Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T16:31:03.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Current Problems in the World Health Organization's Program

Published online by Cambridge University Press:  22 May 2009

Charles S. Ascher
Get access

Extract

The International Health Conference, convened by the United Nations in New York in the summer of 1946, adopted a Constitution for a World Health Organization. It set up an Interim Commission of persons designated by eighteen named states to prepare for the First World Health Assembly and to carry on tasks inherited from previous international organizations. Unexpected delays in ratifications of the Constitution obliged the Interim Commission to operate for two years. WHO has thus been free to shape its destiny only from the time of the First World Health Assembly in the summer of 1948; it began its work formally as of September 1, 1948. The activities from 1946 to 1948 were largely determined by heritages from earner organizations; these, indeed, dominated the first program of WHO. The intervening three years have witnessed new trends, which some observers applaud and others view with doubt, if not alarm. It may be fruitful at this time to record some of these trends, to note the pressures which caused them and their implications for WHO's program and work-plan.

Type
Articles
Information
International Organization , Volume 6 , Issue 1 , February 1952 , pp. 27 - 50
Copyright
Copyright © The IO Foundation 1952

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 World Health Organization, Official Records, No. 9, p. 19–24Google Scholar.

2 Doubts have been expressed as to the wisdom of its maintenance by WHO: the present position is that its continuation is to be reviewed every two years by the Executive Board, Document A4/R/34.

3 The thirteenth session of the Economic and Social Council approved a European International Computation Centre only upon evidence from UNESCO that it would be supported by the countries to be benefited. Document E/2097.

4 At its eighth session the Executive Board approved “WHO's present policy of coordinating, promoting and assisting [research] within budgetary limits” and called upon the Director-General “to investigate the possibility of assisting and encouraging free communication between national research centres.” Document EB8/R/34.

5 The Health Organization of the League of Nations had been called upon to make advice available to Member states, growing out of the body of scientific knowledge brought together by its expert committees, toward the end of its life encompassing advice on the reorganization of national health services. World Health Organization, Official Records, No. 9, p. 22Google Scholar.

6 Ibid., No. 18, Annex 3, p. 27.

7 Ibid., No. 31, Proposed Programme and Budget Estimates for … 1952, Introduction by the Director-General, p. 2.

8 Ibid., No. 33, Annex 6, Section 36, adopted by the Assembly, document A4/R/28.

9 It was in this sense that the Director-General of UNESCO observed to its General Conference that the Program and Budget Commission “had just rejected a series of projects because the available budget seemed too small. That was a proof that program problems were always budgetary problems.” UNESCO document 5C/Proceedings, p. 339. See Ascher, Charles S., Program-Making in UNESCO, 1946–1951, p. 66–69Google Scholar, “Linkage of the Program and Budget”. The confusion is exacerbated for UNESCO by the constitutional provision that the General Conference is to “take decisions on programs drawn up by the Executive Board”, while the financial regulations require the Director-General to prepare the budget estimates.

10 World Health Organization, Official Records, No. 28, p. 191Google Scholar.

11 Ibid., No. 32, Annex 10.

12 Document A4/B/19. Note the indiscriminate use of “program” and “plan” in this brief resolution.

13 World Health Organization, Official Records, No. 10, p. 44Google Scholar. The Pan American Sanitary Organization, of course, had long supported the Pan American Sanitary Bureau out of funds received from the governments in the region.

14 See Odum Howard W., and Harry E. Moore, American Regionalism and Mumford, Lewis, , The Culture of Cities, V, VIGoogle Scholar.

15 The plan of the Region of the Americas for international attack on aedes aegypti, in view of jungle yellow fever in Central America, is another excellent example. The Pan American Sanitary Organization has long stressed regional programs.

16 It is partly to overcome this disparity and to bring together health officers of neighboring countries with immediate common concerns that the hemispheric region of the Americas had set up “sector offices” in Guatemala City, Lima and Rio de Janeiro and that the Regional Office for Africa proposes to set up three “zone offices”.

17 A classic study of the United States National Resources Committee revealed 108 separate “regional schemes” employed by Federal administrative offices, with the number of districts varying from 1 to 307. Regional Factors in National Planning and Development, p. 71.

18 Economic and Social Council document E/SR.506. Note that delegates from the countries making large contributions expressed reservations about the cost of decentralization. Delegates from underdeveloped countries applaud it.

19 The United Nations Advisory Committee on Administrative and Budgetary Questions voices the complaint that the growth of regional commissions of the United Nations is not accompanied by parallel reductions in the staffing of the Economic Affairs and Social Affairs departments. General Assembly document A/1853, paragraphs 11, 324.

20 It might even prove wise to maintain experts of highest competence in a regional office to deal with a disease the incidence of which was concentrated in that area.

21 Ascher, Charles S., “Washington-Field Relationships”, What We Learned in Public Administration During the War, p. 28–43Google Scholar.

22 Witness the statement of a chief of service of a national ministry: “I would like to express my gratitude to [the specialist at headquarters] of WHO for giving me the idea that our government might ask WHO for a consultant to undertake the Survey of … conditions … before we embark on any long-range development plans. After about 18 months I hear that the suggestion has been officially adopted and that consultant will be coming … next autumn.” Bey, M. K. el Khoury, Bulletin of the World Federation for Mental Health, III, p. 67Google Scholar.

23 There is occasional insistence from the Assembly that the organization add a subject to its program – like rheumatism or dental care – but WHO has not suffered the spate of new proposals at each session that has deflected the General Conference of UNESCO from orderly consideration of a carefully prepared plan of work. See Ascher, Charles S., Program-Making in UNESCO, 1946–51, p. 53, 65, 78Google Scholar.

24 There is an occasional dissenting opinion that some recommendations of some expert comproposals mittees are pious generalities or are not capable of practical execution.

25 Two comments by regional directors may be noted. One states, in retrospect, that his office was asked to assume responsibilities in 1950 for which it was not ready. Another states that a regional staff grows stale and repeats itself if there is not a stream of fresh suggestions from headquarters.

26 The delegate of India. Economic and Social Council 506th meeting.

27 It is evidence of the Director-General's recognition of human values in every aspect of WHO's organization that he expressed regret, Directorat the First Health Assembly “to see the committee continuing with an old confusion about the human race. He did not see the rationale of calling the western Pacific area the Far East – East of what? Near East – near what, or East of what?” It was at his instance that names were adopted “relevant to the real gensituation, which did not spring from an ancient orientation that should now be forgotten”. World Health Organization, Official Records, No. 13, p. 268Google Scholar.

28 In a previous article in this journal, “World Health and World Politics”, Charles E. Allen describes some “Ideological Issues” raised in the earlier Health Assemblies before the Soviet bloc withdrew as active members. International Organization, IV, p. 38–42.

29 The Constitution specifies that the Director-General may seek agreements with Member states to permit him to have direct access to health administrations and national health organization (Article 33). Nevertheless, he has found some key proposals to which a health ministry has agreed vetoed by the foreign office.

30 Let it not be thought that medicine generates no politics or pressures for specialism (lobbying at the Assembly by delegates, non-governmental organizations and staff specialists for a program) or for personal prestige. See Ascher, Charles S., “Specialism vs. Manage-ability”, Program-Making in UNESCO, 1946–51, p. 33Google Scholar.

31 Discussion of Article 74 in the Committee to Consider the Draft International Sanitary Regulations. Documents A3–4/SR/Min/36, p. 3–5; Min/37, p. 3–14; Min/38, p. 2–10. The chairman said that “every convention since the first in 1851 had had to compromise between the interests of shipping and transport and what the quarantine experts thought desirable.” (Min/38, p. 7).

32 Economic and Social Council document E/1849, p. 63–74; General Assembly document A/1589. “These criteria in no way conflict with those set up by the three World Health Assemblies and indeed the Organization has pioneered in this direction.” World Health Organization, Official Records, No. 33, p. 3Google Scholar.

33 Witness the paper that Dr. C.-E. A. Winslow has been commissioned to prepare on the economic value of preventive medicine, as a basis for discussion at the Fifth Health Assembly. The next task is to extend this analysis to each Member state as a basis for the formulation of its national health program.

34 Thus the Director-General of UNESCO could present to the sixth session of the General Conference a “Special Project for the Establishment of a World Network of Regional Fundamental Education Centres” with a table projecting for each of twelve years from D-year, the output of trained specialists, totalling 4,200. UNESCO document 6C/PRG/3. Or the Colombo Plan for Cooperative Economic Development in south and southeast Asia could project that the expenditure of £1,868 million in six years should result in an increase of seventeen percent in land under irrigation, 67 percent in electric generating capacity, etc. New Horizons in the East, His Majesty's Stationery Office, London (1950)Google Scholar.

35 General Assembly document A/1587, December 1, 1950.

36 An analysis in 1950 revealed that only five percent of UNESCO's expenditures had an impact on south and southeast Asia, perhaps three-quarters affected chiefly the North Atlantic community. Ascher, cited above, p. 76.

37 Statement at the 16th Meeting of the second session of the Executive Board, November 9, 1948, World Health Organization, Official Records, No. 14, p. 46Google Scholar.

38 Ibid., No. 28, p. 392.

39 United Nations General Assembly Resolution 165 (II).

40 See the comments on the proposal to establish a supervisory commission for UNESCO, Ascher, cited above, p. 70–71.

41 World Health Organization, Official Record, No. 13, p. 316Google Scholar.

42 Ibid., No. 21, p. 261, 343.

43 Ibid., No. 22, p. 11.

44 Ibid., No. 29, p. 11.

45 World Health Organization, document EB8/48. See also document EB9/6: “Responsibilities of the Executive Board Concerning Program and Budget”.

46 A curious difficulty arises. Even if the volume is dispatched to Member states in good time, it is too heavy to include in aviation luggage, so that the delegates who fly from distant countries ask for fresh copies on arrival that they try to assimilate on the eve of the Assembly.

47 It is of interest that UNESCO, too, has suffered from the sense that its General Conference should serve as a forum for a distinguished assemblage of intellectuals to speak to the world on the basic problems of the spirit that beset it. It has experimented with a variety of devices to meet this felt need, but none has proved satisfactory. See Ascher, cited above, p. 53.

48 Ascher, cited above, p. 29, 34, 49–52, 81.