World Health Organization Staff Research Articles

Scandinavian entry points to social medicine and postcolonial health: Karl Evang and Halfdan Mahler in India.

Our contributions examine the Norwegian Karl Evang's (1901-1981) and the Dane Halfdan Mahler's (1923-2016) participation in international health co-operation facilitated by the World Health Organization (WHO) in India in the 1950s. While Evang's was a hectic, but relatively short visit as part of a WHO visiting team of medical scientists in 1953, Mahler's spanned the entire decade on assignments as WHO medical officer to tuberculosis control projects. Mahler's name should be familiar to researchers of international health as the Director-General of the WHO 1973-88, and for his promotion of primary health care through the 1978 Alma-Ata Declaration. Evang, Norway's Director of Health 1938-72, was also a key figure in international health in the mid-twentieth century as one of the original instigators of the WHO, and a participant in much of its early work.A core theme is the place of social medicine, both in Evang's and Mahler's work, and within the WHO and its navigation of complex postcolonial settings in the 1950s. Investigating cross-regional encounters and circulations of social medicine ideas between Evang and Mahler and their Indian interlocutors as well as international WHO staff members, we ask what the role of social medicine was in international health in the early post-war period. Researchers have found that social medicine had its heyday during the 1930s and 1940s, and that a technology-focused, vertical approach became dominant soon after the war. In contrast, we suggest that continued circulation of social medical ideas points towards a more complicated picture.

Digital Transformation of Face-To-Face Focus Group Methodology: Engaging a Globally Dispersed Audience to Manage Institutional Change at the World Health Organization.

Focus group discussions (FGDs) are widely used to obtain qualitative data from purposely selected groups of people. This paper describes how the Learning and Capacity Development (LCD) unit of the World Health Organization (WHO) Health Emergencies Programme (WHE) digitalized FGDs to engage with WHO staff from around the world, to listen, share, and collect their feedback in the development of a WHO learning framework. The impact of the COVID-19 pandemic and the introduction of local lockdowns and travel restrictions resulted in the wide use of digital platforms, such as Zoom, for employee communications and collaboration capable of reaching employees wherever they are working. The LCD/WHE team drew upon the experience of WHO colleagues from human resources, country, and regional offices to set up and hold FGDs in 6 languages with participants from all WHO regions. Building on the findings of a 2019 WHO staff survey, which was part of a comprehensive, organization-wide career development initiative, the digitalized FGDs allowed for the exchange of substantive feedback, novel ideas, and alignment, connecting across different geographies, disciplines, and levels of seniority. As a result, FGDs can be successfully conducted online, but it is essential to remove barriers to participation by adopting a multilingual and flexible approach in multinational and international organizations such as the WHO.

The World Health Organization's Actions Within the United Nations System to Facilitate a Whole-of-Society Response to COVID-19 at Country Level.

The coronavirus disease (COVID-19) pandemic highlighted that managing health emergencies requires more than an effective health response, but that operationalizing a whole-of-society approach is challenging. The World Health Organization (WHO), as the lead agency for health within the United Nations (UN), led the UN response at the global level through the Crisis Management Team, and at the country level through the UN Country Teams (UNCTs) in accordance with its mandate. Three case studies—Mali, Cox's Bazar in Bangladesh, and Uzbekistan—provide examples of how WHO contributed to the whole-of-society response for COVID-19 at the country level. Interviews with WHO staff, supplemented by internal and external published reports, highlighted that the action of WHO comprised technical expertise to ensure an effective whole-of-society response and to minimize social disruption, including those affecting peacekeeping in Mali, livelihood sectors in Cox's Bazar, and the education sector in Uzbekistan. Leveraging local level volunteers from various sectors led to both a stronger public health response and the continuation of other sectoral work. Risk communication and community engagement (RCCE) emerged as a key theme for UN engagement at country level. These collective efforts of operationalizing whole-of-society response at the country level need to continue for the COVID-19 response, but also in preparedness for other health and non-health emergencies. Building resilience for future emergencies requires developing and exercising multi-sectoral preparedness plans and benefits from collective UN support to countries. Coronavirus disease had many impacts outside of health, and therefore emergency preparedness needs to occur outside of health too.

Revealing Politeness Through Illocutionary Act Approach in World Health Organization Staff’s Responses at Corona Virus Press Briefing

This study revealed politeness through illocutionary acts theory in a corona virus press briefing held by WHO (World Health Organization). Taken from a video press briefing entitled “Live from WHO Headquarters - COVID-19 daily press briefing on March 20 th , 2020” uploaded in World Health Organization YouTube Channel, this study were (1) discovering how the illocutionary act and indirect speech act by Yule (1996) represented then (2) linked to the politeness and the universality of indirect speech acts by Brown, et. Al. (1987). The method used qualitative descriptive. This study contributed (1) theoretically to provide a sample of politeness through illocutionary act and indirect speech act taken from a situation in press briefing and (2) practically to give an example of politeness that could be a reference of polite communication when a speaker utters and hopes an action were done by the hearer. The results were (1) politeness in communication could avoid conflict by using indirect speech acts; (2) using generalization and giving resolution without abusing at a certain situation could give politeness in utterances.

The Intellectual Property Turn in Global Health

International intellectual property (IP) law for pharmaceuticals has fundamentally shifted in the twenty-first century from a property-centric to a human rights view. Scholars tend to explain this transformation in the context of both the power struggle between developing and developed countries, and the influence of a social movement that criticized IP rights as hindering access to essential medicines. Yet, these explanations leave out the central role of two international organizations, the World Trade Organization (WTO) and the World Health Organization (WHO), and particularly their permanent staffs, whose boundary disputes have shaped international IP law at the intersection of trade and global health. Bringing into conversation historical and legal literatures on global health and IP, this article traces how a human rights perspective on IP emerged as a strategy to reconcile the WHO staff’s sociomedical views of health with an increasingly dominant set of global IP rules. It shows how the WHO staff used the language of economics—an analytical frame favored by the WTO—to advance a then unorthodox economic understanding of IP as a type of governmental regulation. This allowed the WHO to argue that states should enjoy regulatory autonomy to curtail IP rights in order to meet broader state objectives, such as human rights protection. Paradoxically, despite their divergent views on the nature of IP, both WTO and WHO engagement with it heralded the emergence of a new technocratic view of global health that focuses on patentable medicines and technologies, and that has ultimately turned away from the WHO’s sociomedical roots.

Variations in processes for guideline adaptation: a qualitative study of World Health Organization staff experiences in implementing guidelines

BackgroundThe World Health Organisation (WHO) publishes a large number of clinical practice and public health guidelines to promote evidence-based practice across the world. Due to the variety of health system capacities and contextual issues in different regions and countries, adapting the recommendations in the guidelines to the local situation is vital for the success of their implementation. We aim to understand the range of experiences with guideline adaptation from the perspectives of those working in WHO regional and country offices. Our findings will inform development of guidance on how to improve adaptability of WHO guidelines.MethodsA grounded theory-informed, qualitative study was carried out between March 2018 and December 2018. Seventeen semi-structured interviews were conducted with participants who included WHO guideline developers and staff in the headquarters, regional and country offices recruited from a sample of published WHO guidelines. Participants were eligible for recruitment if they had recent experience in clinical practice or public health guideline implementation. Deidentified transcripts of these interview were analysed through three cycles of coding.ResultsWe categorised the adaptation processes described by the participants into two dominant models along a spectrum of guideline adaptation processes. First, the Copy or Customise Model is a pragmatic approach of either copying or customising WHO guidelines to suit local needs. This is done by local health authorities and/or clinicians directly through consultations with WHO staff. Selections and adjustments of guideline recommendations are made according to what the implementers deemed important, feasible and applicable through the consensus discussions. Second, the Capacity Building Model focuses on WHO building local capacity in evidence synthesis methods and adaptation frameworks to support local development of a national guideline informed by international guidelines.ConclusionsIn comparing and contrasting these two models of guideline adaptation, we outline the different kinds of support from WHO that may be necessary to improve the effectiveness and efficiency of the respective models. We also suggest clarifications in the descriptions of the process of guideline adaptation in WHO and academic literature, to help guideline adaptors and implementers decide on the appropriate course of action according to their specific circumstances.EthicsThis project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).

Rehabilitation Is a Global Health Priority

Rehabilitation Is a Global Health Priority

Building operational readiness for responding to emergencies in the WHO South-East Asia Region

The World Health Organization (WHO) has an essential role to play in supporting Member States to prepare for, respond to and recover from emergencies with public health consequences. Operational readiness for known and unknown hazards and emergencies requires a risk-informed and structured approach to building capacities within organizations such as WHO offices and national ministries of health. Under the flagship priority programme on emergency risk management of the WHO Regional Office for South-East Asia, a readiness training programme consisting of four modules was implemented during 2017-2018, involving staff from WHO country offices as well as from the regional office. The experience of and lessons learnt from designing, developing and delivering this phased training programme have fed into improvements in the curriculum and training methodology. The training programme has also facilitated the development of business continuity plans and contingency plans in some of the 11 Member States of the region and has increased the readiness of WHO staff for swift deployment in recent emergencies. It is recommended that the strengthening of operational readiness for responding to emergencies in the region be sustained and accelerated through the development of a regional training consortium that can scale the training programme up at national level, taking into account country contexts, national health systems and the needs of populations. The resilience of the populations and health systems in the region will be increased if disaster risk reduction and emergency preparedness and response activities are supported by operational readiness.

Meeting public health needs in emergencies-World Health Organization guidelines.

The World Health Organization (WHO) is a leading source of trustworthy guidelines in public health, including in emergencies. In addition to standard guidelines produced in preparation for emergency response, WHO has processes and methods for issuing guidelines in the context of urgent public health need, including rapid advice guidelines (production time 2 to 3 months) and health emergency interim guidelines (days to weeks). There are numerous challenges to producing guidelines in response to an emergency in addition to the compressed timeline which necessitates truncating or modifying standard processes. There is frequently a lack of scientific data on the disease or situation at hand, especially early in the event timeline. Resources are limited, particularly the availability of WHO staff and external experts, and disease and emergency response experts may lack knowledge and experience in developing guidelines. Finally, the rapid production of new information and the resultant short shelf‐life of recommendations pose a significant challenge to keeping guidelines up to date. In order to better meet end‐users’ needs, WHO must anticipate areas of uncertainty in emergency response and proactively develop relevant guidelines, explore optimal ways of communicating gaps in knowledge in the field to guideline developers, and promote and participate in research on the sources of bias in guideline development within compressed timeframes.

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

Developing WHO rapid advice guidelines in the setting of a public health emergency

ObjectivesWe describe newly established guidance for guideline developers at the World Health Organization (WHO) on the process and procedures for developing a rapid advice guideline in the context of a public health emergency (e.g., the 2014 Ebola epidemic). Study Design and SettingWe based our approach on established rapid review methods, which were incorporated into existing WHO guideline development processes. Guidance was further informed by in-depth discussions of issues related to rapid guideline development with WHO staff (n = 6), who oversee the Organization's response to emergencies. ResultsWe discuss criteria for considering if a rapid advice guideline is appropriate and feasible and outline the roles of various contributors across the phases of development. Further, we describe the methods and steps involved in performing rapid reviews, which are more fluid and iterative than for a standard guideline process. In general, rapid advice guidelines involve a shorter timeline, narrower scope, and the use of abbreviated methods for the evidence review. ConclusionImportant differences exist between developing a standard guideline and a rapid advice guideline. However, the core principles for WHO guidelines apply to rapid advice guidelines including minimizing bias, applying transparent processes and the use of explicit methods.

Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator.

BackgroundTwo themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.MethodsThis qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?ResultsAnalysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO’s cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.ConclusionThere are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fully implemented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0128-6) contains supplementary material, which is available to authorized users.

Translation and cross-cultural adaptation of the World Health Organization staff questionnaire on dengue warning signs for use in Brazil

Early recognition of warning signs and treatment of severe dengue cases is the main strategy for reducing case-fatality, especially in children, who usually present few symptoms and can progress rapidly to dengue shock syndrome. The objective of this study was to elaborate the Brazilian version of the World Health Organization (WHO) staff questionnaire on the use and value of dengue warning signs, through translation and back-translation of the WHO questionnaire, followed by an expert panel consensus, pretest (n = 13), and pilot study (n = 20) of the preliminary version. Comparison of the original questionnaire in English and the back-translation showed that 8 of the 49 items had been extensively or completely altered, and three were rephrased. The expert panel added the warning signs listed by the Brazilian Ministry of Health. In the final version of the questionnaire, the item "ranking of warning signs" was rephrased and the answer option "do not know" was excluded. The Brazilian version of the WHO staff questionnaire allows assessing health professionals' experience and perceptions regarding the use of warning signs included in the recent dengue guidelines.

Crossing Borders: One World, Global Health

Crossing Borders: One World, Global Health

Global health diplomacy: five years on

Global health diplomacy: five years on

Global Policy Review of Antiretroviral Therapy Eligibility Criteria for Treatment and Prevention of HIV and Tuberculosis in Adults, Pregnant Women, and Serodiscordant Couples

This article reviews the antiretroviral therapy (ART)initiation criteria from national treatment guidelines for 70 countries and determines the extent of consistency with the current World Health Organization (WHO) recommendations. Published ART guidelines were collected from the Internet, databases, and WHO staff. ART eligibility criteria for asymptomatic people, pregnant women, people with HIV-associated tuberculosis, serodiscordant couples, injecting drug users, men who have sex with men, and sex workers were abstracted from them. Multiple regression analysis was used to determine the relation between ART eligibility criteria, ART coverage, and various population characteristics and policy interventions. Of the 70 countries, 42 (60%) follow WHO’s ART guidelines for asymptomatic people and 31 (44%) for pregnant women,recommending ART at CD4 count of ≤350 cells/mm(3). Twenty-three(33%) countries recommend ART for people with HIV-associated tuberculosis irrespective of CD4 count. Nineteen countries are also recommending or considering earlier ART above CD4 count ≤350 cell/mm(3) for asymptomatic people, pregnant women, and/or serodiscordant couples. Multiple linear regression analysis shows that HIV prevalence, year of publication of guidelines, and HIV expenditure are significantly associated with published ART eligibility criteria. On average, the ART coverage is similar irrespective of published guidelines being consistent with the WHO recommendation(P , 0.53). Published guidelines from a significant number of countries are not following WHO recommendations. Although published guidelines may not reflect practice, it is important to adapt recommendations and services quickly to reflect the emerging science on the health and prevention benefits of earlier access to ART.

"Basically a house of experts: the production of World Health Organization information".

The World Health Organization (WHO) is widely regarded as the preeminent international authority on health and scientific matters. Its information mandate is a powerful one, for it enables the WHO to construct issues as legitimate ones for concern that should be addressed in particular ways. Intensive interviewing of WHO staff was used to elicit writing and editing processes. Approximately 25 people were interviewed repeatedly from year 2004 to 2005 using the snowball sampling method. A core staff in headquarters dominates the selection of topics, writing and editing activities. The authority of senior management in headquarters emerges as more significant than that of country leaders and representatives. In contrast to sister UN agencies, WHO staff prioritize collaboration and input from science and health researchers over that of UN colleagues and its internal editors. Senior management participation ensures stability in WHO information over time and adherence to the WHO scientific mandate across documents.

Where in the world is interprofessional education? A global environmental scan

Despite increasing recognition for the importance of interprofessional education (IPE), little is known about where in the world it occurs, how it is conducted and why it is offered. This international environmental scan was commissioned by the World Health Organization (WHO) to answer these questions and inform efforts to support IPE on a global scale. An internet-based survey targeting educators and researchers in WHO's 193 Member States was conducted between February and April 2008. Participants were recruited by WHO staff through a range of country focal points, collaborating centres, regional networks and partner organizations. The scan garnered 396 responses representing 41 countries from WHO's six regions, various income-economies and many health professions. IPE was often (i) voluntary (22%); (ii) not based on explicit learning outcomes (34%); (iii) not assessed for what was learned (63%); (iv) not offered by trained facilitators (69%); and (v) not formally evaluated (30%). Participants reported many benefits of IPE for education, practice and policy. Results are limited primarily by reliance on self-reports and an English-only, internet-based questionnaire. Significant efforts are required to ensure that IPE is designed, delivered and evaluated in keeping with internationally recognized best practice.

The new Bulletin

Under former Director-General Gro Harlem Brundtland, two World Health Organization (WHO) periodicals--the World Health Forum and World Health Statistics Quarterly--were incorporated into a bright new Bulletin. A position of editor-in-chief was created, and Brundtland appointed Dr Feachem lead Bulletin's transformation as international journal of public health. The stated aim of World Health Forum, which was established in 1980 and echoed Declaration of Alma-Ata in 1978, was to give substance revolutionary idea of 'health for all' by year 2000. It published accounts of field work and was oriented towards primary health care. The World Health Statistics Quarterly, formerly known as World Health Statistics Report, published mainly epidemiological data. These changes were reflected in content of new Bulletin as well as in its staff. Desmond Avery, a former editor of World Health Forum later served as an Editorials/Reviews editor at Bulletin. He recalls how the new management argued that new Bulletin would incorporate World Health Forum, but in reality very little of Forum approach was carried over. With absorption of some of functions of these two publications, Bulletin was targeted specifically public health community and it was expanded and redesigned include policy-relevant discussions alongside research papers that it had always published. Under Brundtland and her senior managers Dr Julio Frenk and Dr Christopher Murray, revamped 1999 Bulletin shifted from bimonthly monthly publication and its articles were more rigorously peer reviewed. An editorial committee was established of WHO staff, representing a wide range of expertise and publishing experience. Despite some tensions, overall, revamp was a success. Avery remembers that the change in 1999 was exciting for us because new team under Brundtland wanted Bulletin compete with journals like British Medical Journal, New England Journal of Medicine and Lancet, whereas traditional Bulletin was more focused on work going on in WHO and its programmes. With new regime, there was a more energetic and ambitious atmosphere. At editorial meetings there was often well-informed and high-powered discussion about articles. It was refreshing as I had been working at an under-funded quarterly journal, which had not been getting much attention. Richard Feachem, when recruited as editor-in-chief, took job seriously and was good at it. We used get him on telephone from San Francisco lead monthly editorial committee meetings. …

A final word

I write this last Inside View with only what can be described as a jumble of emotions. I am astonished that 12 and a half years have passed so quickly and delighted that the International Council of Nurses (ICN) has grown stronger each year under the strategic guidance of the Council of National Representatives (CNR), wise ICN Boards and a highly-talented headquarters staff. Watching nursing move into higher education and closer to realising its potential in many countries has been terrific. It has been a real high for me to have been associated with ICN and the Florence Nightingale Foundation (FNIF) programs such as leadership, the Mobile Library, the Girl Child project, TB, and the Wellness Centres, to name only a few. I enjoyed being part of FNIF's renaissance. I feel incredibly privileged to know and have worked with nurse leaders on all continents (Antarctica aside). I have learned from each of you and have been so impressed with what you accomplish, often against great odds. I have learned that the United Nations system is in need of real re-design and I am saddened that the voice of the health professions remains unheard or unheeded, despite the current dearth of health professionals. Lip service will not suffice in the long run. I am confident that non-governmental organisations (NGOs) will continue to play a key role in global health and that the health professions, working together, will achieve much. I am proud of the interdisciplinary achievements we have made. I am keen to see what comes next. It has been deeply satisfying to watch national nurses associations (NNAs) working together, both in North-South and South-South relationships, and to see all grow stronger because of it. I am disappointed that nursing within the World Health Organization (WHO) continues to shrink; but I accept that increasing nursing's presence cannot be accomplished by ICN alone. It needs the combined effort of WHO staff and external champions, such as ICN. My greatest anxiety lies with ICN's future and whether we will be bold enough to achieve the vision. I have watched other international NGOs open their doors to multiple memberships and become stronger because of it. I hope the NNAs and CNR will have the courage to do the same. Otherwise I fear that parallel regulatory and union organisations will flourish, and that ICN's mandate, numbers and influence will shrink concomitantly. ICN was created 109 years ago to establish and sustain high standards in education and practice globally; this can only be achieved in today's complex environment by being inclusive, rather than exclusive. Strategic alliances and partnerships are the way forward. It is indeed painful to leave ICN but it is easier knowing the Board has selected a strong nurse leader in David Benton, the new Chief Executive Officer. He has an excellent team, and his leadership skills and experience are right for ICN at this time. I know you will work well together. I am still not sure what is next for me – what to be when I grow up – but ICN and international nursing will remain firmly fixed in my sights. I implore you to nurture both. I wish each of you much success and thank you profoundly for your leadership and fellowship.