Lecture 9 World Health Organization, it structure and functions.

LectureLecture 9 9

World Health Organization, it World Health Organization, it structure and functionsstructure and functions

Birth of the WHOThe WHO has its origin in April 1945, during the conference held at San Francisco to set up the United Nations. The representatives of Brazil and China The representatives of Brazil and China proposed that an international health organization proposed that an international health organization should be established and that a conference to frame its should be established and that a conference to frame its constitution should be convened. The constitution was constitution should be convened. The constitution was drawn up at an international health conference in New drawn up at an international health conference in New York in 1946. The same conference set up an "Interim York in 1946. The same conference set up an "Interim Commission" to prepare the ground for the new Commission" to prepare the ground for the new organization and to carry out urgent tasks until the organization and to carry out urgent tasks until the WHO constitution had been accepted by the required WHO constitution had been accepted by the required number of UN Member States. The ratifications were number of UN Member States. The ratifications were secured by 7 April 1948; the formal existence of the secured by 7 April 1948; the formal existence of the WHO as a specialized agency began on that date. WHO as a specialized agency began on that date. The The formation of WHO represents the culmination of efforts formation of WHO represents the culmination of efforts to establish a single worldwide inter-governmental to establish a single worldwide inter-governmental health agency.health agency.

WORLD HEALTH ORGANIZATION• The World Health Organization is a

specialized, non political, health agency of the United Nations, with headquarters at Geneva. In 1946, the Constitution was drafted by the "Technical Preparatory Committee" under the chairmanship of Rene Sand, and was approved in the same year by an International Health Conference of 51 nations in New York. The constitution came into force on 7th April, 1948 which is celebrated every year as "World Health Day". A World Health day theme is chosen each year to focus attention on a specific aspect of public health.

Objective• The objective of the WHO is "the attainment by all The objective of the WHO is "the attainment by all

peoples of the highest level of health" which is set out in peoples of the highest level of health" which is set out in the preamble of the Constitution. The current objective the preamble of the Constitution. The current objective of WHO is the attainment by all people of the world a of WHO is the attainment by all people of the world a level of health that will permit them to lead a socially level of health that will permit them to lead a socially and economically productive life - also known as Health and economically productive life - also known as Health for All. for All.

The preamble of the Constitution states:The preamble of the Constitution states:• "Health is a state of complete physical, mental and

social well-being and not merely the absence of disease or infirmity.

• The enjoyment of the highest attainable standard of The enjoyment of the highest attainable standard of health is one of the fundamental rights of every health is one of the fundamental rights of every human being without distinction of race, religion, and human being without distinction of race, religion, and political belief, economic and social condition.political belief, economic and social condition.

The preamble of the Constitution states:The preamble of the Constitution states:• The health of all peoples is fundamental to the attainment

of peace and security and is dependent upon the fullest cooperation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all.

• Unequal development in different countries in the Unequal development in different countries in the promotion of health and control of disease, especially promotion of health and control of disease, especially communicable disease, is a common danger.communicable disease, is a common danger.

• Healthy development of the child is of basic importance: Healthy development of the child is of basic importance: the ability to live harmoniously in a changing total the ability to live harmoniously in a changing total environment is essential to such development.environment is essential to such development.

• The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.

• Governments have a responsibility for the health of their Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of peoples which can be fulfilled only by the provision of adequate health and social measures".adequate health and social measures".

Membership• Membership in WHO is open to all countries. While

most countries are members of both the UN and of WHO, there are some differences. For example, Switzerland is a Member of WHO, but not of the United Nations. Territories which are not responsible for the conduct of their international relations may be admitted as Associate Members. Associate Members participate without vote in the deliberations of the WHO. Each Member State contributes yearly to the budget and each is entitled to the services and aid the organization can provide. In 1948, the WHO had 56 Members. By 1996 WHO had 190 Member States and two Associate Members.

Structure• The WHO consists of three principal organs: the World Health

Assembly, the Executive Board and the Secretariat.• THE WORLD HEALTH ASSEMBLY: This is the "Health

Parliament" of Nations and the supreme governing body of the organization. It meets annually, usually in May, and generally at the headquarters in Geneva, but from time to time in other countries. (The 14th World Health Assembly met in New Delhi in 1961). The Assembly is composed of delegates representing Member States, each of which has one vote. The main functions of the Health Assembly are: (1) to determine international health policy and programmes (2) to review the work of the past year (3) to approve the budget needed for the following year and (4) to elect Member States to designate a person to serve for three years on the Executive Board and to replace the retiring members. The Health Assembly also appoints the Director General on the nomination of the Executive Board. It is now the practice to organize on the occasion of each Health Assembly, "technical discussions" on some subjects of world interest.

THE EXECUTIVE BOARD: • The Board had originally 18 members, each designated

by a Member State. Subsequently, the number was raised to 24 and 30. The Health Assembly (1976) increased the membership from 30 to 31, providing that no fewer than three are to be elected from each of the WHO regions. The members of the Board are to be "technically qualified in the field of health"; they are designated by, but do not represent their governments. One-third of the membership is renewed every year. The Executive Board meets at least twice a year, generally in January and shortly after the meeting of the World Health Assembly in May. The main work of the Board is to give effect to the decisions and policies of the Assembly. The Board also has power to take action itself in an emergency, such as epidemics, earthquakes and floods where immediate action is needed.

THE SECRETARIAT: • The secretariat is headed by the Director General who

is the chief technical and administrative officer of the Organization. The primary function of the WHO secretariat is to provide Member States with technical and managerial support for their national health development programmes. While in 1948, WHO staff counted 250 persons, the Organization in 1985 counted 4475 international public servants. At WHO headquarters in Geneva, there are 5 Assistant Director Generals each of whom is responsible for the work of such divisions as may from time to time be assigned to him by the Director General.

On 31 December, 1985, the WHO Secretariat comprised of the following divisions:

1. Division of epidemiological surveillance and health situation and trend assessment

2. Division of communicable diseases3. Division of vector biology and control4. Division of environmental health5. Division of public information and education for health6. Division of mental health7. Division of diagnostic, therapeutic and rehabilitative

technology8. Division of strengthening of health services9. Division of family health10. Division of non-communicable diseases11. Division of health manpower development12. Division of information systems support13. Division of personnel and general services14. Division of budget and finance

In order to meet the special health needs of different areas WHO has established six regional organizations.

TABLE 1. WHO Regional Organizations

Region Headquarters

1. South East Asia New Delhi (India)

2. Africa Harare (Zimbabwe)

3. The Americas Washington D.C. (U.S.A.)

4. Europe Copenhagen (Denmark)

5. Eastern Mediterranean Alexandria (Egypt)

6. Western Pacific Manila (Philippines)

Regions• The regional organizations are integral part of the WHO

and have under the constitution an important part in implementing the policies and programmes of the WHO. The regional office is headed by the Regional Director, who is assisted by technical and administrative officers and members of the secretariat. There is a regional committee composed of representatives of the Member States in the region. Regional Committees meet once a year to review health work in the region and plan its continuation and development. Regional plans are amalgamated into overall plans for the Organization by the Director General at WHO's headquarters in Geneva.

The South East Asia RegionThe headquarters of the South East Asia Regional Office (SEARO) is in New Delhi, the official address being World Health House, Indraprastha

Estate, Delhi. The Region has now 11 members. Table 2. WHO: SEARO Member countries

Year of joining Member country SEARO Population 2002 (million)

19721972 Bangladesh 143.819821982 Bhutan 2.219481948 India 1049.519501950 Indonesia 217.419731973 Korea (Dem. People's Rep.) 22.519651965 Maldives Islands 0.319481948 Myanmar 48.919531953 Nepal 24.619481948 Sri Lanka 18.819471947 Thailand 62.2

• The WHO activities in South East Asia Region cover a wide range of subjects such as malaria eradication, tuberculosis control, control of other communicable diseases, health laboratory services and production of vaccines, health statistics, public health administration and rural health services, maternal and child health, nursing, environmental health and water supply, health education, nutrition, mental health, dental health, medical rehabilitation, quality control of drugs and medical education.

Work of WHO

• WHO'S first Constitutional function is to act as the directing and coordinating authority on all international health work. This function permits WHO's Member States to identify collectively priority health problems throughout the world, to define collectively health policies and targets to cope with them, to devise collectively strategies, principles and programmes to give effect to these policies and to attain the targets. The WHO also has specific responsibilities for establishing and promoting international standards in the field of health, which comprise the following broad areas:

PREVENTION AND CONTROL OF SPECIFIC DISEASES

• Almost all communicable diseases are or have been at sometime the subject of WHO activities. The global eradication of smallpox is an outstanding example of international health cooperation. With the same energy and commitment with which WHO eradicated smallpox, it is now directing the global battle against AIDS.

• An important activity of WHO is epidemiological surveillance of communicable diseases. The WHO collects and disseminates epidemiological information on diseases subject to International Health Regulations and occasionally other communicable diseases of international importance through an Automatic Telex Reply Service (ATRS) and the "Weekly Epidemiological Record" (WER). The latter contains more complete details and brief reviews of communicable diseases of international importance. Member States can also make use of the "WHO Emergency Scheme for Epidemics" whenever necessary. The aim of International Health Regulations is to ensure maximum security against international spread of diseases with the minimum interference with world traffic.

PREVENTION AND CONTROL OF SPECIFIC DISEASES

• The WHO has also paid attention in its programme of work to non-communicable disease problems such as cancer, cardiovascular diseases, genetic disorders, mental disorders, drug addiction and dental diseases.

• The activities of WHO have also branched out into the fields of vector biology and control, immunology, quality control of drugs and biological products, drug evaluation and monitoring and health laboratory technology as these activities are relevant to the control of both communicable and non-communicable diseases.

• Immunization against common diseases of childhood (Expanded Programme on Immunization) is now a priority programme of the WHO. The 30th World Health Assembly adopted a resolution aimed at ensuring immunization of all children.

DEVELOPMENT OF COMPREHENSIVE

HEALTH SERVICES • WHO's most important single function is to promote and support

national health policy development and the development of comprehensive national health programmes. This broad field of endeavour encompasses a wide variety of activities such as organizing health systems based on primary health care, the development of health manpower and utilization, building of long-term national capability, particularly in the areas of health infrastructure development, and managerial capabilities (including monitoring and evaluation) and health services research. Appropriate Technology for Health (ATH) is another new programme launched by the WHO to encourage self-sufficiency in solving health problems. The new programme is part of WHO's efforts to build up primary health care. WHO's main activities in 1980 were towards promoting national, regional and global strategies for the attainment of Health for All.

FAMILY HEALTH

• Family health is one of the major programme activities of WHO since 1970, and is broadly subdivided into maternal and child health care, human reproduction, nutrition and health education. The chief concern is improvement of the quality of life of the family as a unit.

ENVIRONMENTAL HEALTH

• Promotion of environmental health has always been an important activity of WHO. WHO advises governments on national programmes for the provision of basic sanitary services. Recent activities are directed to protection of the quality of air, water and food; health conditions of work, radiation protection and early identification of new hazards originating from new technological developments. A number of programmes have been developed such as the 'WHO Environmental Health Criteria Programme' and 'WHO Environmental Health Monitoring Programme' towards improving environmental health. The WHO is committed to attain the target adopted by Habitat, the UN Conference on Human Settlements that was to have “Water for All by 1990”.

HEALTH STATISTICS • From its earliest days in 1947, WHO has been concerned with the

dissemination of a wide variety of morbidity and mortality statistics relating to health problems. The data is published in the:

• (a) Weekly Epidemiological Record • (b) World Health Statistics Quarterly and • (c) World Health Statistics Annual. • Readers interested in current data may obtain it from the Chief

Statistician, Dissemination of Statistical information. WHO, Geneva. In order that statistics from different countries may be comparable, WHO publishes 'International Classification of Diseases' which is updated every 10th year. The Tenth Revision of ICD came into effect from 1 January 1993. Assistance is also given to countries in the improvement of their medical records, and in the planning and operating national health information systems.

BIO-MEDICAL RESEARCH • The WHO does not itself do research, but stimulates and

coordinates research work. It has established a world-wide network of WHO collaborating centers, besides awarding grants to research workers and research institutions for promoting research. There are Regional Advisory Committees on health research which define regional health research priorities and a Global Advisory Committee, which in close collaboration with the regional committee deals with policy issues of global import. Six tropical diseases (malaria, schistosomiasis, trypanosomiasis, fllariasis, leishmaniasis and leprosy) are the target of the WHO Special Programme for Research and Training in Tropical Diseases to develop new tools, strengthen research institutions and training workers in the countries affected.

HEALTH LITERATURE AND INFORMATION • WHO acts as a clearing house for information on

health problems. Its publications comprise hundreds of titles on a wide variety of health subjects. The WHO library is one of the satellite centers of the Medical Literature Analysis and Retrieval System (MEDLARS) of the U.S. National Library of Medicine. MEDLARS is the only fully computerized indexing system covering the whole of medicine on an international basis. The WHO has also a public information service both at headquarters and each of the six regional offices.

COOPERATION WITH OTHER

ORGANIZATIONS

• WHO collaborates with the UN and with the other specialized agencies, and maintains various degrees of working relationships. Besides, WHO has also established relations with a number of international governmental organizations.