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3 Big Ideas Emerge from the 2018 World Health Assembly

World Health Assembly

This year's annual meeting of the World Health Organization revealed some insights into an evolving organization. Photo courtesy of Pape Gaye.

Is the World Health Organization reembracing its original principles?

As the World Health Assembly (WHA) ended last month, I was left wondering: is this a new and improved World Health Organization (WHO), or is it simply becoming what its founders intended all along?

Here are a few things that made this annual meeting of the WHO different from past years, and offer us some insight about how the organization might be evolving.

A physical focus on noncommunicable diseases

The day before WHA officially began, hundreds of participants and curious locals followed the WHO’s new Director-General Dr. Tedros Adhanom Ghebreyesusin on a brisk walk around Geneva to commemorate the struggle against noncommunicable diseases (NCDs) and celebrate health, well-being, and the WHO’s 70th birthday.

Official short yoga breaks, during which the hundreds of delegates stretched, breathed, and moved, broke up hours of deliberations in the main committee rooms. And for the most part, the agenda ran on track and on time.

The focus on NCDs continued throughout the WHA, as the assembly confirmed the need to support countries in strengthening health systems to better prevent, detect, manage, and treat them.

A new 5-year plan and the 1 billion goals

Health is “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” —WHO founding documents, 1946

The WHO’s 13th General Program of Work (GPW) 2019-2023—which will guide the organization for the next five years and was unanimously approved at the assembly—brings WHO back to its roots with a strong focus on universal health coverage.

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” This sounds like a human rights-focused definition of UHC that could have been written today. It was written, however, more than 70 years ago as part of WHO’s constitution, which was adopted in 1946—two years before WHO’s establishment.

The new GPW’s tagline is “Promote health, keep the world safe, serve the vulnerable.” Since the beginning, one of the WHO’s main roles has been serving as the coordinating authority on national health work, helping governments (“upon request”) to strengthen their health services.

This is more crucial now than ever, as countries’ health systems struggle to meet their populations’ needs for universal primary health services, including noncommunicable disease care, along with pandemic response and ongoing infectious disease control.

Without strong primary health care, this will not be possible.

We’ve seen already that fragile health systems can crumble under the weight of a single Ebola outbreak, or fall apart during natural disasters, or be torn asunder during war and civil unrest. Our health systems must be strong enough to manage ongoing infectious diseases and emerging threats, including prevention, detection, and management of heart disease, cancer, and other NCDs.

“Without strong primary health care,” the plan states, “this will not be possible.”

The WHO has, since its early days, worked to improve some of the social determinants of health, including nutrition, housing, sanitation, working conditions, and more. More than 70 years ago, WHO committed to addressing maternal and child health and welfare, mental health, and even “the ability to live harmoniously in a changing total environment.”

To reach these objectives, the new GPW focuses on three new targets—the ambitious “1 billion goals”:

  • Advance universal health coverage, ensuring 1 billion more people benefit from universal health coverage.
  • Address health emergencies, ensuring 1 billion more people are better protected from health emergencies.
  • Promote healthier populations, ensuring 1 billion more people are enjoying better health and well-being.

These goals are not mutually exclusive. All will require stronger, more resilient health systems—including strong policies, management, and an emboldened global health workforce.

No longer the World Disease Organization

“WHO will act with a sense of urgency, scale, and quality. The health of the world’s people cannot wait.” —GPW, WHO, 2018

The 13th GPW is focused on outcomes—unlike the previous plan, which was organized by disease-specific programs of work. The program focuses on the original definition of health, not just the absence of diseases. It includes strong goals around health systems and capacity-building, especially at the country level. The director-general also is focused on soliciting more comprehensive health systems funding, moving away from disease-specific buckets of money that lead to siloed programming.

The focus on leadership and governance includes strong support for the health workforce.

One of most important of the 10 key outcomes the new GPW identifies is “strengthened leadership, governance, management, and advocacy for health.” Without strong leadership and governance, management skills, and civil society advocacy, it’s hard to imagine achieving this bold program of work.

At IntraHealth International, we’re excited that the focus on leadership and governance includes strong support of the global health workforce—the people who make health happen.

The world’s health organization has been widely criticized, especially over the past few years—including during the Ebola and Zika outbreaks. In 2016, Reuters reported: “Public health specialists, non-governmental organisations and some of the WHO’s biggest donors say the organisation is unwieldy, poor at coordinating responses to epidemics, and too thinly spread. And increasingly it struggles to set its own priorities because many of its donors give it money earmarked for specific projects.”

Although I left the WHA wondering about the future of the “new and improved” WHO, I also left with a new sense that the new WHO better understands the challenges it faces. I left with optimism and excitement that the WHO can change and become more efficient and inclusive. The organization has an ambitious role to play in this world of changing epidemiological profiles and political priorities.

The 2016 Reuters article also reported, “There’s another big problem, many people say: The WHO tries to do too much.”

I hope the newfound focus on leadership, governance, and capacity building—especially supporting in-country offices—is the shift the organization needs to remain relevant and critical in today’s world.

IntraHealth has been in official relations with the World Health Organization since 2014 and participates in a variety of technical working groups and hubs. Our delegation at the World Health Assembly took part in a wide range of sessions during the 71st World Health Assembly. Our delegation included several frontline health workers who shared their stories.