Structure

WHO is a specialized agency of the UN, as provided for in the Charter of the United Nations. A goal-oriented organization with policies, program, and budget defined through well-developed mechanisms, WHO consists of three constituent bodies:

• The World Health Assembly, which is the highest decision-making body, is held in May each year and is attended by delegations from WHO's 191 member states and two associate members. Its main tasks are to decide on major policy matters and to approve the biennial program budget.

• The Executive Board consists of 32 persons, acting in their personal capacity, highly qualified in the field of health and designated for a 3-year term by as many member states, which are chosen by the Health Assembly on the basis of equitable geographical distribution. The board, which normally meets twice a year, gives effect to the decisions and policies of the Assembly, while advising it and preparing its agenda. • The Secretariat serves to carry out the decisions of the World Health Assembly and the Executive Board; it is the entire staff of WHO headed by the director-general, who is appointed as its chief technical and administrative officer for a 5-year term by the World Health Assembly on the nomination of the Executive Board.

In general, all technical activities that are of universal applicability—such as biological and epidemiological standardization, the overall assessment of the efficacy of methods and materials, and promoting the control of disease—are the responsibility of the headquarters in Geneva (Figure 2). WHO's highly decentralized structure enables it to respond directly to the needs of its membership, upon request, through its six regions, each consisting of a regional committee and a regional office. The regional offices, with their own directors, are responsible for formulating policies of a regional character and for monitoring regional activities. In many countries there is a resident WHO representative who is the main intermediary for support of WHO and who participates with the government in

planning and managing national health programs. The location of the six regional offices and the member states covered are shown in Figure 3.

Some 40% of WHO's 4300 staff members, including PAHO, work in countries all over the world, either in field programs or as WHO representatives; 30% are in the six regional offices and 30% at headquarters in Geneva.

WHO's normative, i.e., standard-setting, functions also include preparation and updating of the International Classification of Diseases, assignment of generic names for pharmaceuticals, and, since 1957, evaluating the safety for human consumption of selected food additives and contaminants in food and establishing acceptable daily intakes for these substances through the Joint FAO (Food and Agriculture Organization)/WHO Expert Committee on Food Additives.

The committee's reports, as well as those of a similar FAO/WHO group responsible for evaluating the safety of pesticide residues, are used in the formulation of national food legislation intended to protect consumers from hazardous additives or contaminants and by the Codex Alimentarius Commission—another joint FAO/WHO body—in establishing international food standards. (Food legislation is one of the many topics regularly covered by one of WHO's half-dozen specialized international periodicals, the quarterly International Digest of Health Legislation.) Codex originated at a time— the early 1960s—when international efforts were being made to increase world trade by reducing tariff barriers, as well as nontariff barriers resulting from differing food regulations. Consistent with a dynamic system that is still changing to deal with ever-changing circumstances, the international community has decided to use health-related Codex standards, guidelines, and recommendations as a reference in implementing relevant aspects of the trade agreements administered by the World Trade Organization (WTO) since 1995.

While the member making the largest contribution to the WHO regular budget is assessed at a maximum 25%, members making the smallest each pay 0.01%. Apart from its regular budget—US$842 654 000 for the biennium 1998-1999—WHO receives voluntary contributions from both governmental and nongovernmental sources. In recent years the total amount of these contributions has been roughly equivalent to regular budget levels. They include contributions for fostering research in tropical diseases and human reproduction, improving community water supply, expanding immunization, preventing and controlling diarrheal diseases, leprosy, malaria, and yaws, and preparing a credible emergency health response to disasters and natural catastrophes.

Working with Others

From its beginning, WHO set out to work not through its small staff alone but with and through others. Many thousands of individual researchers

WHO African Region WHO Region of the Americas

WHO 96460

WHO Eastern Mediterranean Region WHO Western Pacific Region

Figure 3 WHO regional offices and the areas they serve.

WHO African Region WHO Region of the Americas

WHO South-East Asia Region WHO European Region

WHO 96460

WHO Eastern Mediterranean Region WHO Western Pacific Region

Figure 3 WHO regional offices and the areas they serve.

WHO South-East Asia Region WHO European Region and scientists, including Nobel laureates, have put their talents at the disposal of WHO—and their number continues to grow. The same is true of WHO collaborating centers, which have grown steadily in number and breadth of disciplines. Rather than duplicate efforts, WHO entrusts critical technical functions to established laboratories and research institutes.

From the outset, WHO was also mandated to work with other agencies within the newly created UN family of organizations. Food and nutrition work, for example, quite naturally came to involve the FAO, as did work against animal diseases and, as mentioned above, in the area of food additives, food standards, pesticide residues, and contaminants. Later, WHO joined forces with the International Labor Organization (ILO) and the United Nations Environment Program (UNEP) in establishing the International Program on Chemical Safety. Recognition of the increasing seriousness of the global burden of malnutrition led WHO and FAO to convene jointly, in Rome in December 1992, the International Conference on Nutrition, which was attended by over 1000 representatives of 159 member states and the European Union. The resulting World Declaration and Plan of Action for Nutrition pledged to eliminate or substantially reduce the major forms of malnutrition and their contributing factors before the end of the decade. The declaration's nine goals for the year 2000 and the strategy and actions of the Plan of Action serve as the platform for WHO's support to countries, especially those most in need, in five priority areas:

• assessment, prevention, and management of protein-energy malnutrition;

• overcoming micronutrient malnutrition (chiefly iodine deficiency disorders, and vitamin A and iron deficiencies);

• improvements in infant and young child feeding (breast feeding and complementary feeding);

• nutrition emergencies, particularly training in preparedness and management;

• prevention of diet-related noncommunicable diseases (including obesity, cardiovascular diseases, and some cancers) and food-related communicable diseases (including diarrhea and parasites).

The views of the United Nations Educational, Scientific and Cultural Organization (UNESCO) are regularly sought, for example, on questions relating to bioethics and the health of schoolchildren. Occupational health is likewise a shared activity with the ILO, while drug dependence and abuse call for collaboration with the United Nations International Drug Control Program. After nearly a decade of providing direct financial support and technical guidance for AIDS (acquired immunodeficiency syndrome) activities in more than 150 developing countries, in January 1996 WHO became one of the cosponsors, together with the United Nations Children's Fund (UNICEF), the United Nations Development Program (UNDP), the United Nations Population Fund (UNFPA), UNESCO, and the World Bank, of the Joint United Nations Program on HIV/AIDS (UNAIDS). Building on the relationship already established with the General Agreement on Tariffs and Trade (GATT), WHO works with the GATT's successor, the WTO, in connection with health-related Codex standards, guidelines, and recommendations.

One of WHO's closest partners has been UNICEF, with which, for example, the early yaws and malaria campaigns were carried out. More recently, joint activities include support to countries in preventing and controlling micronutrient malnutrition and improving infant and young child feeding practices by promoting breast feeding and appropriate complementary feeding practices with emphasis on using locally available foods. To guide their concerted efforts in all fields, since 1948 the two agencies regularly confer on matters of joint health policy.

Collaboration was also initiated with professional, charitable, and other nongovernmental organizations (NGOs) pursuing aims consonant with those of WHO. By the end of the first decade, WHO had established official relations with no fewer than 40 such bodies, ranging from the International Council of Nurses to the International Commission on Radiation Units and Measurements, and from the World Federation for Mental Health to the International Union of Nutritional Sciences. Work of vital importance for WHO's technical programmes of support for its membership has been made possible through the enthusiasm and resources of these and other valuable organizations, which have in turn benefited from the moral support and the technical information provided by WHO.

Collaboration continues unabated; examples include joint work on cancer pain relief with the International Association for the Study of Pain; efforts to ensure safe blood and blood products undertaken by WHO's Blood Safety unit together with the blood programs of the International Federation of Red Cross and Red Crescent Societies, the International Society of Blood Transfusion, and the World Federation of Hemophilia; support for polio eradication provided through Rotary International; reinforcement of technical support to member states for the prevention and control of iodine deficiency disorders with the help of the

International Council for Control of Iodine Deficiency Disorders; and implementation of the Joint WHO/UNICEF Baby-Friendly Hospital Initiative— which strives to ensure the world over a health care environment for new-borns where breast-feeding is the norm—with the help of La Leche League International and the International Lactation Consultant Association. The success of these joint ventures is most strikingly illustrated by the ever-lengthening list of NGOs admitted into official relations with WHO, which now numbers more than 190.

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