PHA-Exchange> What's next for WHO?

[ghassan shahrour]

Dear Colleagues PHM members,

What's next for WHO? by Anders Nordstr?m was publishe at 
The Lancet 2006; 368:177-179 on July 15, 2006

Hope you find this article interesting
Regards
Ghassan Shahrour, MD

Al-Yarmouk

Damascus Syria

yarmouk at medinews.com



What's next for WHO? 

The unexpected and shocking death of Lee Jong-wook, Director-General of WHO, on May 22, the first morning of the Fifty-ninth World Health Assembly, placed WHO in the unprecedented situation of being without its leader at a peak decision-making season.

Where does Dr Lee's death leave WHO? Remarkably, WHO has not been incapacitated, although his loss continues to be deeply felt. The organisation has maintained momentum in part because of his management style, which strategically devolved responsibility, and also because of a change in the way in which WHO is finding solutions to global health problems. In the past, there was sometimes a conceptual divide between the adoption of a resolution by the governing bodies as a generally good principle and the more painful realisation of it in practice in countries. The watershed came with tobacco control. The process to arrive at the WHO Framework Convention on Tobacco Control was slow and difficult, fraught with legal complexities, and detailed negotiations over texts. But the end product is a powerful instrument that is already proving useful to Member States in enforcing a rigorous, internationally supported approach to improving health.

The rapid and destructive spread of H5N1 avian influenza throughout the world, and its related threats to human health, have similarly triggered direct engagement in the voluntary early implementation of the revised International Health Regulations (2005).1 The significance of this agreement to early compliance goes beyond the practical implications for improving surveillance and early warning systems, essential though those are. The added value is that it represents a real energy and drive to build the necessary capacity in countries.

The reforms introduced by Dr Lee have given WHO greater credibility, accountability, and purpose. Those directions are most clearly shown in his 10-year global health agenda, Engaging for Health, for WHO, its Member States, and partners. This vision for the future was adopted by the World Health Assembly only days after Dr Lee's death.2 Drafted, negotiated, and consulted on for more than a year, this overarching framework has evolved substantially. The framework includes a new focus, for example, on health and security, universal coverage, health-related human rights, determinants of health, and strengthening health systems.

Over the past few years we have been building a platform of agreed positions, based on good science, global health priorities, and political realism. Simultaneously we have been refining the secretariat of WHO as a useful mechanism through which to support programme and policy implementation in countries.

Preparedness is vital—and not just for the advent of pandemic influenza, although that is a pressing responsibility. We also have a long-term responsibility to support countries' health systems to advance to the point where they are more or less self-sufficient, maintaining the flexibility to respond where we are needed.

Dr Lee wrote: “Natural disasters—whether climatic, seismic or infectious—illustrate how quickly situations can change and how precarious health can be. We have to plan for this unpredictability.”3 Countries have seen us respond quickly and effectively to unexpected public-health events and emergencies of all sorts. In this response we are supported by modern communications resources, a massive oncall network of skilled medical and scientific experts, through mechanisms such as the Global Alert and Response Network, and our partners in non-governmental organisations, civil society, the UN community, and the private sector.

In its most immediate sense, all of WHO's work is to do with building long-term health security in countries. The role of infectious diseases in security is one aspect that WHO will bring to the table at today's G8 meeting in St Petersburg. It is also the topic of next year's World Health Report. There are certain areas, however, where insecurity is particularly critical. Two such areas are the absence of a trained health workforce, and the continuing vulnerability of the health of women and children. These two areas are not easy issues to tackle, but there is momentum to work on them. We are working towards building health security and supporting the essential building blocks of the health workforce. We launched the Health Workforce Alliance during the recent World Health Assembly in May, which will directly help countries to put into practice the 10-year action plan set out in the World Health Report 2006.4

A great deal still needs to be done to improve women's health and wellbeing. Women are being killed, maimed, or physically and mentally debilitated, by disease, by deprivation or malnourishment, and by cultural practices such as female genital mutilation. Rape is considerably more frequent, and much harder to prevent or redress, in populations displaced by war or natural disaster. The worst situation is when pregnancy and childbirth result in death or harm to either mother or child.

Like many of the most difficult problems, achieving change in the right places will result from a combination of approaches, applied to a single end. Unilateral, disconnected efforts—through health, education, financing, environmental change—have not brought the results that we need. The newly launched Partnership on Maternal, Newborn, and Child Health will be an important force for coalition and joint action in this regard.

On June 16 (to continue a series of such meetings), I met with Dr Thorya Obaid, the Executive Director of UNFPA, and her senior staff. We agreed to accelerate action on improving maternal and newborn health. This action includes immediate plans to capitalise on the global strategy for the prevention and control of sexually transmitted infections, approved just weeks before at the World Health Assembly, pilot introduction of vaccination against human papillomavirus, and joint plans for supporting countries in implementing the reproductive health strategy.5,6 Violence against women is being addressed, for example, through a new strategy against sexual violence, and the 2005 multicountry study on domestic violence.7 In the wider field of efforts to ensure equity, health-related human rights, and gender equity in policymaking, WHO is developing a strategy on gender equity.

Immunisation and the range of skills associated with that degree of community outreach remain a cornerstone of our work. It will play an even larger role in future, as new vaccines, such as those against rotavirus and pneumococcal infections, come onstream. Dr Lee was determined to finish poliomyelitis eradication. Poliomyelitis remains endemic in only four countries: Afghanistan, India, Nigeria, and Pakistan. We are committed to his ideal. In this effort we rely on the continued support of the international community. We are working urgently to capitalise on the excellent infrastructure and resources of the poliomyelitis staff network (which spans some 50 countries) to support surveillance and reporting on avian and pandemic influenza as well as on other infectious diseases. The vaccine delivery systems are already successfully bringing other antigens and life-saving interventions to communities, such as vitamin A supplementation, anthelminthics, and insecticide-treated bednets.8

The 2004 Global Strategy on Diet, Physical Activity and Health, followed by the launch last October of the global report on chronic disease, clearly articulated the action needed to tackle the major risk factors for non-communicable diseases and other causes of illhealth.9,10 “If these determinants are to be dealt with effectively, the boundaries of public health have to change.”3 The Commission on the Social Determinants of Health launched a year ago is further building the case for strong collaborative action in this area.

Meanwhile, growing numbers of people are going on long-term treatment, and not only for diseases such as cancers, stroke, cardiovascular disease, and diabetes. AIDS is also a chronic condition. The issue of access to drugs was vitally important to Dr Lee. Although the 3 by 5 numerical targets were not met, the initiative's longer-term aim of universal access is being addressed now through WHO's new 5-year strategy that emphasises the essential continuum between prevention, treatment, and care. I will draw attention at G8 to the urgency of continued support to work on HIV, and also promote this strategy at the XVI International AIDS Conference in Toronto.

Over the past 3 years, we have been working to clarify what resources and skills WHO needs (and does not need) to carry out its mandate. Those decisions reflect a continuing evolution in WHO. They depend on what our core functions are, and a forecast of the future challenges and opportunities: the global health agenda. WHO's roles and functions are redefined in this agenda, and the related management reforms and programme budgets take them forward. The repeated themes are of increased accountability, and of adjustment to a functional shape and structure that allows us to work best, providing the right kind of resources promptly. This is work that is relevant beyond WHO, and which we are sharing with others in the UN system to support reform.

In the successful completion of the Health Assembly's agenda, and the flood of messages and support from all sides that followed Dr Lee's death, the central theme was one of commitment to sustain progress and to deliver. This Health Assembly was a meeting that pressed on with its agenda, and worked out solutions, even when they were on subjects as contentious as intellectual property rights.

The position of Director-General is similarly complex, allowing for a range of decisions that are personal, political, and corporate. That is why it matters very much indeed who the next incumbent will be. We will soon know. As a result of the Executive Board's negotiations, Member States agreed on a process to accelerate the consideration of candidatures, and the election of the new Director-General will be completed on Nov 9, 2006. In one sense, the question of where we are heading is amply answered by looking at the mandates given by our Member States.

This is a fascinating and crucial time for WHO. We have been given the green light on so many issues of pressing public-health significance by our Member States—our constituency. We know that we have their support and motivation to put those plans into action, and we intend to do just that. With my team, I am dedicated to continuing the directions set by Lee Jong-wook, and also to give our full support to the new Director-General so that WHO can go on to play an even more active role in world health.

I declare that I have no conflict of interest.

References
1. WHO. Application of the international health regulations. 2005: 
http://www.who.int/gb/ebwha/pdf_files/WHA59/WHA59_2-en....
(accessed July 3, 2006). 

2. World Health Assembly. Eleventh general programme of work 2006–2015: resolution. May 27, 2006: 
http://www.who.int/gb/ebwha/pdf_files/WHA59/A59_R4-en.p...
(accessed July 3, 2006). 

3. WHO. Eleventh general programme of work 2006–2015: foreword. April 24, 2006: 
http://www.who.int/gb/ebwha/pdf_files/WHA59/A59_25-en.p...
(accessed July 3, 2006). 

4. WHO. The world health report 2006: working together for health. 2006: 
http://www.who.int/entity/whr/2006/en/index.html
(accessed July 3, 2006). 

5. WHO. Prevention and control of sexually transmitted infections: draft global strategy. May 18, 2006: 
http://www.who.int/gb/ebwha/pdf_files/WHA59/A59_11-en.p...
(accessed July 3, 2006). 

6. WHO. Reproductive health. April 15, 2004: 
http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_13-en.p...
(accessed July 3, 2006). 

7. WHO. Multi-country study on women's health and domestic violence: initial results on prevalence, health outcomes and women's responses. 2005: 
http://www.who.int/entity/gender/violence/who_multicoun...
(accessed July 3, 2006). 

8. Global Polio Eradication Initiative. Global polio eradication initiative: annual report. May, 2006: 
http://www.polioeradication.org/content/publications/An...
(accessed July 3, 2006). 

9. WHO. Resolution WHA 57/9: global strategy on diet, physical activity and health. April 17, 2004: 
http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_9-en.pd...
(accessed July 3, 2006). 

10. WHO. Preventing chronic diseases: a vital investment: WHO global report. 2005: 
http://www.who.int/chp/chronic_disease_report/en/
(accessed July 3, 2006). 



This Free Full Text at:

http://www.thelancet.com/journals/lancet/article/PIIS0140673606690144/fulltext
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