Let's start by talking about how the World Health Organization is governed. Following World War II, the United Nations was created. While health was not originally part of the UN's mandate, the Brazilian and Chinese delegations made the recommendation that a global health body be established. And the World Health Organization was created in 1948. Its original priorities included malaria, tuberculosis, maternal and child health and sanitary engineering. Many of those original priorities remain on WHO's agenda today. And little about the structure of WHO and how it is governed has changed since that time. Today, there are 194 member states of the WHO, plus seven entities that have a observer status. These include Taiwan, the Vatican, the Palestinian Authority, and the Red Cross. The member states elect a director general to a five year term. Heads of W.H.O. have referred to the fact that they have 194 bosses, a structure that is unwieldy at best. The annual meeting of the WHO is the World Health Assembly held in Geneva, Switzerland each May. All of the members states attend the assembly and vote on the resolutions that are presented there. There is an executive board of the assembly which is composed of 34 member state representatives, who are elected to three year terms. The primary function of the board, is to ensure the decisions and policies of the World Health Assembly are implemented, to advise it, and generally facilitate its work. The executive board meets each January when they set the agenda for the assembly to take place four months later. The group then reconvenes following the assembly to discuss more administrative matters. The focus of the World Health Assembly is to review and vote on resolutions, supervise the financial policies of the WHO and review and approve the proposed program budget. It also considers reports of the executive board and instructs it in regard to matters which need further action, study or investigation. In 2011 WHO director general Margaret Chan kicked off the WHO governance reform process which aimed to clarify and strengthen the positioning of the organization to achieve greater coherence among the many players involve in global health. The process looked to reform WHO in three areas, pragmatic reform to improve people's health, managerial reform in pursuit of organizational excellence, and governance reform to increase coherence in global health. WHO has two outcomes it is trying to reach with governance reform. First, improve strategic decision making, and second, strengthen engagement with other stakeholders. The concept of engaging with a broader set of stakeholders beyond member states to solve global health problems may seem straightforward. However, this has become quite controversial within the World Health Assembly. And there has been a long debate about a new proposed policy which is called the framework on engaging non-state actors, also known by the acronym FENSA. As mentioned earlier, the assembly is made up solely of sovereign governments. While other organizations are allowed to attend these assemblies as observers, there is no mechanism to formally engage them in the decision making processes. This structure leaves out many organizations who partner closely with the WHO including private companies who make the drugs and devices which are critical to improving health, non-governmental organizations who play a huge role delivering health services such as Doctors Without Borders, and philanthropies, such as Rockefeller Foundation or the Gates Foundation, who fund significant initiatives in global health. At the time of this lesson, the FENSA issue remains controversial and continued debate is expected. That's a quick overview on how the WHO is governed overall. Let's now take a moment to review what we've learned so far. I do want to mention a few other initiatives that govern certain aspects of WHO's work. The Framework Convention on Tobacco Control or FCTC is the only international treaty that governs the way WHO works on an issue. The goal of FCTC is to ensure a global cross-border effort on tobacco control. We'll discuss this further later on. Another aspect of WHO's work has a specific government structure are the international health regulations which defines what countries need to do to prepare for outbreaks and epidemics. Another topic we'll discuss in an upcoming lesson. Finally, there is a new governance structure that was put in place following several panels and commissions that looked at WHO's widely criticized slow response to the West Africa Ebola outbreak. WHO has created a new leadership role, an executive director for outbreaks and emergencies who reports to the director general of the WHO. A new advisory committee has also been created that has the mandate to review the progress that the office is making and preparing for and responding to outbreaks and other emergencies. In summary, it's important to understand how the WHO is governed as it significantly affects the WHO's ability to operate in their overall impact. I believe that WHO governance reform is essential as underscored by the issues raised during the recent West Africa Ebola outbreak.
