Crash Course: So, how does the WHO work?

This is a complicated question, but if I’ve begun to understand anything during my internship at the World Health Organization’s HQ here in Geneva, the inner-workings of the organization itself have been a useful (if not essential) addition to the list. Read on for the run-down!

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Photo Courtesy of the WHO

But first, a quick inside look at the WHO’s SHOC (Strategic Health Operations Center) room where we were lucky enough to sit for a seminar. Essentially, it’s the nerve center for the WHO’s crisis management operations where teams receive and respond to information coming in from all corners of the world during emergencies (think anything from the recent Ebola outbreak in West Africa to the 2009 H1N1 pandemic). It comes complete with a mega-screen and computers that appear with the press of a button Air Force One-style (sadly, they only let us take pictures when everything had been turned off, but you get the idea).

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The Anatomy of the WHO (Fast Facts)

  • the World Health Organization is one of 15 specialized agencies of the United Nations (others include the World Trade Organization (WTO), the World Intellectual Property Organization (WIPO), etc.)
  • it is officially designated as “the directing and coordinating authority on international health within the United Nations’ system”
  • it was founded in 1948 (the constitution was ratified on April 7 of that year, a day which is now celebrated as World Health Day)
  • was preceded by similarly minded organizations including the Pan American Sanitary Organization, the Office International d’Hygiene Publique, and the Health Organization of the League of Nations (which preceded the United Nations itself)

Who makes up the WHO?

The WHO has 194 member states. This is a member states organization, first and foremost (i.e. an organization for and by its constituent country representatives). From these member states, 34 individuals are elected by the World Health Assembly to serve on the Executive Board for a 3-year term (the Executive Board meets twice yearly).

The organization has 6 regional offices and 150 country offices. Notably, only about 20% of WHO staff work at the Headquarters n Geneva–the majority of staff members are thus scattered around the world.

Who pays for the WHO?

Ah, the million dollar question. The WHO’s budget consists of 3 main components. First is core funding which comes from what we me might call “dues” that are paid by member states. Surprisingly, though, this only makes up 23% of the WHO’s budget. This is important considering that the attention usually goes where the money flows. And where exactly does the majority of that money flow from? About 80% of the WHO’s funds comes from voluntary contributions from donors such as the Rockefeller Foundation and the Bill & Melinda Gates Foundation (a particularly big donor) and are often earmarked for specific programmes and initiatives. The last component comes from private sector funding (individual checks and in-kind donations, for example) though this only makes up about 1% of the budget and tends to be geared towards neglected tropic diseases.

Still, the big take-away: most of the WHO’s departments remain underfunded.

What does the WHO actually do?

Despite being a global authority on public health issues, it’s important to realize that the WHO doesn’t actually have that much power. Remember, it’s a neutral organization and even though it can make recommendations, it has no powers of enforcement. Ultimately that is left up to individual state governments. The WHO has a few main areas of focus currently: health security (e.g. response to public health emergencies), Noncommunicable Diseases (NCDs) which constitute the majority of the global disease burden, healthy life course (ensuring healthy development from birth to death), and health systems.

What are some major accomplishments to which the WHO has contributed?

  • eradication of smallpox in 1979 (the first and so far only major infectious disease to be eradicated)
  • The WHO has used Article 19 of its Constitution (power to produce a legally binding document) a grand total of 3 times in its history:
    • creation of the International Classification of Diseases (ICD), a diagnostic tool that is used to assess population health and the prevalence of diseases and other health problems
    • creation of the International Health Regulations (IHR), a tool that countries use to help identify and stop disease outbreaks
    • creation of the WHO Framework Convention on Tobacco Control (FCTC)–this was considered a landmark achievement as it was the first legally binding  global public health treaty passed and has the aim of reducing tobacco usage worldwide. Notably, the United States and Switzerland are among the 18 UN member states that have either not signed or ratified the Convention.

What are the biggest issues on the agenda today?

  • Antimicrobial Resistance (AMR). I’ve heard this called the “greatest global health threat of our time.” With antibiotic and microbial resistance rapidly rising and too little investment in new drug development, we are threatened by a future in which our medicines no longer work and the diseases we thought we’d cured come back with a vengeance
  • Universal Health Coverage (UHC). This was declared to be a top priority in 2005 by WHO member states, and efforts continue towards achieving it. Not to be confused with universal insurance coverage, UHC refers to the goal of ensuring that all people have access to health services and can receive them without suffering financial hardship. The WHO hopes to help countries develop their health financing systems in order to achieve this
  • Polio. Polio was declared a “public health emergency” by the WHO in April 2014 and a new report called the Endgame Strategy has been launched to help coordinate the international response (though polio today is mainly endemic in 3 main countries– Nigeria, Afghanistan and Pakistan). If this goal is achieved, polio would be the second disease to be fully “eradicated” since smallpox.

Why should I care?

The WHO isn’t perfect. With the majority of WHO staff members working in offices around the world, strengthening individual country health systems is the best way to make the work of the WHO as an international coordinating body more effective. While those dedicated to efficiency might be frustrated by the towering hierarchy of an organization like the WHO, it’s important to keep in mind that although this is a technical organization, it is still ultimately responsible to its member states. Everyone gets a seat at the table. This work is about health, politics and national security. Our biggest responsibility is to participate.

 

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