The World Health Organization

Achievements and Failures

Yves Beigbeder

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781317011521
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

The World Health Organization (WHO) is undergoing a crisis of credibility and challenge. Having been subjected to a severe financial crisis and criticisms of its management of pandemics such as the H1N1 flu case and the outbreak of Ebola, with a new Director-General at its helm, it is an ideal time to review the WHO's past and current achievements including on-going operations and reported failures. Whilst time is given to recurrent attacks on WHO performance, it is balanced by also highlighting the WHO's leadership, its member states, and its influence on other actors, NGOs and business. As such, this study reviews the WHO's actions in the most visible programmes such as SARS, H1N1, Ebola and also smallpox, malaria, onchocerciasis, polio and AIDS. The author also discusses the desirable balance between operational and normative functions and proposals for reform of the Organization.

Part I
WHO’s mandate, governance and programmes

1 Mandate, structure and partners

The World Health Organization (WHO) is one of the 12 specialized agencies brought into relationship with the United Nations by a formal agreement. It is one of the four ‘large’ specialized agencies, together with the International Labour Organization (ILO), the Food and Agriculture Organization of the United Nations (FAO), and the United Nations Educational, Scientific and Cultural Organization (UNESCO). Like other specialized agencies, WHO has its own governing bodies, budget and secretariat.

WHO is currently undergoing an identity crisis in view of the rise of many partners and rivals in the same global health field. A reform process is proceeding, but faces a serious funding crisis: WHO’s dependency on voluntary financial contributions amounts to its partial privatization. Unlike other UN specialized agencies, WHO is a decentralized, regionalized organization: the power vested in Regional Directors as elected officials has tended to weaken the authority of the Director-General.

The origins

The creation of WHO stemmed from the International Sanitary Conferences which met between 1851 and 1938, and the adoption of the first International Sanitary Convention in 1903.

These aimed at defending Europe against exotic pestilential illnesses – plague, yellow fever and cholera – while imposing minimum interference with international commerce.

Their action was necessarily hampered by the lack of reliable and scientific knowledge of the illnesses, and reflected the state of international relations at the time, dominated by European states, the USA and Latin American countries.

Several health organizations were created on a regional basis: small Sanitary Councils in Constantinople (1839), Alexandria (1843), Tangiers (1840) and Teheran (1867). The first real intergovernmental health organization was the Pan American Sanitary Bureau, created in 1902 in Washington, DC, followed in 1907 by the Office international d’hygiène publique in Paris. After the First World War, the Organisation d’hygiène was set up in 1923 in Geneva under the auspices of the League of Nations. In the humanitarian field, the Allied Powers established in 1941 the United Nations Relief and Rehabilitation Administration (UNRRA): it gave aid to millions of people in 25 countries, including medical assistance, vaccinations, food, clothing, medical and other supplies.

The origin of WHO’s normative work is found in the early International Sanitary Conventions.

The existence of the Pan American Sanitary Bureau prior to WHO’s creation led to the regionalization of WHO.¹

WHO’s mandate

WHO’s overall objective is ‘the attainment by all peoples of the highest possible level of health’ (WHO 2014a). It should ‘act as the directing and coordinating authority on international health work’: however, its ‘authority’ is only that conferred by non-binding resolutions of its directing body, the World Health Assembly (WHA), regulations, directives and recommendations, and by a few binding conventions.

WHO’s functions are listed in Article 2 of the Constitution. They are reproduced in Box 1.1.

Box 1.1 WHO’s functions

In order to achieve its objective, the functions of the Organization shall be:

a.to act as the directing and co-ordinating 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 such duties as may be assigned thereby to the Organization and are consistent with its objective;

l.to promote maternal and child health and welfare and to foster the ability to live harmoniously in a changing total environment;

m.to foster activities in the field of mental health, especially those affecting the harmony of human relations;

n.to promote and conduct research in the field of health;

o.to promote improved standards of teaching and training in the health, medical and related professions;

p.to study and report on, in co-operation with other specialized agencies where necessary, administrative and social techniques affecting public health and medical care from preventive and curative points of view, including hospital services and social security;

q.to provide information, counsel and assistance in the field of health;

r.to assist in developing an informed public opinion among all peoples on matters of health;

s.to establish and revise as necessary international nomenclatures of diseases, of causes of death and of public health practices;

t.to standardize diagnostic procedures as necessary;

u.to develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products;

v.generally to take all necessary action to attain the objective of the Organization.

Source: WHO Constitution, Article 2 in WHO Basic Documents, 48th edition.

These functions can be grouped in several categories:

•strengthening national health services, a ‘horizontal’ function, which includes advice to governments on specific areas such as maternal and child health, hospital services, mental health and social security;

•an operational role, fighting epidemic, endemic and other diseases, aid in emergencies – a ‘vertical’ function;

•environmental work on the prevention of accidental injuries, the improvement of nutrition, housing, sanitation, recreation, economic or working conditions – a broad programme involving the economic and social determinants of health for which WHO needs cooperation with other agencies (for instance, FAO concerning nutrition, ILO on working conditions). Sanitation is well within the domain of WHO, but housing, recreation and economic conditions in general appear well beyond WHO’s capacity: ‘action’ in this category is dependent on the global economy, on the economies of states and on decisions taken by states’ governments to consider, or not, the health impact of their legislation;

•an important normative role: to propose conventions, agreements and regulations, to establish and revise international nomenclatures of diseases, of causes of death, to standardize diagnostic procedures, to develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products, a role best assumed by a global intergovernmental agency;

•a research function: to promote and conduct research in the field of health: WHO can encourage laboratories to initiate research, for instance concerning neglected diseases, but it has not conducted research, except at its International Agency for Research on Cancer in Lyon (France). As a global organization, WHO is uniquely placed to assume research promotion functions requiring solid technical competence and authority through its Expert Committees;

•a training function: to promote improved standards of teaching and training in the health, medical and related professions;

•an information function: to establish and maintain epidemiological and statistical services, provide information, counselling and assistance, and to assist in developing an informed public opinion among all peoples on matters of health.

WHO’s structure

WHO has a complex structure which includes the WHA, the Executive Board, the secretariat, and regional bodies.

The WHA, composed of delegates of the 194 member States, meets in annual session in May of each year at the UN Palais des Nations in Geneva. The Assembly determines the policies and programmes of the organization, appoints the Director-General for five-year terms, reviews and approves the reports and activities of the Executive Board, and approves the budget every two years.

For Kickbusch and Orbinski (2012),

the World Health Assembly has become the incomparable meeting point for global health diplomacy…. Health experts, advocates from civil society, business representatives and representatives of a multitude of other global health organizations interact with officials from health and foreign ministries and representatives from the donor community, development agencies and the large donations, as well as with other UN bodies.

The Executive Board consists of 34 persons technically qualified in the field of health, each one designated by a member state elected to do so by the WHA according to equitable geographical distribution. The Board meets at least twice a year. It submits proposals to the Assembly, gives effect to the Assembly’s policies and decisions and takes emergency measures with regard to events requiring immediate action. It acts as the executive organ of the Assembly.

The secretariat

The secretariat is composed of the Director-General, elected by the WHA and the technical and administrative staff he/she appoints as required. The secretariat establishes and maintains relationships with member States, it prepares and submits to the Executive Board the financial statements and budget estimates. It prepares reports as requested by the Board and the Assembly, and takes action following decisions by the two governing bodies.

The Director-General may take independent policy initiatives subject to review and approval by the governing bodies. For example, the third Director-General, Dr H. Mahler, together with UNICEF, launched the ‘Health for All’ initiative in 1975, a revolutionary concept. Examples of other such initiatives are given in Chapter 2.

Staff members are international civil servants who are not to seek or receive instructions from any government or any authority external to the organization. In turn, member States should respect the exclusively international character of the Director-General and his/her staff and not seek to influence them. These obligations are not always respected by governments, which may offer policy advice, or warn the Director-General against unwanted policies, or insist on the appointment of their nationals to senior posts.

As of 31 December 2014, WHO had a total of 7,309 staff members. Temporary staff constituted 14.7 per cent of this total. For 2014, staff costs amounted to $867.5 of the organization’s total expenditure of $2,316.6 million (WHO 2015e).

WHO’s regional organizations are an integral part of the organization. They consist of a Regional Committee composed of all member States of a given region and a regional office. WHO has six regions: Africa, the Americas, the Eastern Mediterranean, Europe, South-East Asia, and the Western Pacific. Regional committees enjoy great autonomy in programme, budget and staffing matters, which was increased during Director-General Dr Mahler’s term of office. The regional office is headed by a Regional Director appointed by the Executive Board in agreement with the Regional Committee: in practice, the selection of a new Regional Director is made at the regional level, by political agreement of all, or a majority of, member States in the region. The creation of semi-autonomous regions was one of the requirements of the USA to allow the integration of the Pan American Sanitary Bureau into WHO in 1948. No other UN specialized agency has the same degree of regionalization.

In WHO, the powers vested in Regional Directors as elected officials have tended to weaken the authority of the (also) elected Director-General, and have been, at times, a source of tension between headquarters and regional offices. For Legge (2012), ‘this degree of decentralization fragments the organization, j...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Foreword
• Preface
• List of abbreviations
• Part I WHO’s mandate, governance and programmes
• Part II Global outbreaks and pandemics
• Part III Communicable diseases: control, elimination or eradication?
• Part IV Fighting non-communicable diseases
• Conclusion
• Bibliography
• Index