How is the WHO governed?

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Global Health Diplomacy

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The State University of New York

Global Health Diplomacy

47 ratings

Having completed this course, learners will be able to: Describe and analyze the opportunities, challenges and limits of Global Health Diplomacy. Examine the diplomatic, financial, and geopolitical context that underlies global health decision-making. Explain the role of the many players in the space, including governments, philanthropists, and multilateral institutions . Course Objective The field of global health is often thought of purely in medical or public health terms, but there are important geopolitical and policy dimensions of global health that underlie programmatic responses to global health challenges. By completing this course, learners will be able to explain the specific institutions and initiatives that are fundamental to current global health diplomacy activities and functions, and how these influence global health outcomes. Learners will further be able to summarize real-world examples where global health diplomacy either helped or limited global health outcomes, and explain the reasons for those outcomes.

From the lesson

What is global health governance and how does it work?

This module begins with defining the term “global health governance” and goes on to provide multiple case studies of the different types of governance mechanisms.

How is the WHO governed?6:06

Meet the Instructors

Gabrielle Fitzgerald
Executive in philanthropy and global health
Peter Small
Founding Director
Global Health Institute, Stony Brook University

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.

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