Origins and Background

In 1945, the United Nations Conference on International Organization, meeting in San Francisco, unanimously approved a proposal by Brazil and China to set up an autonomous international health organization within the United Nations system. The constitution of the World Health Organization (WHO) was adopted by the International Health Conference, convened by the United Nations Economic and Social Council (ECOSOC) in New York in 1946.

WHO came into being on 7 April 1948 when the 26th member of the United Nations ratified the constitution. Since then, this date is celebrated every year as World Health Day, when WHO promotes a chosen theme of international public health interest around the globe. WHO now has 191 Member States and two Associate Members.

The objective of WHO is the "attainment by all peoples of the highest possible level of health." Health as defined in WHO's constitution is "a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity." In support of its objective, the organization has a wide range of functions, including:
-- acting as the directing and coordinating authority on international health work;
-- promoting technical cooperation;
-- assisting governments, upon request, in strengthening their health services;
-- furnishing appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of governments;
-- stimulating and advancing work on the prevention and control of epidemic, endemic and other diseases;
-- promoting, in cooperation with other specialized agencies where necessary, the improvement of nutrition, sanitation, recreation, economic and working conditions and other aspects of environmental hygiene;
-- promoting improved teaching and training standards in the health, medical and related professions;
-- establishing and stimulating the establishment of international standards for food, biological, pharmaceutical and similar products and standardizing diagnostics procedures; and
-- fostering activities in the field of mental health, especially those affecting the harmony of human relations.

WHO also proposes conventions, agreements, and regulations, and it makes recommendations about international nomenclature of diseases, causes of death and public health practices.

WHO is made up of three organs: the World Health Assembly, the Executive Board and the Secretariat. The World Health Assembly is the organization's governing body. It determines WHO's policies and programmes and approves its budget. It meets annually in May and is attended by delegates of Member States and other participants, such as intergovernmental organizations and NGOs in official relations with WHO. The Executive Board, which meets twice a year, acts as the health assembly's executive organ. The board is made up of 32 health experts who represent member countries and are elected for a three year term.
The secretariat consists of WHO staff (about 4,000 persons) under the Director General. Appointed by the World Health Assembly on the nomination of the Executive Board, the Director General is the organization's chief technical and administrative officer.

WHO, with its headquarters in Geneva, is highly decentralized. There are six regional organizations, which are integral parts of WHO; each has a committee and a regional office. In addition WHO has representatives or liaison offices in nearly 200 countries. The regional offices are in Brazzaville (temporarily located in Harare), Washington DC, New Delhi, Copenhagen, Alexandria and Manila. Each region (Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean and the Western Pacific) has a regional committee whose annual sessions are attended by representatives of Member States of the region concerned. Each regional committee formulates policy on regional matters and monitors regional activities. The regional committee makes suggestions on the appointment by the Executive Board of the regional director who heads each office.

WHO's programme budget for each biennium is prepared in accordance with the general programme of work, which covers six years. The budget takes into account a number of overall policies and principles approved by the World Health Assembly.

WHO's regular budget is supplied by assessed contributions by Member States and Associate Members. WHO also receives voluntary contributions from Member States and from other sources. In May 1999, the 52nd World Health Assembly decided upon a regular budget of US$842.64 million for the biennium 2000-2001.

WHO Activities

For WHO, health is a fundamental human right and a worldwide social goal. This basic principle was reaffirmed in 1977 when WHO decided that the main social target of governments and of WHO should be the attainment by all peoples of a level of health that allows them to lead a socially and economically productive life. This was the birth of the Health for All (HFA) movement. The next year, in 1978, the joint WHO/UNICEF International Conference on Primary Health Care adopted the Declaration of Alma Ata, which asserted that primary health care was the key to health for all. In 1981, the World Health Assembly unanimously adopted a Global Strategy for Health for All by the Year 2000. In 1995 the Member States of WHO requested WHO "to take the necessary steps for renewing the health-for-all strategy together with its indicators, by developing a new holistic global health policy based on the concepts of equity and solidarity, emphasizing the individual's, the family's and the community's responsibility for health, and placing health within the overall development framework." This work led to the adoption in 1998 of a framework for the development of HFA in the future.

Health for All does not mean that disease and disability will no longer exist, or that doctors and nurses will be taking care of everybody. It means that resources for health will be evenly distributed, and that essential health care will be accessible to everyone with full community involvement. Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain, at every stage of their development in the spirit of self reliance and self determination.

Primary health care is based on the following eight elements: education about prevailing health problems and how to prevent and control them; promotion of food supply and proper nutrition; adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic disease; appropriate treatment of common diseases and injuries; and provision of essential drugs.

The holding of the International Conference on Primary Health Care and adoption of the Global Strategy for Health for All caused a major shift in WHO's general programme of work. The general programmes of work, formulated by WHO's Executive Board and approved by the World Health Assembly, provide a framework for all the organization's activities. Each general programme consists of "an organized aggregate of activities directed towards the attainment of specific objectives." Since WHO's founding, the health assembly has approved nine such programmes. The eighth general programme of work (1990 1995) stressed action at country level, and the ninth focuses on supporting countries and the international community in concerted, sustained and complementary action to bring about greater equity in health and to tackle specific health-development problems. The goals and targets of the ninth general programme of work indicate the minimum to be achieved by global health action--by international organizations of the United Nations system, NGOs, bilateral and multilateral donor and development agencies, banks and countries themselves--during the period 1996 2001.

Proposals for the focus of WHO's work during the final biennium of its ninth general programme of work, while reflecting and building upon the foundations of previous activities, also herald a changed WHO. A recent restructuring reoriented priorities and outlined the strategic focus of WHO's work in the following overarching areas.

Communicable Diseases
The burden of communicable diseases, including HIV/AIDS--which kills an estimated 17 million people a year--continues to be a key impediment to social and economic progress and imposes unacceptable suffering on people already living in adverse conditions. The main focus of WHO's work will be to reduce the negative impact of malaria and tuberculosis through global partnerships, and to maintain its contribution to international efforts to eradicate poliomyelitis. In addition, it will concentrate on strengthening global systems for monitoring health problems of international public health importance, and building national surveillance systems that enable an effective response to epidemics.

Noncommunicable Diseases
These are responsible for nearly half of global deaths, and the proportion is increasing. The main challenge is to develop and test preventive strategies, which will address several major lifestyle related diseases through their common risk factors. Special emphasis will be given to cancer and cardiovascular disease and to promoting international investment in tobacco control.

Sustainable Development and Healthy Environments
WHO is concerned with poverty as a major cause and as a consequence of ill health. Planned work will focus on the contribution that better health, and access to good quality health services, can make to the reduction of global poverty; and on the development and advocacy of policies and practices in health--and other sectors of the economy--that influence the health and wellbeing of poor people. Within the framework of the broader imperatives of sustainable development, it will further explore links between the environment, health and the process of globalization.

Health Systems and Community Health
WHO seeks to promote an integrated approach to health care, and its work will focus especially on the delivery of high quality health services for children, adolescents and women, in line with recommendations of the 1994 International Conference on Population and Development and 1995 Fourth World Conference on Women. There will be a new focus on developing WHO's role in international response to the global HIV/AIDS epidemic. In addition, WHO will strengthen its capacity to back up the development of management and support systems that are most critical for sustaining essential health services.

Evidence and Information for Policy
This area of work responds to the worldwide need for a more systematic and evidence based approach to policy formulation and evaluation. The initial focus of work will be to develop methods, tools and standards required to collect evidence for health policy analysis, and to compile information bases that collate the evidence and make projections over time. A particular concern will be to design and test robust methods for examining the effects of different approaches to health care financing.

Health Technology and Pharmaceuticals
Securing access of all groups in all countries to essential drugs remains a bedrock principle. WHO seeks to influence the development, production, quality, cost and distribution of health technology and drugs in ways that positively impact on peoples' health. Two key areas of emphasis have been identified in the next biennium. First, in the field of clinical technology, assuring the safety, quality and cost effectiveness of blood transfusion products and services will be a special concern. Second, WHO will give special attention to developing its role in immunization.

Social Change and Mental Health
WHO will place greater emphasis on the health consequences of social change and global demographic trends. Disabilities associated with mental illness such as depression, schizophrenia and other neuropsychiatric disorders together constitute 12.5% of the global burden of disease. Mental health will be given particular prominence during the next biennium. Work will focus on the promotion of good mental health, prevention and early treatment of major mental and neurological disorders, and appropriate treatment and psychosocial rehabilitation of people with these disorders.

External Relations and Governing Bodies
WHO cannot work alone: it needs to show leadership and reach out to others to pursue its key leadership role in international health. The principal challenge and primary focus will be to revitalize relationships with other organizations of the United Nations system--in line with WHO's particular strengths and emerging global health priorities--and to develop new frameworks for partnerships with non-governmental organizations and the private sector.

Another major initiative is the creation of "Cabinet Projects" whose purpose is to achieve, inter alia, rapid visibility and impact in selected areas of critical importance to global health. They involve working in close partnership with networks of national and international organizations. As of writing there are three such projects, described below.

· The Roll Back Malaria project will help to bring about a significant reduction in the burden of disease associated with malaria as a result of improvements in poorer peoples' access to a range of effective antimalaria interventions. This will be achieved through improvements in the capacity of national health sectors, and other sectors associated with human development, to respond to the requirements of poor people. The Roll Back Malaria project--with its focus on contributing to the effectiveness of actions taken by other groups, within and outside WHO--will serve as a pathfinder for accelerating action to improve public health more broadly in poorer regions of the world.

· The Tobacco Free Initiative will provide global leadership and mobilize national and international action to prevent and reduce tobacco use. It will focus on global support for evidence based tobacco control policies, new and strengthened partnerships for action, heightened awareness of the need to deal with tobacco at all levels of society, and faster implementation of national and global policies.

· The Partnerships for Health Sector Development project will create a new understanding of health sector development. It will explore ways for headquarters and regional and country offices to work more synergistically in providing country advice and support, placing technical inputs in a broader political and economic context and cutting across traditional programme boundaries. Working with a wide range of partners, the project will provide the practical and conceptual basis for WHO to exert a more decisive influence in shaping the international debate on sector approaches to health development.

The foregoing provides an overview of the priorities of WHO during 2000-2001. Many of the activities will result, inter alia, in the preparation of a document or publication. The aim is to ensure the availability of valid information on scientific and technical subjects, health services management and other matters relating to health. Information is presented in a variety of forms for wide dissemination in diverse settings for all the parties involved in attaining health for all. These include policy makers, health professionals, scientists and researchers, administrators, health educators, and the general public. Thus WHO publishes books for medical and scientific specialists, as well as to stimulate the interest of public health decision makers, promote the transfer of appropriate technology into public health practice or for use by middle level and primary health care workers in a translated version. Many of these are translated into national languages.

Over 80 books were published in English during 1996 1997; many were also published in French, Spanish and other languages. The Bulletin of the World Health Organization, a peer reviewed public health journal, appears in twelve issues each year. The quarterly WHO Drug Information provides up to date information on medicinal products, reports on major drug regulatory action throughout the world, and gives prescribing information on selected essential drugs contained in WHO's Model List. The organization's other periodicals are the Weekly Epidemiological Record and the International Digest of Health Legislation. Apart from publications issued by WHO headquarters, books and journals dealing with more regional subjects are published by the regional offices.

All information collected by WHO is indexed in a bibliographic database, WHOLIS (WHO Library Information System), which covers not only WHO publications but also includes technical documents and material produced by technical programmes, co publications, press releases, audiovisual material. WHOLIS is available to countries in several electronic media, including CD ROM and the Internet.

Follow-Up to Conferences

WHO has always collaborated closely with the organizations and entities of the UN system. The series of conferences, including those organized by the specialized agencies such as the 1992 International Conference on Nutrition and the 1996 World Food Summit, have provided opportunities for the system to strengthen collaboration. Concerning conferences held under the auspices of the United Nations, WHO is the lead agency or "task manager," responsible for coordinating UN system efforts related to health and related issues that emerged from the 1995 World Summit for Social Development. The major themes of, and recommendations from, the other conferences have either direct or indirect relevance to WHO and form the basis of a common platform for action. WHO, recognizing the challenge of a coordinated UN system effort to achieve objectives of the major UN conferences and the need to avoid duplication of implementation at country level, has an ongoing dialogue with its UN partners focused specifically on follow-up issues. This dialogue encompasses high-level WHO representation at various inter-agency fora, participation in technical meetings, inputs into policy and programme development, and joint activities at global, regional and country levels, as well as a continuous exchange of information.

NGO Relations

WHO has a long tradition of close collaboration with non governmental organizations. Since its founding, WHO has considered NGOs as potential partners in health development and has encouraged cooperation with them. Article 71 of its Constitution says that WHO may make suitable arrangements for consultation and cooperation with NGOs in carrying out its international health work. "Mutually supportive relations" are key words in WHO/NGO work. The foundation for such collaboration was laid by Member States at the first World Health Assembly in 1948, where a statement of principles was adopted to guide WHO informal and formal relations with NGOs. The statement of principles established a formal status known as "official relations with WHO" and set out procedures for admission into this relationship.

The important role of NGOs was confirmed in the 1985 World Health Assembly technical discussions on the topic of Collaboration with NGOs in Implementing the Global Strategy for Health for All. These discussions, attended by many representatives of international and national NGOs, concluded that "a growing partnership between governments and NGOs was an inescapable necessity for the attainment of health for all." WHO recognized the need to broaden the range of national and international NGOs with which it collaborates and to strengthen NGO participation. As a result, in 1987 the World Health Assembly adopted the amended Principles Governing Relations Between the WHO and Non Governmental Organizations. The principles specify the objectives of WHO's collaboration with NGOs and provides the framework within which WHO and national, regional and international NGOs may collaborate. In particular, it sets out the procedures for admitting NGOs into official relations with WHO and the privileges conferred by their relationship. As of February 1999, there were 193 NGOs in official relations with WHO.

The objectives of WHO's collaboration with NGOs are "to promote the policies, strategies and programmes derived from the decisions of the organization's governing bodies; to collaborate with regard to various WHO programmes in jointly agreed activities to implement these strategies, and to play an appropriate role in ensuring the harmonizing of intersectoral interests among the various sectoral bodies concerned in a country, regional or global setting."

The variety and richness of NGO/WHO relations is difficult to capture in the space available, but the following provides examples of the major types of collaboration, and indeed involvement of international NGOs, in the work of WHO.

Advisory
International Co ordination Group on the Vaccine Provision for Epidemic Meningitis Control (ICG). This group was established in January 1997 to coordinate an equitable supply of epidemic response items to countries most in need. The ICG is composed, inter alia, of UN agencies, WHO Collaborating Centers related to meningococci/meningococcal disease, Médecins Sans Frontières (MSF), and International Federation of Red Cross and Red Crescent Societies, research partners and certain manufacturers. ICG is managed by an Executive Group, composed of MSF, UNICEF, IFRC and WHO. The group advises the secretariat on best use of the stocks of vaccine and other materials in epidemic situations as well as coordination of the international response to meningitis epidemics.

Advocacy
The large national membership of such NGOs as the International Council of Women contributes to the broad dissemination of key WHO health education and information, which serves to strengthen national NGO activities and their contribution to debate on health issues.

Coordination and Service Provision
In order to reduce the global burden of blindness, which currently affects an estimated 40 45 million people worldwide, a broad coalition of international non-governmental and private organisations launched with WHO a global initiative entitled Vision 2020: The Right to Sight. The objective of the initiative is to eliminate avoidable blindness by 2020. Under it a major concerted international effort will be made in such areas as advocacy and resource mobilization, joint planning and strengthening national capacities through human resource development and the transfer of appropriate technologies to developing countries.

Data Collection and Health-Information Management
The International Association of Cancer Registries provided data for use in recent WHO world health reports. The International Society for Burn Injuries designed a computer programme permitting establishment of a hospital-based burn registry on a personal computer.

Emergency and Humanitarian Action
Subject to identified needs and availability of funds, WHO works with and includes NGOs, inter alia, in emergency and humanitarian activities. For example in Afghanistan it collaborates with NGOs on various technical issues, most recently in March 1999 when 39 local and international NGOs and three UN agencies attended a health sector planning workshop; in Somalia WHO routinely collaborates and coordinates with some 30 NGOs, mainly international, in such areas as provision of anti malarials, bed nets, training of national and international staff, and organization of leprosy and tuberculosis (TB) treatments.

Financial
Joint collaboration may also include funding-for example the Islamic Organization for Medical Sciences for activities related to guinea worm eradication, the International Council for Control of Iodine Deficiency Disorders for micronutrient activities, and the German Pharma Health Fund for activities in Lao People's Democratic Republic and Mauritania for the control of schistosomiasis and intestinal parasites.

Human Resources Development
This can be illustrated with two approaches. First, the organization closely collaborated with NGOs such as the World Federation for Medical Education in the development and implementation of WHO's policy on changes in medical education and medical practice. Second, WHO has created opportunities for regular joint training seminars, such as those for government and industry decision-makers and nutritionists in developing countries undertaken with the Industry Council for Development.

Participation in NGO Meetings
An example of this area is when WHO addressed the Tenth World Psychiatric Congress of the World Psychiatric Association, attended by over 10,000 participants, on the Nations for Mental Health initiative. Other types of meetings permit WHO to technically support an NGO activity. For example, WHO is a member and adviser of the International Planned Parenthood Federation's International Medical Advisory Panel, whose recommendations are applied by family planning programmes throughout the world.

Professional
WHO Resolution WHA47.12 calls for development of the pharmaceutical profession. NGOs such as the International Pharmaceutical Federation and the Commonwealth Pharmaceutical Association are crucial partners in this development process.

Publications
The Manual of Diagnostic Ultrasound is a joint publication with the World Federation for Ultrasound in Medicine and Biology, and Guidelines for the Development of a National Programme for Haemophilia is produced in collaboration with the World Federation of Hemophilia. Cancer Pain Relief and Palliative Care in Children was published in collaboration with the International Association for the Study of Pain.

Scientific Review and Clinical Support
The International Commission on Non-ionizing Radiation Protection reviewed scientific literature on the biological effects and health consequences of exposure to non-ionizing radiation. On the basis of pioneering work undertaken by the International Union Against Tuberculosis and Lung Disease in nine countries in Africa and Latin America during the 1980s, the directly observed treatment, short-course (DOTS) strategy was developed to control and cure tuberculosis. This is the WHO recommended treatment strategy for detection and cure of TB.

Standard-Setting and Development of Nomenclature
The International Association on Water Quality will contribute to the revision of WHO guidelines on drinking-water microbiology. The World Federation of Neurology contributed to the relevant sections of the tenth revision of the International Classification of Diseases.

The WHO Executive Board is responsible for deciding on an NGO's admission into official relations with WHO. In making its decision the board is guided by a set of criteria requiring, among other things, that the aims and activities of the NGO are in conformity with the spirit, purposes and principles of the Constitution of WHO, that they concentrate on development work in health or health related fields, and that they are free from concerns that are of a commercial or profitmaking nature. The NGO should normally be international in its structure and/or scope, with members exercising voting rights in relation to its policies or action. Thus eligible organizations include various types of international NGOs with a federated structure, foundations that raise resources for health development activities in different parts of the world, and similar bodies promoting international health. Normally the NGO must also have completed a two year period of working relations entered into by an exchange of letters specifying joint activities for collaboration. Once granted official relations status, the NGO's activities with WHO are reviewed every three years by the WHO Executive Board to determine whether the status is maintained.

WHO regional offices and country representatives are also working to promote partnerships in the health field at the country level by, for example, organizing exchanges between NGOs and government representatives.

Concerning NGOs at WHO headquarters the Department of External Cooperation and Partnerships facilitates contacts between the technical clusters, and it administers procedural aspects of WHO's formal relations with NGOs. Each WHO regional office has an equivalent unit dealing with national and regional NGOs.

Contact: Director, Department of External Cooperation and Partnerships, WHO, Avenue Appia, CH 1211 Geneva 27, Switzerland, telephone +41 22/791 2790, fax +41 22/791 3111, e mail <ngo@who.ch>.

Chief, Interagency Resources Mobilization, WHO Regional Office for Africa, Parirenyatwa Hospital, PO Box BE 773, Belvedere, Harare, Zimbabwe, telephone +1-407/726 5062, fax +1-407/726 5062.

Chief, Office of External Relations Coordination (DEC), WHO Regional Office for the Americas/Pan American Sanitary Bureau, 525 23rd Street NW, Washington DC 20037, United States, telephone +1-212/974 3000, fax +1-202/974 3663.

Regional Adviser, Coordination, Resource Mobilization and Emergency Relief, WHO Regional Office for the Eastern Mediterranean, PO Box 1517, Alexandria 21511, Egypt, telephone +20-3/482 0223, fax +20-3/483 8916.

Regional Adviser, Partnerships in Health and Emergency Assistance, WHO Regional Office for Europe, 8 Scherfigsvej, DK-2100 Copenhagen Ø, Denmark, telephone +45/39 17 17 17, fax + 45/39 17 18 18.

Director, Health Policy and Management, WHO Regional Office for South East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Road, New Delhi 110002, India, telephone +91 11/331 7804, fax +91 11/332 7972.

External Relations Officer, DPM/COR, WHO Regional Office for the Western Pacific, P.O. Box 2932, Manila 1099, Philippines, telephone +63 2/528 9984, fax +63 2/521 1036.