The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health.
In the previous blog we looked WHO origin, objective, mission, their governance body and structure and also international organisations managed by WHO. This blog will focus on the presence of WHO in different countries, its goodwill ambassadors, how is WHO funded, its work and relation with India and more.
Map of the WHO's regional offices and their respective operating regions.
- The regional divisions of WHO were created between 1949 and 1952, and are based on article 44 of the 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 the regional level, including important discussions over WHO's budget, and in deciding the members of the next assembly, which are designated by the regions.
- Each region has a regional committee, which generally meets once a year, normally in the autumn. Representatives attend from each member or associate member in each region, including those states that are not full members.
- The WHO employs 7,000 people in 149 countries and regions to carry out its principles.
- In support of the principle of a tobacco-free work environment, the WHO does not recruit cigarette smokers.
- The organization has previously instigated the Framework Convention on Tobacco Control in 2003
- The WHO operates "Goodwill Ambassadors"; members of the arts, sports, or other fields of public life aimed at drawing attention to WHO's initiatives and projects.
- There are currently five Goodwill Ambassadors (Cynthia Germanotta, Alisson Becker, Dr Natália Loewe Becker, and Ellen Johnson Sirleaf).
Promoting compliance, risk management and ethics
- The WHO Office of Compliance, Risk Management and Ethics (CRE) promotes transparency and management of corporate-level risk, within the framework of WHO’s ethical principles.
- To this end, CRE promotes the practice of the ethical principles derived from the international civil service standards of conduct for all WHO staff and associated personnel.
- CRE provides clear and action-oriented advice in a secure and confidential environment where individuals can freely consult on ethical issues. The aim is to help individuals in performing their duties professionally and fairly and to manage their personal affairs in a way that does not interfere with their official responsibilities.
The Office of Compliance, Risk Management and Ethics (CRE) offer the following services:
- Confidential ethics advice
- Promotion of ethics awareness and education
- Promotion of ethics standards
- Protection of staff from retaliation for reporting wrongdoing
- Administration of declarations of interest for staff and external experts ∙ Authorization of outside activities
How is the WHO funded?
1. Assessed Contributions
o These are the dues countries pay in order to be a member of the Organization. o The amount each Member State must pay is calculated relative to the country’s wealth and population.
o These contributions have declined, and now account for less than one-fourth of its funding.
2. Voluntary Contributions
o These come from Member States (in addition to their assessed contribution) or from other partners (organisations & individuals)
o They can range from flexible to highly earmarked.
o Top funders include Bill and Melinda Gates (USD 367.7 million), GAVI Vaccine Alliance, World Bank, Rotary International and the European Commission.
WHO and India
- India became a party to the WHO on 12 January 1948.
- Regional Office for South-East Asia is located in New Delhi.
o In 1967 the total number of smallpox cases recorded in India accounted for nearly 65% of all cases in the world. Of these 26,225 cases died, giving a grim picture of the relentless fight that lay ahead.
o In 1967, the WHO launched the Intensified Smallpox Eradication Programme.
o With a coordinated effort by the Indian government with the World Health Organization (WHO), smallpox was eradicated in 1977.
o India began the battle against the disease in response to the WHO’s 1988 Global Polio Eradication Initiative with financial and technical help from the World Bank.
o Polio Campaign-2012: The Indian Government, in partnership with UNICEF, the World Health Organization (WHO), the Bill & Melinda Gates Foundation, Rotary International and the Centers for Disease Control and Prevention contributed to almost universal awareness of the need to vaccinate all children under five against polio.
o As a result of these efforts, India was removed from the list of endemic countries in 2014.
- It has also been instrumental in the country’s transition from hospital-based to community-based care and the resultant increase in health posts and centres focusing on primary care.
- The WHO Country Cooperation Strategy – India (2012-2017) has been jointly developed by the Ministry of Health and Family Welfare (MoH&FW) and the WHO Country Office for India (WCO).
World Health Concerns & WHO
- Air pollution and Climate Change
- Nine out of ten people breathe polluted air every day. In 2019, air pollution is considered by the WHO as the greatest environmental risk to health.
- Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain, killing 7 million people prematurely every year from diseases such as cancer, stroke, heart and lung disease.
- The primary cause of air pollution (burning fossil fuels) is also a major contributor to climate change, which impacts people’s health in different ways.
- Between 2030 and 2050, climate change is expected to cause 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress.
- Noncommunicable Diseases
- Noncommunicable diseases, such as diabetes, cancer and heart disease, are collectively responsible for over 70% of all deaths worldwide, or 41 million people.
- The rise of these diseases has been driven by five major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution.
- These risk factors also exacerbate mental health issues. The suicide is the second leading cause of death among 15-19 year-olds.
- Global Influenza Pandemic
- The WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic strains: 153 institutions in 114 countries are involved in global surveillance and response.
- Fragile and Vulnerable Settings
- More than 1.6 billion people (22% of the global population) live in places where protracted crises (through a combination of challenges such as drought, famine, conflict, and population displacement) and weak health services leave them without access to basic care.
- Antimicrobial Resistance
- It is the ability of bacteria, parasites, viruses and fungi to resist modern medicines which threaten to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis.
- The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy.
In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin – the most effective first-line drugs – and 82% of these people had multidrug-resistant tuberculosis.
- Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment.
- WHO is working with these sectors to implement a global action plan to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.
- Ebola and Other High-Threat Pathogens
- In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which spread to cities of more than 1 million people. One of the affected provinces is also in an active conflict zone.
- WHO’s R&D Blueprint identifies diseases and pathogens that have the potential to cause a public health emergency but lack effective treatments and vaccines.
- This watchlist for priority research and development includes Ebola, several other hemorrhagic fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents the need to prepare for an unknown pathogen that could cause a serious epidemic.
- Weak Primary Health Care
- Primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life.
- Yet many countries do not have adequate primary health care facilities. This neglect may be a lack of resources in low- or middle-income countries, but possibly also a focus in the past few decades on single disease programmes.
. Vaccine Hesitancy
- It is the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases.
- Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy.
- However, some countries that were close to eliminating the disease have seen a resurgence.
- The WHO has identified complacency, inconvenience in accessing vaccines, and lack of confidence as key reasons underlying hesitancy.
- It is a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to 20% of those with severe dengue, has been a growing threat for decades.
- A high number of cases occur in the rainy seasons of countries such as Bangladesh and India.
- Now, the dengue season in these countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in almost two decades), and the disease is spreading to less tropical and more temperate countries such as Nepal, that have not traditionally seen the disease.
- WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.
- The progress made against HIV has been enormous in terms of getting people tested, providing them with antiretrovirals (22 million are on treatment), and providing access to preventive measures such as pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to prevent infection).
- Today, around 37 million worldwide live with HIV.
- Reaching people like sex workers, people in prison, men who have sex with men, or transgender people is hugely challenging. Often these groups are excluded from health services.
- A group increasingly affected by HIV are young girls and women (aged 15–24), who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa despite being only 10% of the population.
- The WHO is working with countries to support the introduction of self-testing so that more people living with HIV know their status and can receive treatment (or preventive measures in the case of a negative test result).
WHOs' Organisational Challenges
- The WHO has been dependent on donor funds – mainly from rich countries and foundations like the Bill and Melinda Gates Foundation – rather than through secured funding from countries.
o As a result, currently 80% of WHO’s funding is tied to programs that donors choose. Work programs that are vital to WHO’s mandate remain under-funded as they clash with the interests of big donors, especially of rich and developed countries.
o Consequently WHO’s role as a leader in global health has been supplanted by other intergovernmental bodies such as the World Bank, and increasingly by big foundations.
o The organisation’s efficacy has come under question, especially after its inadequate performance in containing West Africa’s Ebola epidemic of 2014. o It was because of WHO's insufficient funding, structuring, staffing and bureaucracy.
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