The WHO and World Health Governance – Oct. 28 ish
What is the World Health Organization:
Directing and coordinating authority for health within United Nations
o Provide leadership on global health matteres
o Shape the health research agenda
o Set norms and standards
o Articulate evidence-based policy options
o Provide technical support to countries
o Monitor and assess health trends
Health authority for UN.
Mandate about coordinating and advocate for global health issues, impact
research agenda, support countries, tracks epidemics, compares mortality rates,
helps countries with health admin.
Head of Organization – appointed by WHA
The World Health Assembly (WHA)
Supreme decision-making body for WHO; delegates from 194 states
Determines policies, appoints Director-General, supervises financial policies,
approves budget, receives Executive reports of the Executive and instructs re
Meet in Geneva once a year in May.
Main function: set policies for WHO.
WHO then carries out policies.
Similar to board of directors.
The Executive Board
34 members of WHA
Advises and facilitates work of WHA
Smaller group comes out of WHA
Elected to terms from WHA.
Help set agenda, exec work of WHA, provide advice.
Staff of 8000 – work at HQ, 6 regional offices and in countries and collaborating
Family, Women‟s and Children‟s Health (FWC)
General Management Cluster
Health Security and Environment (HSE)
Health Systems and Innovation (HIS)
HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM)
Noncummunicable Diseases and Mental Health (HTM)
Polio, Emergencies and Country Collaboration (PEC)
Diplomats meet in San Francisco to form the United Nations
Discuss setting up a global health organization
WHO‟s Constitution comes into effect
Delegates from 53 of WHO‟s original 55 member states come to the first World
Health Assembly (WHA), set priorities:
Malaria; women‟s and children‟s health; TB; venereal disease; nutrition and
WHO takes over responsibility for the International Classification of Disease (ICD)
History: Golden Age
Most effective, most impressive accomplishments, to end of 70‟s
Global yaws control program!
Yaws disease = crippling/disfiguring,
Affected 50 million people in 1950s
1 shot of long acting penicillin, cut disease by 95%
World Health Assembly adopts resolution to create the Expanded Programme on
First Essential Medicine List!
The International Conference on Primary Health Care in Alma-Ata, Kazakhstan;
sets goal of “Health for All”
Focus on primary care
Social determinants of health on the map internationally
Eradication of smallpox!
Probably biggest accomplishment to date, 1 and only time major infection has
been eradicated History: New directions of declining efficacy?
- Much criticism
- Most WHO cited accomplishments become less about intervening directly and
more about providing public health advice to states
- Losing power to direct adtivity in world health scene, in part due to financial
Global Polio Eradication Initiative
Reduced by 99%
Also spearheaded by other organizations, eg. UNICEF, rotary international
WHO losing/sharing its turf
WHO Framework Convention on Tobacco Control
Adoption of the Global Strategy on Diet, Physical Activity and Health
World Health Assembly revises the International Health Regulations
Who pays? Who calls the tune?
Assessed contributions (ACs) from WHO member states (means-tested)
Many member states in arrears
Increasingly funding organization and administration expenses, which are
Shrinking as proportion of WHO expenditures
Some are poor, many on list are European countries, US is by far the worst
offender $36 million
- WHA have frozen regular budget of WHO
“EBFs” or extra-budgetary funds – voluntary contributions from member states and non-
Unpredictable, mostly inflexible
Primarily come from wealthy countries
Increasingly funding WHO‟s major programs, creates instability
- 1970: EBFs = 20% of WHO budget (80% from ACs)
- 2010/2011: EBFs = 80% of budget (20% from ACs)
- Research expenditures declining Rest of the money comes from contributions: EBFs.
Amounts are not predicatable, donors decide how much to give.
Amounts are not flexible, they are dedicated funds, strings attached, donors tell
WHO what they can use the money for.
Less and less on research
More on public health
Many major programs like HIV/AIDS, maternal child health etc. coming to be
primarily funded by EBFs, leads to instability in programs.
- Most of EBFs from US, worldbank, and UK.
- Want to control where their money is going and what the WHO is doing.
- Gates Foundation one of the big funders +
- Rotary international.
- Increased control over what the WHO does.
Moral of the Story: Rich western nations are increasingly bankrolling the WHO
and are exercising increasing control over its activities Critiques and Problems
Navarro on the WHO‟s Health Systems: Improving Performance (2000)
WHO overemphasizes effects of medical care on he