A World Health Organization Primer

Srimathy Vijayan, MS IV

Disclosures
In This Article

Organizational Structure and Employees

WHO, like many other international organizations, has a somewhat complex organizational structure. The headquarters is based in Geneva, Switzerland, and there are 6 regional offices located around the world and 147 individual country offices. The importance of this structure lies in the fact that the regional offices can focus on health matters that are of concern in their particular region and can act as a liaison with their local country offices to further develop and implement policies. In contrast, the headquarters is concerned with more general matters that are likely to affect all parts of the world.

WHO's structure has also been stated as one of the most decentralized organizations within the UN agencies.[4] The need for effective communication between headquarters and the regional and country offices is therefore imperative. WHO is currently undertaking a new program to ensure that it can flourish despite its decentralized structure, by initiating a global management system.[5]

Scattered among these various offices are more than 8000 public health experts including doctors, epidemiologists, scientists, managers, and administrators,[3] who play a pivotal role in helping achieve WHO's mandate.

Headquarters

The WHO headquarters in Geneva has a staff of 1800 workers. Within headquarters, the staff is divided to make up different teams. Each team works on a specific program or project for WHO. More information regarding all the programs and projects WHO is currently undertaking can be found at http://www.who.int/entity/en/. The team can be as small as 3 members or as large as 20, depending on the amount of work conducted within a particular program or project, and of course, depending on funding. Several teams make up a particular department, and a departmental director is responsible for the overall functioning of the department. At the top of the pyramid are clusters to which several departments report directly. For example, the substance abuse program is part of the mental health department, which in turn is in the non-communicable diseases and mental health cluster. This cluster itself has an overall head with the title Assistant Director-General. For persons who work within WHO, this hierarchy appears essential and ingrained, but to an outsider, the organizational structure can sometimes seem unnecessarily complicated.

The Regional Offices

Each regional office is considered a separate functional unit of WHO. Each office has a regional committee made up of delegates from the ministries of health of that region's member states. The regional offices work primarily on their region's agenda, which in turn is decided by the regional committee, which meets annually. The committee is also responsible for reviewing progress of such agendas, and every 5 years it elects a regional director. However, there are some examples of how regional offices integrate the work being done at the global level at headquarters. For example, WHO assists regions and member states to formulate policies that are coordinated with WHO's overall constitution, ensuring that all the offices are working toward the same goal.

Additionally, most member states have a WHO country representative (or a liaison) responsible for close coordination of WHO activities with the ministry of health in the respective member state. In this capacity, WHO country representatives bridge the gap between the regional offices and the national health ministry within member states, and thus they advise and support the ministry in planning and managing health programs.

The regional offices are pivotal in public health monitoring. They provide a range of health indicators collected by individual countries, contributing to the WHO database of global health statistics. From the viewpoint of member countries, the regional offices are intended as a resource bank, providing information to health professionals and technical support to governments.

The Working Agenda

Another important question is how WHO becomes informed about current public health challenges and how the organization prioritizes among competing health-related concerns, given the temporal and fiscal constraints of member states. It is essential that WHO be judicious as well as realistic. This ultimately means some agendas will be given priority over others, and some member states will not necessarily be satisfied. For a public health concern to be discussed as part of the agenda of the WHA, the relevant team, whether it is from a regional office or from headquarters, must submit a provisional agenda to the WHA executive board. This agenda is discussed before the meeting by the board and considered for further discussion at the upcoming WHA. If the board decides that there should be further discussion, it facilitates discussion among the delegates at the WHA about whether further action, study, investigation, or a report may be required. Consequently, those agendas that are valid and evidence-based, as well as pressing and therefore important to WHO's mandate, will be adopted as resolutions. Resolutions form the working agenda for WHO and are subsequently reviewed in future executive board meetings and WHA. For a full list of the most recent resolutions adopted by WHO, please refer to http://www.who.int/gb/e/index.html.

The Director-General

Another task of the WHA is to appoint the Director-General, who heads the organization. Candidates for the Director-General position are nominated by the executive board and elected by delegates at the WHA. Currently the Director-General of WHO is Dr. Margaret Chan, who was appointed November 9, 2006. Dr. Chan was formerly the Assistant Director-General for Communicable Diseases and Representative of the Director-General for Pandemic Influenza. In her acceptance speech, Dr. Chan made it clear that her priorities for WHO are the health of people in Africa and the health of women. She further emphasized that the impact of WHO must be judged by the work it conducts for these 2 groups of people because attention must be paid to people with the greatest need.[6]

Furthermore, WHO has developed a WHO 6-point agenda to improve public health. The 6 points are as follows:

  1. Promoting development;

  2. Fostering health security;

  3. Strengthening health systems;

  4. Harnessing research, information and evidence;

  5. Enhancing partnerships; and

  6. Improving performance.

This takes into account the increasing extension of international public health into other sectors such as trade and also considers the development of new players in international health such as nongovernmental organizations and transnational corporations.[7]

How is WHO Funded?

WHO is a member-led organization; therefore, a proportion of the funding it receives is from its member states. The WHA approves the budget and divides it into 4 interdependent categories:

  1. Essential health interventions;

  2. Health systems, policies, and products;

  3. Determinants of heath; and

  4. Effective support for member states.

It is then further divided for the regional offices to reflect the needs of the areas. Aid is allocated so that those regions that require more aid receive a greater proportion of the budget.

The total WHO budget approved by the WHA for the biennium 2006 through 2007 was US $3.3 billion. Member states provided 28% of the funding, with the remaining 72% coming from a diverse range of voluntary contributors such as other UN organizations, foundations, and the private sector.[8]

Beginning with the biennium 2008 through 2009, a 6-year strategic plan otherwise known as the "medium-term strategic plan 2008-2013" will be implemented. The strategic plan puts forward 13 objectives, more of which can be found at http://www.who.int/gb/e/e_amtsp.html. The aim of this is to provide a program structure that better reflects the needs of countries and regions, facilitating more effective coordination and collaboration across the organization.[9] The strategic plan and its first program budget for 2008 through 2009 were adopted by the WHA in May 2007. The proposed budget for the biennium 2008 through 2009 is US $4.227 billion, which is said to reflect the increased demands being placed on the organization. This money is meant to address several specific areas in the strategic objectives that are seen as emerging health problems and have been expressed as individual concerns of member states. These include the following[10]:

  • Reducing maternal and child mortality by aiming at universal access to, and coverage with, effective interventions as well as strengthening health services;

  • Addressing the epidemic of chronic noncommunicable diseases, with an emphasis on measures to reduce risk factors such as tobacco consumption, poor diet, and physical inactivity;

  • Implementing the International Health Regulations (2005) to respond rapidly to outbreaks of known and new diseases and emergencies, building on eradication of poliomyelitis to develop an effective surveillance and response infrastructure;

  • Improving health systems, focusing on human resources, financing, and health information; and

  • Improving the performance of WHO through more efficient ways of working and building and managing partnerships to achieve the best results in countries.

The Millennium Development Goals

One of the key priority areas that has received great media attention is the Millennium Development Goals (MDGs). These goals have also been adopted by many other UN organizations who have agreed to collaborate with WHO to ensure they are met. In September 2000, the largest-ever gathering of heads of states, including those from 189 countries, endorsed and adopted the UN Millennium Development declaration, which set out a series of goals to be met by 2015.[11] Eight goals in the section on development and poverty eradication are known as the MDGs and are focused on health.

There has been criticism of the goals and their ambition.[12] Nevertheless, there should also be praise for bringing all of these goals to the attention of the international community with the intention of working toward achieving such goals. WHO and the other participants continually assess the extent to which the goals are being met.[13] Thus far, data suggest positive results, although the final outcome is to be determined.

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