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Monday, January 26, 1998 Published at 14:20 GMT



Special Report

50 years of the WHO - successes and failures

The World Health Organisation is preparing to elect a new Director General in its 50th year. The BBC's Health Correspondent, Richard Hannaford, reports from Geneva on the challenges facing the new DG:

To millions around the globe the organisation is known for providing healthcare to impoverished people in developing nations.

But for many others the WHO has become a by-word for international politicking and financial mismanagement.

There are persistent criticisms that many appointments within the organisation owe less to ability than to political patronage. Most of the controversy, however, has focused on the post of the organisation's director general. At the last election in 1993, there were allegations of vote buying. This year the job is up for election once again and many countries are watching the proceedings with a lot of suspicion.

At the end of this month, the WHO's Executive Board will nominate its candidate for the post. That person's name will then go forward to the World Health Assembly meeting in May where the 191 member countries will decide to accept or reject the Board's choice.

The man or woman elected, will shape the WHO's policies for the 21st century.

History

The idea of a World Health Organisation was first thought of as long ago as 1851, but it was not until after World War II when, flushed with idealism, a specially convened conference was held in New York in 1946 which drew up the organisation's constitution. The World Health Organisation was officially established on the 7th April 1948 when the United Nations formally ratified its constitution.

Objectives

Its primary objective is "the attainment by all peoples of the highest possible level of health". Health being not just the absence of illness or infirmity - but the complete physical, mental, and social well being of the individual.

Today, the WHO is the main directing and co-ordinating authority on international health work. It can provide governments with technical help to supply healthcare and deliver emergency aid in times of crisis.

But the organisation is perhaps best known for its work to prevent and control epidemics like Aids, Tuberculosis, Malaria and other diseases.

Successes

Perhaps the WHO's greatest triumph so far came in 1977 when it announced that it had achieved its aim of eradicating small pox from the globe. It is also on course to eliminate poliomyelitis - possibly by 2010.

Four other tropical diseases - leprosy, river blindness, chagas disease and filariasis are on its hit list. It believes that within 10 years all four can be removed as public health dangers - given a little additional investment.

Its encouragement of breast feeding and its campaign to immunise children in developing nations against six diseases of childhood - diphtheria, tetanus, whooping cough, poliomyelitis, measles and TB, also stand as proud achievements.

But perhaps its biggest impact has been its influence on public health medicine. Its emphasis on community solutions rather than hospital based healthcare has led to a revolution in the design of health services not only in developing nations but also in industrialised ones.

It has also expanded its agenda to include social and environmental issues. Nowadays it is accepted that it has as much right to talk about water quality as it has to discuss medicines and to address the issues of bad housing and environmental pollution as well as infant mortality and Aids.

Failures


[ image: The WHO wrongly predicted that Malaria would be eradicated]
The WHO wrongly predicted that Malaria would be eradicated
However there have been some notable failures. Despite initially declaring that Malaria would be eradicated, the WHO has had to concede that the disease has proved more persistent and resistant to drugs than it originally realised. There is also the depressing fact that Cholera, Diarrhoea and Tuberculosis are still killing thousands of children and adults each year in the developing world despite cures being available.

In the case of TB, misuse of antibiotics has caused severe problems with the disease becoming resistant to the initial treatments. A new TB programme has been set up to try to address the problem but progress is proving slow.

Criticism

But many of these setbacks would have been accepted by the WHO's critics were it not for allegations that the organisation has become bureaucratic and hamstrung by internal politicking.

For the past 10 years, Dr Hiroshi Nakajima has been the Director General of the WHO. He was the first Japanese citizen ever to be elected as head of a UN agency. However, he has come in for fierce criticism both from inside and outside the organisation.

His critics have accused him of being autocratic, bureaucratic, and lacking in communication skills. When he stood for a second five-year-term in 1993, there were allegations that funds had been used to buy votes.

Although a financial audit found no evidence of that, the report was critical in tone. It noted that there had been "a sizeable increase in the number and value of contracts let in the last six months of 1992 with individual members ... of the executive board (which is responsible for recommending a candidate for the post) compared to the equivalent period in 1991".

Such was the bad feeling surrounding the re-election that someone got into the ornamental pond at the WHO's Headquarters in Geneva and killed and gutted a Koi carp called D-G.

Dr Nakjima's nomination was narrowly endorsed by the World Health Assembly but he had lost the support of the United States and other Western governments.

Financial constraints

As a result of the bad feeling engendered by his re-election and shrinking aid budgets world-wide, the WHO has found itself under increasing scrutiny by the major financial donors.

Controversy broke out again in 1995 when the WHO's external auditor told the Assembly that the Secretariat in Geneva had failed to cooperate with his inquiry into alleged fraud, waste, and financial impropriety.

While many of the projects run by the WHO found themselves under tight financial constraints, the budget to fight Aids continued to grow. But continued criticism about the way it was managed led to the United Nations transferring responsibility for Aids to a new UN programme.

Also during this time the WHO began to lose its role as the world's main health authority, as non-governmental organisations and even other UN agencies began to play an important role in shaping international health policy.

The Issues

Despite the criticism, it is agreed by all that some form of international organisation is needed to co-ordinate public health programmes across the world. In the age of inter-continental jet travel the belief that one country's epidemic threatens all is a reality.

At the same time, the pattern of illness is changing. More and more heart disease and cancers are becoming not just the diseases of the affluent countries, but also of those aspiring to affluence.

The WHO of the 21st century will face all these problems against a background of even tighter financial constraints. The new director general must restore his organisation's credibility for financial management and fair dealing.

To this end he or she will face pressures to reform and re-structure the organisation. Many vested interests will have to be challenged.








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