liyuan, Yohei Sasakawa and the Vienna Philharmonic Orchestra) and a further ambassador associated with a partnership project (Craig David).[92]

Country and liaison offices[edit]

The World Health Organization operates 147 country offices in all its regions.[93] It also operates several liaison offices, including those with the European Union, United Nations and a single office covering the World Bank and International Monetary Fund. It also operates the International Agency for Research on Cancer in Lyon, France, and the WHO Centre for Health Development in Kobe, Japan.[94] Additional offices include those in Pristina; the West Bank and Gaza; the US-Mexico Border Field Office in El Paso; the Office of the Caribbean Program Coordination in Barbados; and Northern Micronesia office.[95] There will generally be one WHO country office in the capital, occasionally accompanied by satellite-offices in the provinces or sub-regions of the country in question.

The country office is headed by a WHO Representative (WR). As of 2010[update], the only WHO Representative outside Europe to be a national of that country was for the Libyan Arab Jamahiriya ("Libya"); all other staff were international. Those in the Region for the Americas, they are referred to as PAHO/WHO Representatives. In Europe, WHO Representatives also serve as Head of Country Office, and are nationals with the exception of Serbia; there are also Heads of Country Office in Albania, the Russian Federation, Tajikistan, Turkey, and Uzbekistan.[95] The WR is member of the UN system country team which is coordinated by the UN System Resident Coordinator.

The country office consists of the WR, and several health and other experts, both foreign and local, as well as the necessary support staff.[93] The main functions of WHO country offices include being the primary adviser of that country's government in matters of health and pharmaceutical policies.[96]

Financing and partnerships[edit]

The WHO is financed by contributions from member states and outside donors. As of 2012[update], the largest annual assessed contributions from member states came from the United States ($110 million), Japan ($58 million), Germany ($37 million), United Kingdom ($31 million) and France ($31 million).[97] The combined 2012–2013 budget has proposed a total expenditure of $3,959 million, of which $944 million (24%) will come from assessed contributions. This represented a significant fall in outlay compared to the previous 2009–2010 budget, adjusting to take account of previous underspends. Assessed contributions were kept the same. Voluntary contributions will account for $3,015 million (76%), of which $800 million is regarded as highly or moderately flexible funding, with the remainder tied to particular programmes or objectives.[98]

In recent years, the WHO's work has involved increasing collaboration with external bodies.[99] As of 2002[update], a total of 473 non-governmental organizations (NGO) had some form of partnership with WHO. There were 189 partnerships with international NGOs in formal "official relations" – the rest being considered informal in character.[100] Partners include the Bill and Melinda Gates Foundation[101] and the Rockefeller Foundation.[102]

Controversies[edit]

IAEA – Agreement WHA 12–40[edit]

In 1959, the WHO signed Agreement WHA 12–40 with the International Atomic Energy Agency (IAEA). A reading of this document can result in the understanding that the IAEA is able to prevent the WHO from conducting research or work on some areas, as seen hereafter. The agreement states that the WHO recognizes the IAEA as having responsibility for peaceful nuclear energy without prejudice to the roles of the WHO of promoting health. However, the following paragraph adds that "whenever either organization proposes to initiate a programme or activity on a subject in which the other organization has or may have a substantial interest, the first party shall consult the other with a view to adjusting the matter by mutual agreement".[103] The nature of this statement has led some pressure groups and activists (including Women in Europe for a Common Future) to claim that the WHO is restricted in its ability to investigate the effects on human health of radiation caused by the use of nuclear power and the continuing effects of nuclear disasters in Chernobyl and Fukushima. They believe WHO must regain what they see as "independence".[104][105][106]

Roman Catholic Church and AIDS[edit]

Main article: Roman Catholic Church and AIDS

In 2003, the WHO denounced the Roman Curia's health department's opposition to the use of condoms, saying: "These incorrect statements about condoms and HIV are dangerous when we are facing a global pandemic which has already killed more than 20 million people, and currently affects at least 42 million."[107] As of 2009[update], the Catholic Church remains opposed to increasing the use of contraception to combat HIV/AIDS.[108] At the time, the World Health Assembly President, Guyana's Health Minister Leslie Ramsammy, condemned Pope Benedict's opposition to contraception, saying he was trying to "create confusion" and "impede" proven strategies in the battle against the disease.[109]

Intermittent preventive therapy[edit]

The aggressive support of the Bill & Melinda Gates Foundation for intermittent preventive therapy of malaria triggered a memo from the former WHO malaria chief Akira Kochi.[110]

Diet and sugar intake[edit]

Some of the research undertaken or supported by WHO to determine how people's lifestyles and environments are influencing whether they live in better or worse health can be controversial, as illustrated by a 2003 joint WHO/FAO report on nutrition and the prevention of chronic non-communicable disease,[111] which recommended that sugar should form no more than 10% of a healthy diet. The report led to lobbying by the sugar industry against the recommendation, to which the WHO/FAO responded by including in the report this statement: "The Consultation recognized that a population goal for free sugars of less than 10% of total energy is controversial". It also stood by its recommendation based upon its own analysis of scientific studies.

Countries by World Health Organization membership status
WHO Headquarters in Geneva

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