Student: Tareq Al Rubei
Event: TIMUN 2000, Alternative Assignment
Links to other sites on the Web: Back to the Model UN 2000-2001 page
World Health Organization
World Health Organization (WHO), specialized agency of the United Nations, established in 1948, with its headquarters at Geneva. WHO admits all sovereign states (including those not belonging to the United Nations) to full membership, and it admits territories that are not self-governing to associate membership. In 1999 there were 191 members. WHO is governed by the World Health Assembly, consisting of representatives of the entire membership, which meets at least once a year; an executive board elected by the World Health Assembly; and a secretariat headed by a director-general. There are regional organizations in Africa, the E Mediterranean, SE Asia, Europe, the W Pacific, and the Americas. WHO has made notable strides in checking polio, leprosy, cholera, malaria, and tuberculosis, and sponsors medical research on tropical and other diseases. WHO has drafted conventions for preventing the international spread of disease, such as sanitary and quarantine requirements, and has given attention to the problems of environmental pollution.
WHO is defined by its Constitution as the directing and coordinating authority on international health work, its aim "the attainment by all peoples of the highest possible level of health". The following are listed among its responsibilities, to assist governments, upon request, in strengthening health services. To establish and maintain such administrative and technical services as may be required, including epidemiological and statistical services. To provide information, counsel, and assistance in the field of health; · to stimulate the eradication of epidemic, endemic, and other diseases, to promote improved nutrition, housing, sanitation, working conditions, and other aspects of environmental hygiene; to promote cooperation among scientific and professional groups which contribute to the enhancement of health. To propose international conventions and agreements on health matters; · to promote and conduct research in the field of health. To develop international standards for food, biological and pharmaceutical products; and, to assist in developing an informed public opinion among all peoples on matters of health.
History of WHO
Cholera overruns Europe First International Sanitary Conference
is held in Paris to produce an international sanitary convention,
but fails. International Sanitary Convention, restricted to cholera,
is adopted. Another international convention dealing with preventive
measures against plague is adopted. International Sanitary Bureau,
later re-named Pan American Sanitary Bureau, and then Pan American
Sanitary Organization, is set up in Washington D.C. This is the
forerunner of today's Pan American Health Organization ,
which also serves as WHO's Regional Office for the Americas.
L'Office International d'Hygiène Publique is established in Paris,
with a permanent secretariat and a permanent committee of senior
public health officials of Member Governments. League of
Nations is created and is charged, among other tasks, with taking steps in
matters of international concern for the prevention and control of disease.
The Health Organization of the League of Nations is set up in Geneva,
in parallel with the OIHP. International Sanitary Convention
is revised to include provisions against smallpox and typhus.
International Sanitary Convention for aerial navigation comes into force.
Last International Sanitary Conference held in Paris.
Conseil Sanitaire, Maritime et Quarantinaire at Alexandria is handed
over to Egypt. (The WHO Regional Office for the Eastern Mediterranean
is its lineal descendant). United Nations Conference on International
Organization in San Francisco unanimously approves a proposal by Brazil
and China to establish a new, autonomous, international health organization.
International Health Conference in New York approves the
Constitution of the World Health Organization (WHO).
WHO Interim Commission organizes assistance to Egypt to
combat cholera epidemic.
WHO Constitution comes into force on 7 April
(now marked as World Health Day each year),
when the 26th of the 61 Member States who signed it
ratified its signature. Later, the First World Health
Assembly is held in Geneva with delegations from 53
Governments that by then were Members.
Text of new International Sanitary Regulations adopted by the
Fourth World Health Assembly, replacing the previous
International Sanitary Conventions.
These are renamed the International Health Regulations,
excluding louse-bourne typhus and relapsing fever, and
leaving only cholera, plague, smallpox and yellow fever.
Report from the Executive Board concludes that there is
widespread dissatisfaction with health services.
Radical changes are needed. The Twenty-sixth World
Health Assembly decides that WHO should collaborate
with, rather than assist, its Member States in
developing practical guidelines for national health care systems.
WHO launches an Expanded Programme on Immunization to
protect children from poliomyelitis, measles, diphtheria,
whooping cough, tetanus and tuberculosis. Thirtieth World
Health Assembly sets as target: that the level of health
to be attained by the turn of the century should be that
which will permit all people to lead a socially and
economically productive life: Health for All by the Year
2000. Joint WHO/UNICEF (United Nations Children's Fund)
International Conference in Alma-Ata, USSR, adopts a
Declaration on Primary Health Care as the key to attaining
the goal of Health for All by the Year 2000. United Nations
General Assembly, as well as the Thirty-second
World Health Assembly, reaffirms that health is a powerful lever for
socioeconomic development and peace.
A Global Commission certifies the worldwide eradication of smallpox, the last known natural case having occurred in 1977. Global Strategy for Health for All by the Year 2000 is adopted, and is endorsed by the United Nations General Assembly, which urges other international organizations concerned to collaborate with WHO. United Nations General Assembly expresses concern over the spread of the AIDS pandemic. The Global Programme on AIDS is launched within WHO. 40th Anniversary of WHO is celebrated. Forty-first World Health Assembly resolves that poliomyelitis will be eradicated by the year 2000. Children's Vaccine Initiative launched with UNDP, World Bank, and the Rockefeller Foundation. WHO Centre for Health Development opened in Kobe, Japan. 50th Anniversary of the Signing of the WHO Constitution.
As of 31 December 2000, the rate of collection of annual contributions in respect of the regular budget is higher than in 1999. Out of a total amount of $ 421 305 220, $ 365 083 120 or 86.66% has been collected, as compared to 84.58% in 1999. Whereas 119 Members had paid their contributions in full and 25 Members in part, 49 Members had not yet paid any part of their assessment. Advance payments in respect of the year 2001 contributions are listed on page 7 of this statement.
Strengths and Weaknesses:
Taiwan and the WHO
The fight to get the State Department to push for Taiwan's observer status in the World Health Organization continues.
Last year, Public Law 106-137 requested a report from the Clinton Administration on its efforts on Taiwan's behalf. The resulting report was less than acceptable. In an April letter to the President, twenty Senators, include Joseph Lieberman, demanded more.
Dear Mr. President:
We are writing with respect to the recent report issued by your Administration concerning Taiwan's participation in the World Health Organization (WHO)….
We believe…that the report fails to address the crux of the issue: the people of Taiwan are being systematically denied access to the benefits of organizations such as the WHO, the primary objective of which is, after all, "the attainment by all peoples of the highest possible level of health." Denying such benefits in the case of the people of Taiwan is, we believe, a gross dereliction of duty by the WHO, and should not stand unchallenged….
While the report reaches the right conclusion that Taiwan's participation with the WHO should be supported, it does not, in our view, create a systematic plan for reaching that objective. We believe it is incumbent on your administration to support more vigorously humanitarian efforts by the people of Taiwan to gain access to international health policy planning. The overwhelming support from Congress for this principle has manifested in numerous requests of the Administration to push for meaningful participation by Taiwan in the WHO and other international organizations.
We understand the importance of sovereignty and statehood concerns as they relate to participation in international organizations. Your Administration has in the past set aside similar concerns, however, when humanitarian factors are at stake. In the case of Taiwan's membership in the WHO, functional humanitarian concerns greatly outweigh matters of organizational form. Accordingly, a failure by your Administration to properly champion the participation by Taiwan in the WHO would be a decision to place matters of mere political convenience above overriding humanitarian concerns. …We urge you to take concrete steps to ensure that no people are denied the highest possible standards of health or other human rights by the political limitations of international organizations to which the United States is a party.
Sen. Frank Murkowski Sen. Joe Lieberman
Sen. Jesse Helms Sen. Jay Rockefeller
Sen. Wayne Allard Sen. James Inhofe
Sen. Robert Torricelli Sen. Jim Bunning
Sen. Jon Kyl Sen. Robert Bennett
Sen. John Ashcroft Sen. Connie Mack
Sen. Max Baucus Sen. Mary Landrieu
Sen. Bob Smith Sen. Susan Collins
Sen. Paul Coverdell (+) Sen. Mike DeWine
Sen. Conrad Burns Sen. Richard Bryan
Seven of Taiwan's House friends, Reps. Sherrod Brown (D-OH), Steve Chabot (R-OH), Tom Lantos (D-CA), Pete Stark (D-CA), Phil English (R-PA), Dana Rohrabacher (R-CA), Bob Wexler (D-FL) and John Larson (D-CT), introduced a bill earlier this year that mandates State Department pursuit of observer status for Taiwan at the May annual summit of the World Health Organization in Geneva.
We are hopeful that the basic mandate from this bill might be inserted in one of this year's remaining Appropriations Bills. Here is the text:
"The Secretary of State shall initiate a United States plan to endorse and obtain observer status for Taiwan at the annual week-long summit of the World Health Assembly in May 2001 in Geneva, Switzerland, and shall instruct the United States delegation to Geneva to implement such plan."
YUGOSLAVIA’S RETURN TO THE WORLD HEALTH ORGANIZATION
Yugoslavia will return to the World Health Organization (WHO) automatically, as soon as its return to the UN membership is resolved, which is expected to take place at the next session of the UN General Assembly in May, said the WHO representative in Belgrade, Dr. Rista Tervahauta. According to him, the cooperation between WHO and Yugoslavia in the realization of many health programs even during sanctions was not abandoned, but was taking place, although under difficult conditions. He said that the Federal Ministry for Labor, Health and Social Policies has accepted that Yugoslavia takes an active part in the realization of six priority programs of the WHO, immediately upon its return to the membership of this organization.
WHO pleads with Saudi Arabia to let in Ugandan pilgrims
World Health Organization officials are pleading with Saudi Arabia to lift a ban on Ugandan pilgrims to Mecca that was imposed out of fear they might spread the deadly Ebola virus in the kingdom.
"The worst-case scenario of the Ebola epidemic is virtually over. They don't have full information, because if they did they would not have taken this decision," said Dr. Oladapo Walker, the WHO representative in Uganda.
An official at the Saudi embassy, who declined to give his name, confirmed reports in the state-owned New Vision newspaper Thursday that Ugandan pilgrims are being denied visas.
Muslims try in their lifetime to make at least one pilgrimage to Mecca, the holiest of Muslim sites and birthplace of the Prophet Mohammed.
Mahdie Kakoza, an official of the Uganda Muslim Supreme Council, said about 700 Muslims had registered with the organization to make the 10-day pilgrimage, which begins in late February.
Walker said he had written to the Saudi embassy, saying there was no possibility of Ugandans spreading the Ebola virus in the kingdom.
An outbreak of the deadly virus was confirmed October 14 in northern Uganda and later spread to two other regions. The disease has so far claimed 173 lives here.
The Ministry of Health has begun a countdown of two consecutive 21-day periods. If no new cases are reported between the middle and the end of February, the outbreak will be declared over in Uganda.
Roles of WHO in an Economic Crisis
WHO, as a specialized agency of the United Nations (UN) system, has unique roles, to provide technical assistance. These roles become even more critical in a time of economic crisis. Specific roles, and concrete examples of how these roles have been implemented in Indonesia, include the following:
Advocacy for a social safety net, including health
In January 1998, WHO convened a meeting of representatives of UN agencies in Jakarta to alert the UN agencies of the threats to the health of the most vulnerable groups in Indonesia due to the economic crisis and to note that the UN agencies, working together, could play a significant role in ameliorating the effects of the crisis on health. This led to such innovative approaches as the UNIDO effort to explore the potential of the Indonesian fine chemical industry to manufacture the raw materials needed by Indonesian pharmaceutical manufactures to continue to make essential drugs.
In February, April, and July of 1998, WHO either chaired, or co-chaired, with the Ministry of Health, informal donor meetings in the health sector on the economic crisis and its impact on health. These meetings brought together government agencies, UN agencies, development banks, bilateral development assistance agencies, and nongovernmental organizations to discuss the impacts of the crisis on health, the needs of the government to address these impacts, and the willingness of donors to help meet these needs. Such meetings helped to keep health high on the list of government and donor priorities for inclusion in a "social safety net."
Throughout the crisis, WHO has met with numerous donors and potential donors to advocate the important "link" that health should play in a "social safety net" in Indonesia, including provision of information on: gaps developing for needed raw materials for essential drugs; essential imported medical supplies (x-ray films, sutures, IV kits and blood bags, test kits and reagents); and the operational costs for providing services to the poor by village midwives (bidan di desa), health centres (puskesmas) and first referral-level hospitals (district hospitals).
In addition, WHO, at the regional level, called a Meeting on the Economic Crisis and its Impact on Health in Bangkok in March 1998, and supported a Regional Meeting of Parliamentarians on the same subject in Jakarta in December 1998, to draw linear attention to the crisis, and for countries to share their experiences in coping with the crises. At the global level, WHO has been involved in advocacy for health under times of economic crisis. As recently as December 1998, WHO headquarters called a special meeting in Geneva to review the experiences with structural adjustments and their impacts on health and to recommend ways that WHO can be even more proactive and effective at global, regional and country levels during times of economic crises.
Technical assistance to government in assessing the likely impacts of the crisis on health and developing interventions to ameliorate those impacts
WHO prepared materials, in collaboration with government counterparts, on the likely early effects of the economic crisis on health, including availability of essential drugs and vaccines, declining health status of the poor and near poor population, increase in the utilization of government health services, and decrease in the demand for private sector health services. Short-term interventions recommended to address these likely impacts included: issuing Ministry of Finance letters of credit to immediately import at least a six-month supply of critical consumables (e.g., x-ray films and laboratory reagents) and the raw materials to make essential drugs; halting of non-essential new civil works, construction and equipment purchases; reprogramming donor-assisted projects to the highest priority needs; targeting scarce resources to the priorities of maternal and child health care in areas of greatest need; maintaining the distribution of doctors and village midwives in the poorest rural areas; paying subsidies to support operational costs of health centres and hospitals in areas with a high proportion of poor; rapidly developing the kartu sehat (health card for the poor) system to correct its deficiencies; and establishing a sensitive monitoring system for the health effects of the crisis. Intermediate and longer term recommended actions included: encouraging increased use of generic drugs and promoting health insurance with cross-subsidies for the poor.
As the crisis unfolded, WHO continued its dialogue with the Ministry of Health and the central planning bureau (BAPPENAS) to identify additional areas of impact of the crisis on health and to refine cost-effective recommendations on interventions. Such work is based upon the technical expertise of in-country WHO international and national staff as well as selected visits of technical experts from its Regional Office and headquarters (e.g., a consultation by the headquarters’ Drug Action Programme on the issues of rational drug use, drug dispensing policies, and drug registration procedures).
Technical assistance to the government in developing monitoring systems
WHO provided technical assistance to the Government in developing monitoring systems (with recommended outcome health indicators, such as levels of malnutrition in children, and process indicators, such as essential drug prices and availability). Such monitoring, although still at an early stage, will ultimately help to determine the actual impacts of the crisis on the health status and delivery of health services, target interventions to the areas of greatest need, and assess the effects of interventions. For example, WHO is working with the Ministry of Health to improve the collection and analysis of information about drug supplies at the district level. In addition, support is being given for a rapid assessment of drug supplies and prices at all administrative levels. In Indonesia, the Ministry of Health has created a crisis centre to be a focal point for this monitoring activity and WHO provides the services of international and national staff in supporting this activity.
It is a challenge to balance the needs of a streamlined, timely, complete and focused monitoring system at a time of crisis versus the routine reporting systems for health data. In addition, more needs to be done to link information with interventions and to provide data useful to decision-makers. Ideally, the monitoring systems in the crisis can be a stimulus to a more effective routine data collection system that will remain in place after the crisis – rather than a parallel system that is only temporarily established and then dismantled after the crisis has passed.
Supporting coordination efforts of the government
WHO works to support the government’s efforts in coordinating inputs by the international community (UN agencies, development banks, bilateral development assistance agencies, and nongovernmental organizations) to avoid duplication of efforts and reduce gaps in critical areas. Such support ranges from helping to organize informal donor meetings of all donors in the health sector, to providing the services of in-country WHO international and national staff to work, together with Ministry of Health counterparts, on a one-to-one basis with donors to develop and refine their individual project or sector loans and grants.
Technical assistance to others in the international community
WHO also provides technical assistance to others in the international community, both on request and through proactively offering, regarding their project or health sector loans or grants to help maximize the impacts of these loans or grants on improving health. In Indonesia, examples have included: consultations with UN agencies (such as UNICEF, UNFPA, and UNIDO), development banks (such as World Bank and the Asian Development Bank), bilateral development assistance agencies (such as US Agency for International Development , Japanese International Cooperation Agency, and the Australian Agency for International Development), and nongovernmental organizations (such as PATH and UPLIFT International).
Although WHO is primarily a technical assistance agency, it sometimes provides limited funds for critical shortfalls where other donors may not be able to mobilize funds quickly. In Indonesia, examples have included: providing $100 000 for an emergency purchase of HIV test kits to ensure continuity of testing for blood safety while other donor funds were being mobilized to assure a longer term supply of the test kits, helping to support the establishment of a Health Development Reform Task Force, and assisting in the formation of a crisis centre within the Ministry of Health.
The economic crisis provides an opportunity to learn what approaches work and don’t work that may be useful as the crisis continues and may have applicability to other countries experiencing a similar crisis. Some of these lessons learned in Indonesia, to date, include the following:
Crisis as opportunity
At first, the crisis seems overwhelming in its nature. From the WHO side, we appreciate that, in a crisis situation, it is often difficult to look ahead from the immediate crisis at hand to the looming crises yet to come. However, the crisis forces a "new look" at virtually all policies, strategies and programmes due to the threats of contracting funds. Often the problems existed before and are only exacerbated by the crisis. In this way, the crisis can also be seen as an opportunity to solve key problems and make significant improvements in both government and donor programmes and interactions.
In the health sector, this means that we also need to view the crisis as an opportunity for change and to improve efficiency. In Indonesia, such opportunities include: (a) developing timely and comprehensive monitoring systems to look at utilization rates of health centres and hospitals, availability and costs of essential drugs, and increases in diseases (especially those associated with poverty) to assess trends and the effects of interventions; (b) increasing the proportion of government budgets to the social and health sectors (real increases as compared to increases due only to the donor projects being valued at a higher rate of exchange due to their dollar-based funding); and (c) Improving the procurement of raw materials, finished products and medical equipment being imported for the health sector.
Importance of priority setting
In a situation of scare resources, decisions must be made on funding priorities. For example, is it better to use public funds for the medicines needed to keep 1 000 terminally-ill cancer patients alive for a few months longer, or to use these funds to provide the antibiotics needed for treating pneumonia in 100 000 children? In an ideal world, all medical care needed for all peoples would be available. We do not live in that ideal world in any country and, in Indonesia, some of these choices may have to be made. In the absence of consensus on such issues, conflicts over the use of funds will arise and often the most vocal, rather than the most needy, will win. The government should focus its resources on subsidizing public goods and cost-effective interventions. On the other hand, such insurance schemes should be established as would enable all people to have access to treatments for more costly diseases, such as cancer and renal failure.
Potential to lose priority setting pressures in the face of additional funds
The pressures brought by an economic crisis to prioritize, may, however, be deferred as additional funds are provided by the donor community. There is a balance between providing a safety net whereby extremely difficult choices (such as whether or not to use the funds to save 100 000 children from pneumonia or 100 000 children from diarrhoeal diseases) do not have to be made, and between providing a surplus of funds that allows cost-inefficient programmes to easily continue (including non-competitive procurement of medical equipment and imported raw materials for the manufacture of essential drugs, practices of corruption, and non-rational drug prescribing practices).
Donor driven or inappropriate consumer driven programmes
A crisis may result in donors with good intentions providing materials that may not be in the best interests of the country. A good example is the donation of medical supplies and pharmaceuticals. In Indonesia, for example, dialysis supplies have been sent by donors without first checking to see if they are compatible with the dialysis equipment used in the country. Pharmaceuticals have been donated that were short-dated or not in the drug formularies of the country.
Consumers, too, can put pressure on the government to supply items that may, in fact, worsen the situation. An example in Indonesia has been the concerns expressed by some mothers about the prices of infant formula. Importation and distribution, by the government and donors, of infant formula may create the impression that infant formula is preferable to exclusive breast-feeding for the first 4-6 months of life. Rather than the protective effect of exclusive breast-feeding (and the fact that breast milk is free), infants will potentially be weaned to an infant formula that may be overly diluted (because of its expense, even if subsidized) and prepared with contaminated water (because of the difficulty and expense of boiling or using bottled water for proper formula preparation) in situations with unsafe water supplies.
Disbursement of funds without clear guidelines
In the good-intentioned effort to disburse funds quickly to create a social safety net, there must first be a well thought-out guideline as to how to use the funds. For example, in Indonesia, a social safety net programme disbursed funds (10 000 rupiah per poor family) to district levels to support health services for the poor by village midwives and health centres. However, many midwives and health centres delayed drawing on these funds because of their initial concerns that there was not sufficient guidance on exactly what the funds could be used for. They feared that if they used the funds without detailed guidelines, they might later be subject to an audit that could accuse them of not properly using the funds.
Paucity of data for decision making
Of great concern to many donors, and to the government as well, is the difficulty of activating the routine information systems to rapidly report, in a timely and complete manner, essential indicators by which to measure trends in health status and the provision of health services, to target the vulnerable populations in greatest need, and to determine the effect of intervention programmes. In Indonesia, these concerns have led, in some cases, to the development of parallel information systems that may duplicate the work of the routine system, or overlap with the work of other parallel information systems being set up by different units within the government, funded by different donors. In addition, there is a tendency to set up an elaborate, centralized reporting system. Interventions are conducted locally and useful information is most needed at these levels to guide local efforts. The establishment of a crisis centre, with a mandate to oversee all data collection efforts to monitor the crisis, may help to stimulate the routine system and maximize the benefits of specialized reporting systems. This will ensure that the data for decision-making are readily available and will also provide donors with the confidence that their contributions are accounted for and making an impact on ameliorating the effects of the crisis.
The effects of other sectors on health
There are many other sectors whose activities have direct or indirect impacts on health. Transportation affects the distribution of food, medicines and referral medical care. Agriculture and the availability of agricultural products affect the nutritional status of the population. Education levels affect basic health knowledge and literacy has been demonstrated as a factor in improved health. Family planning limits the too many, too often, too young and too old pregnancies that lead to high maternal mortality rates and a cycle of poverty. Industry and employment affects the levels of poverty. Environment and public works affect the availability of safe water and adequate sanitation. It is a challenge during a crisis to see how to maximize the positive impact of the different sectors on health and, in turn, how good health can lead to positive impacts in the other sectors (e.g., a healthy worker is a more productive worker in industry or agriculture).
It is clear that the Government of Indonesia and its Ministry of Health are very concerned about the implications of the economic crisis on the health of the Indonesian people. It is also recognized that, in addition to health, there are great concerns regarding the entire social sector and the need to establish a "social safety net" to protect the most vulnerable segments of society.
The development and donor community in Indonesia, including WHO, is also very concerned about the health implications of the economic crisis and is showing an unprecedented degree of flexibility of approach to ensure that loan and grant projects are suitably adapted to the new realities.
Is the common goal to achieve sustainable development of the Indonesian people threatened by the potential of this economic crisis to take back many of the hard-won development gains, including those in health, such as decreases in infant and childhood mortality rates, increases in life expectancy, and decreases in fertility rates?
No one person or agency has all the answers; and no one, alone, can solve all of the problems. But, working together, creative and innovative ways can be found to help ensure that the most vulnerable groups will continue to have access to primary health care services. After the process of overcoming this crisis, it may be possible to ultimately look back at some future time and realize that such a crisis has provided the impetus that was needed for improving efficiencies in the health system; strengthening competition in such areas as pharmaceuticals, medical equipment and vaccines in the era of globalization; and establishing reforms for health financing to protect the poorest of the poor.
WHO’s role is to advocate and provide technical assistance to those working on structural adjustment policies, to encourage placing "a human face" on such adjustments and to put into place the "social safety net" that prevents the most vulnerable segments of our society from plunging into a cycle of poverty and ill-health – each conspiring to create an inescapable spiral of needless suffering, disability and even death.
United States of America and its allies, simply every country that needs help.