Headquarters In Geneva Research Articles

At the Roots of The World Health Organization's Challenges: Politics and Regionalization.

The World Health Organization's (WHO's) leadership challenges can be traced to its first decades of existence. Central to its governance and practice is regionalization: the division of its member countries into regions, each representing 1 geographical or cultural area. The particular composition of each region has varied over time-reflecting political divisions and especially decolonization. Currently, the 194 member countries belong to 6 regions: the Americas (35 countries), Europe (53 countries), the Eastern Mediterranean (21 countries), South-East Asia (11 countries), the Western Pacific (27 countries), and Africa (47 countries). The regions have considerable autonomy with their own leadership, budget, and priorities. This regional organization has been controversial since its beginnings in the first days of WHO, when representatives of the European countries believed that each country should have a direct relationship with the headquarters in Geneva, Switzerland, whereas others (especially the United States) argued in favor of the regionalization plan. Over time, regional directors have inevitably challenged the WHO directors-general over their degree of autonomy, responsibilities and duties, budgets, and national composition; similar tensions have occurred within regions. This article traces the historical roots of these challenges.

Editorial introductions

Editorial introductions

International Partnership for Therapeutic Drug Development of NTDs by DNDi

The Drugs for Neglected Diseases initiative (DNDi), with headquarters in Geneva, is a non-profit drug research and development (R&D) organization and Product Development Partnership (PDP) which was established in 2003 by 7 founding organizations such as Médecins Sans Frontières (MSF), the Pasteur Institute, The Specific Programme for Research and Training in Tropical Diseases (WHO-TDR), etc. DNDi has worked mainly on the development of new treatments for neglected tropical diseases (NTDs), which is difficult to achieve under market economy conditions. DNDi has promoted overall drug discovery research including the screening of drug candidates, hit to lead, lead optimization, pre-clinical and clinical studies in the area of infectious diseases with a focus on malaria, sleeping sickness (human African trypanosomiasis; HAT), Chagas disease, leishmaniasis, filarial diseases and pediatric formulations for HIV treatment. DNDi's achievements include the development of novel therapies based on patient needs through innovative partnerships with over 130 organizations in industry, government, academia, and public institutions around the world. To date, DNDi has registered 6 novel treatments adapted to the needs of patients in poor countries, and has another 12 novel entities in development. DNDi Japan is a Japanese non-profit organization (NPO) based on the global principles of DNDi and, as the only PDP in Japan, is supporting NTD drug discovery projects in collaboration with Japanese pharmaceutical companies, academic institutions and government agencies by utilizing Japan's excellent R&D capabilities to develop new treatments for NTDs in order to contribute to global health.

Global Public Health: A Review and Discussion of the Concepts, Principles and Roles of Global Public Health in Today's Society

AbstractGlobal public health as a concept needs examination. Given that the use of the term has become so common, across such broad topics, it is worthwhile to take stock, review and evaluate how it is being used. In an ever‐changing and increasingly globalised context, how should global public health be understood and how should it adapt?We conducted a literature review of articles between 1990 and 2014 that included the phrase ‘global public health’ in the title and/or abstract. Using these articles and some specifically selected influential articles from outside the search parameters we found that the articles rarely engage with political factors impacting on health, instead focusing on disease‐specific challenges or technical issues.This article seeks to contribute to a wider study and discussion on the role of global public health in today's global setting, conducted by the World Federation of Public Health Associations (WFPHA) in collaboration with the World Health Organization (WHO) headquarters in Geneva.

In Memoriam: Hanneke De Boer (1946-2015).

In Memoriam: Hanneke De Boer (1946-2015).

Offline: “Our systems simply couldn't cope”

Offline: “Our systems simply couldn't cope”

Offline: Delivering a new future for Africa

Post-Ebola, commentators have been given permission to say in public what they have thought in private for a long time—namely, that WHO's Regional Office for Africa (AFRO) has a record and reputation for failure second to none in global health today. In advance of an unprecedented meeting convened by the new Regional Director for WHO AFRO, Dr Matshidiso Moeti, earlier this month, I asked a group of Africa health experts for their views on WHO's work on the continent. WHO AFRO does have strengths. Most importantly of all, its country offices. Africa has one of the fastest growing collections of national economies in the world today. It has progressively expanding scientific capacities. Yet for all of these advantages, WHO AFRO is not well respected. Its performance has been a persistent disappointment. It can claim no important or substantive wins from its work. It is seen as a large bureaucracy with little impact. There has been no effective leadership for decades. Staff are “decent but unambitious”, and are therefore not respected for their competency. One disadvantage is the location of the Regional Office in Brazzaville, Congo. It is isolated, distant, and remote, characteristics that are said to be true of the entire organisation. WHO AFRO needs to be brutally honest with itself, our advisers suggested. A poor history of Regional Directors. A low talent pool across the organisation. Corrupt appointments made as rewards for past service, instead of on merit. Donor voices that dominate because there is no clear strategy from WHO AFRO's leadership. And basic public health functions in countries that have been ignored or neglected. To worsen WHO AFRO's influence still further, the Regional Office has a poor relationship with WHO's headquarters in Geneva. WHO AFRO has the largest regular budget of any WHO region, but there is little or no accountability about how its funds are spent. The prospects for WHO AFRO are bleak: an accelerating brain drain, declining self-determination as a continent, and a chronic erosion of trust and confidence. Yet for all of these dismal weaknesses, the country devastation and institutional crises precipitated by Ebola have created a remarkable opportunity—to lead change, and to promote transparency and accountability, around a clear set of new priorities for Africa. Does such a vision suggest a rationally optimistic outlook or simplistic radical naivety? There is one reason to be hopeful: a new Regional Director for WHO AFRO, Dr Moeti, who is motivated for change. She wants to strengthen health and economic security in Africa, and she intends to deliver on the promise of the Sustainable Development Goals for the continent. She knows that her first priority must be to re-establish confidence in WHO AFRO among key partners, especially those who might consider investing in WHO's work. One decision shows her commitment to working differently. She has appointed an Independent Advisory Group, chaired by Francis Omaswa and Helene Gayle, to give her strategic advice on WHO AFRO and “on mechanisms to support improved health systems performance of Member States towards better health outcomes”. The group met for the first time earlier this month in Johannesburg (full disclosure: I am one of 16 members). Two important strands of work emerged. First, to embark on ambitious internal reforms, changing the culture of WHO AFRO to one of accountability for results and resources. Second, to implement a 10-year African Health Transformation Programme. One aim of this initiative is to deliver universal health coverage across 47 countries. Dr Moeti and her Advisory Group want to make Africa a destination for leadership in health. The Lancet will make its contribution to this vision through our Commission on the Future of Health in Sub-Saharan Africa. This Commission, chaired by Peter Piot, includes leading African voices on health and medical science. Last week in London, Tumani Corrah, Peter Lamptey, Nelson Sewankambo, Alex Ezeh, Bongani Mayosi, Bright Simons, and Nduku Kilonzo met with Peter Piot and others to consider what they could do to add value to existing efforts to scale up action on health in Africa. The Commission will complete its work this year, and we plan to launch its findings early in 2016. The next few years will be decisive for Africa. There is also every prospect that a new Director-General of WHO, succeeding Margaret Chan in July, 2017, will come from the continent. Now is therefore not the time for armchair criticism of WHO AFRO or African efforts to advance health on the continent. Now is a moment to join hands and get to work for Africa.

Perspectives of a Nigerian former WHO-HQ intern.

Data shows member state diversity of WHO interns is highly skewed towards a few high income countries. In this opinion piece I outline the experience faced by an aspiring Nigerian intern seeking to undertake a placement at the World Health Organization Headquarters in Geneva. I describe the financial challenges faced, efforts to overcome them, and the impact of the internship on my professional career. This article serves as an illustration of the barriers to wider access to unpaid internships. Moreover, it signposts to initiatives actively seeking to address these barriers.

David Evans: putting universal health coverage on the agenda

David Evans: putting universal health coverage on the agenda

Quality of care and midwifery services to meet the needs of women and newborns.

Quality of care and midwifery services to meet the needs of women and newborns.

Fighting the War or Preparing for Peace? The ILO during the Second World War

Fighting the War or Preparing for Peace? The ILO during the Second World War During the Second World War the ILO stood for an alternative, democratic internationalism in response to Nazi international/European plans. The ILO was able to serve as an international platform and was directly involved in the Allied war effort. Moreover, examining the ILO allows us to better understand the multi-layered processes and rationales that brought about a shift in the political and social balance of power during the Second World War. After the ILO moved to Montreal in May 1940, the handful of French functionaries guarding the organisation's deserted headquarters in Geneva could only look on helplessly as the reformist labour movement, together with the vision of a social Europe that it promoted, was defeated. Meanwhile, on the campus of McGill University in Montreal, the ILO underwent a twofold transformation in exile. Dependent on British and North American funding and staff, it became the champion of the pragmatic solutions to social issues implemented in those countries. Through its work for the United Nations alliance it expanded its activities in the fields of expertise and technical assistance, to the detriment of its work in setting international labour standards. While it had been founded in 1919 to protect workers and to provide an international platform for the reformist workers movement, the ILO emerged from the war as an organisation focusing increasingly on providing economic and social expertise.

Through the eyes of a detention doctor: Interview with Raed Aburabi

Dr Raed Aburabi has been working for the International Committee of the Red Cross (ICRC) for twenty years. He is currently in charge of the health in detention unit at the ICRC's Headquarters in Geneva. As part of his work, he visits countries in which the ICRC operates in order to develop a dialogue with the detaining authorities on improving health services and conditions in places of detention.

The British Left in the Problems of Peace Lectures, 1926–38: Diversity that E.H. Carr Ignored

The proceedings of the Problems of Peace conferences held annually at the League of Nations headquarters in Geneva from 1926 to 1938 included lectures from an array of ideological positions. Some contributors were from the Left, ranging from moderate liberal socialists to the more firmly anti-capitalist thinkers. Those of the latter category presented challenges to the existing international order, holding views that bore some affinities to E.H. Carr's beliefs. They were, however, unlike Carr, committed to liberal-democratic processes as a means to change. Nevertheless, in the turbulent environment of the inter-war years optimism gave way to anxiety among many on the Left. A wider division between the moderate and more radical British democratic socialists emerged. Some thinkers repositioned themselves within the broader Left. These different positions and shifts are evident in the Problems of Peace lectures, and this helps expose the limitations of Carr's binary utopianism/realism division of inter-war international thought. A weakness of the socialists in question is that the demands for change are conventional and thus undeveloped where the real have-not peoples of the empires are concerned. Nevertheless, by ignoring the lectures Carr neglected diversity and innovation in the internationalism of the British inter-war Left.

Save the WHO Program for Hearing Loss Prevention

Save the WHO Program for Hearing Loss Prevention

Caza de focas en la OMC: Bienestar animal y moralidad pública en debate

Long evaded, the question of animal welfare makes its entry to the World Trade Organization (WTO). The recent seal hunt debate creates the break with the eviction tradition of this question through the protection of public morality. The issue of this debate is the following: Is the Community regulation on products derived from seals in conformity with WTO law? This question was discussed again on the 29-30 April 2013 at the WTO headquarters in Geneva . On one side, Canada and Norway as complainants. On the other, the European Union (EU) defending the legitimacy of its trade restriction. Adopted in 2009, the EU Seal products regulation came into force in 2010. It consists in prohibiting the importation and marketing of seal products. Theoretically ambitious for animal welfare protection, its exceptions are weakening the moral force of this ban, far from being general. This paper aims to present its main inconsistencies and innovations towards animal welfare consideration through public morality at WTO.

The Public Health Service in the Czech and Slovak Republics Celebrates its 60th Anniversary

Since the Age of Enlightenment, efforts to prevent disease in Europe have traditionally upheld an acceptably good standard. An implicit factor was the charitable attitude of many physicians and health workers as well as the drive to create the organizational and educational background necessary for the principles of primary prevention to be introduced into actual practice. The Institute of Hygiene of the Czech Faculty of Medicine, now known as the Institute of Hygiene and Epidemiology, 1st Faculty of Medicine at Charles University in Prague, was founded in 1 897. An analogical institute at the German Faculty of Medicine in Prague was founded at an earlier date, in 1 884.An important milestone in the development of regional efforts in the field of public health was the establishment of the National Institute of Public Health in 1925. The prominent figures in this process had largely acquired their expertise in the USA; hence a modern school of epidemiology was formed, among its leading lights the eminent Karel Raska, who became the Director of the Division of Communicable Diseases at the WHO Headquarters in Geneva and was one of the authors and managers of the smallpox eradication programme. During the post-war period, leading specialists from Czechoslovakia were trained in epidemiology at the London School of Hygiene and Tropical Medicine, a contact that has remained to this day.Anetwork of regional public health stations, based on the Soviet model, was set up in 1953. This was followed by the founding of Prague's 3rd Faculty of Medicine at Charles University in 1953.These days, what we miss most is an expert critical analysis of the successes, failures or potential errors of the public health service over the past six decades, and to even the score are some examples of the various practical applications of our preventive medicine, specifically in the field of epidemiology.The post-war period involved a campaign against venereal diseases, and decrease in incidence of tuberculosis and, with the much underestimated and close cooperation of the veterinary service, brucellosis.The former Czechoslovakia was the first country worldwide to start mass anti-polio vaccinations in the early 1960's, thus becoming a precedent for other states, and Czechoslovak doctors participated in the first ever eradication of smallpox; neither of these facts were ever fully appreciated both on the national and international level, although the eradication of smallpox as such was a global event that deserved the Nobel Prize Award.In the field of non-infectious diseases, there was an extensive epidemiological study of endemic goitre in the late 1 940's and early 1950's, performed by our clinical endocrinologists. The standards presented therein continue to mirror the relatively strict qualitative criteria of current epidemiological studies and have led to the systematic iodination of salt; likewise, this country was among the first to introduce fluoridation of drinking water to prevent caries, again on the basis of a thorough epidemiological study.Unfortunately, the frequent socio-political changes in this country throughout the last century undeniably disrupted the ongoing system of prevention. Accordingly, the present primary prevention system must adapt to existing social and economic change; much has been achieved, but a backup to the complex structure of existing primary prevention is urgently required.Czech public health is rooted in the German school founded by Max von Pettenkofer and Robert Koch. The Czech school enriched its predecessor with experimental aspects by providing safe drinking water via Kabrhel's Index and, later, through recognition of the pathophysiological factors expounded in the works of Teissinger, who by the mid-1 930's had laid the foundations of present-day biological exposure tests or biomarkers of exposure to environmental toxicants. Several years after the last London smog episode, when the best available health indicator was recorded mortality, Kapalin and Symon were demonstrating adverse environmental effects on growth changes and haematological parameters in exposed children; in this they contributed to the application of more sensitive and sophisticated indicators of health status. …

Against Internationalism

This text is an artwork meditation on the question of what constitutes ‘Indigenous People’ in a world defined by nations, nationalities and states. Across the media these appear to be ‘people who need help’, such as the Ainu in Japan, Aboriginals in Australia, Sami in Scandinavia, Negritos in the Philippines and so on. The author reports on his work in the 1970s at the Human Rights Commission of the UN headquarters in Geneva, where his brief was intended to be a twenty-year project investigating Europe's invasions and colonization of the peoples of North and South America. He concludes that the real ‘world problem’ is not indigenous people but boundaried nations, so often created against stateless peoples, and asks, what if we had a world law against the buying and selling of land; if the earth is the earth and not a commodity?

World Health Organization Global Initiative for Emergency and Essential Surgical Care: 2011 and Beyond

The world's burden of surgical diseases is large and increasing. Unfortunately, <5 % of all surgical procedures are performed in countries ranked within the lowest one-third in terms of per-capita health expenditures [1]. The unmet need for surgical care results in unacceptable morbidity/mortality rates associated with a host of conditions (trauma, pregnancy-related complications, other emergencies). This is especially true for rural and marginalized populations in low- and middle-income countries (LMICs). Recognizing that variations in the spectrum of surgical diseases are observed among and within countries, “essential” surgery and anesthesia may be viewed as a core group of services that can be delivered within the context of universal access. These high-priority interventions are those for which: (1) there is a large public health burden; (2) the treatment is highly successful; (3) the treatment is cost-effective [2]. To date, essential surgery and anesthesia have received minimal financial and political support as public health strategies because of the perception that the services are costly, are resource-intensive, require highly specialized training, and benefit only a fraction of the population relative to competing health interests. Evidence is amassing to refute these claims. The World Health Organization (WHO) Global Initiative for Emergency and Essential Surgical Care (GIEESC) was launched in 2005. It is a global forum whose goal is to promote collaboration among a diverse group of stake-holders (individuals, institutions, societies, universities, ministries of health, other nongovernmental organizations) to strengthen the delivery of surgical services at the primary referral level in LMICs (http://www.who.int.surgery) [3–6]. The inaugural meeting was at WHO headquarters in Geneva, Switzerland in November 2005 [7], and subsequent biennial meetings were hosted by ministries of health in Dar es Salaam, Tanzania in September 2007) [8] and Ulaanbaatar, Mongolia in June 2009) [9]. There are currently more than 624 GIEESC members from 93 countries representing all six WHO regions. In all, 45 % of members are from LMICs. The LMICs with ≥10 GIEESC members are India, Nigeria, Ethiopia, Ghana, and Uganda. The WHO GIEESC members have contributed to a number of activities aimed at strengthening the delivery of essential surgical services in LMICs. One component involved the implementation, local adaptation, and translation of training tools that were developed by the WHO's Emergency and Essential Surgical Care (EESC) project, which was initiated in the Clinical Procedures Unit of the Department of Essential Health Technologies in 2004 [3–6]. These training tools include the WHO Integrated Management of Emergency and Essential Surgical Care (IMSCStoolkit [10] and the Manual of Surgical Care at the District Hospital [11]. These materials have been introduced in 39 countries through collaborations with the respective Ministry of Health (MoH) and WHO country offices. The materials have been translated into Mongolian, Spanish, Chinese, Vietnamese, Korean, Dari, and Farsi. A WHO situational analysis tool to assess the availability of EESC at the level of individual health facilities was developed in 2007. It was based on infrastructure, human resources, procedures, equipment, and supplies [12]. This questionnaire has now been utilized in more than 35 countries, and the data collected and entered in the WHO EESC Global Database has been published to highlight gross deficiencies in the availability of EESC [13–22]. The WHO EESC Global Database was created to facilitate data entry from different countries. The situational analysis tool has been integrated into the WHO's Service Availability Mapping (SAM) technology [23] with the goal of facilitating monitoring the availability of surgical services at the facilities level. This technology was introduced in Mongolia in 2009. Plans have been made to continue with a surgical module in the WHO's recent adaptation of facilities-based monitoring, Service Availability and Readiness Assessment (SARA). A planning tool was developed to assist policymakers integrate EESC into their national health plans.An online Global MedNet serves as a platform for online discussions and for posting announcements and materials related to GIEESC (http://www.who.int/ surgery/globalinitiative/en/).

15 years of APOC—a lifetime of public health evidence

The sculpture Sightless Among Miracles outside WHO headquarters in Geneva, Switzerland, celebrates the ongoing successes of onchocerciasis control in Africa. At the unveiling of the sculpture in 1999, the Onchocerciasis Control Programme (OCP), a joint effort of four UN agencies, had been running for 25 years. In that time, it covered 30 million people in 11 countries in sub-Saharan Africa, primarily through a programme of regular larvicide spraying in an effort to control the Simulium vector of Onchocerca volvulus.

Results from the 2012 World Radiocommunication Conference [Spectrum Policy and Regulatory Issues

Every three or four years, thousands of delegates, representing most nations of the world, gather to make decisions on the efficient and equitable use of the radio spectrum. The World Radiocommunication Conference (WRC) is held under the auspices of the International Telecommunication Union (ITU), a specialized agency of the United Nations. Most WRCs are held at the ITU's headquarters in Geneva, Switzerland, although countries occasionally offer to host the conference, as Turkey did in 2000.