New directions for WHO?

Abstract

Since its inception over 50 years ago, the World Health Organization (WHO) has earned trust and respect globally for its achievements as the lead agency for directing and coordinating international health work. Through technical cooperation and policy guidance, it promotes and coordinates international efforts to control major infectious diseases. The global eradication of smallpox and the imminent elimination of poliomyelitis are outstanding examples of its successful programmes. Less dramatic but also of great value are the Organization's activities in setting standards for vaccines and other biomedical products, and helping to define optimal strategies for disease control in various settings. In spite of significant gains in classical areas of disease control, however, some of the common infectious diseases still plague many developing countries. Furthermore, there is the constant threat of the emergence of new infections like HIV/AIDS and the recrudescence of old ones such as tuberculosis, not to mention the new danger that smallpox and other infectious agents could be used as weapons of biological warfare or terrorism. As the traditional health problems decline, WHO is taking on the growing challenge of chronic diseases--cancers, cardiovascular diseases, diabetes, etc.--which have become increasingly prominent causes of morbidity and mortality. WHO also makes significant contributions to the strengthening of health services. The Alma-Ata Conference in 1978, cosponsored with the United Nations Children's Fund (UNICEF), generated a global consensus about primary health care as the key to health development, establishing the principle of equity as a requirement of social justice and the ethical basis of health systems. In collaboration with other development partners, WHO helps governments to improve their health services. It contributed to the analysis that led to the publication of the World Development Report in 1993, in which the World Bank raised a number of issues about health policy and planning with particular reference to cost-effectiveness and value for money. Following up the report, WHO has been refining methods for measuring the burden of disease and making financial analyses, using national health accounts. These new methods now feature in the process of health reform that many nations are currently undertaking with WHO's support. Where will the Organization go from here? It already has a full agenda, straining its limited resources, but it cannot ignore new, pressing challenges to global health. WHO will need to continue to play its role in technical cooperation for the control of specific diseases as well as providing guidance on the development and reform of health systems. The World Health Report (WHR) for 2000 clearly marks a new departure for the Organization. Going beyond the theoretical analysis of health and disease, the report confronted the controversial issue of the performance of national health systems. Using a combination of eight measures, it ranked countries on the basis of the attainment and performance of their health services. The publication generated fierce controversies, with critics challenging WHO on two main counts. Some questioned the quality of the data and the analytical methods on which WHO based its conclusions. …