INTERNATIONAL HEALTH AGENCIES
Dr. Neha Agrawal
CONTENTS
• History and development
• Objectives
• Types of international health agencies
• Multilateral agencies
• Bilateral agencies
• Non-governmental agencies
• Conclusion
HISTORY AND DEVELOPMENT
“Nothing on earth is more international than disease”
(Paul Russel)
Spread of epidemics
• Plague of Athens in 430 BC
• The Black Death
• Yellow fever in West Indies and Panama Canal area
• Epidemics in Russia after 1918
The Black Death
• Communities isolated themselves or the infected communities
• 14th century – Europe
Ships, travellers, cargoes detained for 40 days
• Practice of isolation for a limited period- ‘Quarantine’
• Quarantine became an established practice in many countries
• Became necessary for international
agreement and cooperation on quarantine matters
ORIGIN OF INTERNATIONAL HEALTH WORK
• First International Sanitary Conference,1851 in Paris
– to introduce uniformity into quarantine measures – ended in failure
• 10 Conferences between 1851 and 1902
– Unable to reach an agreement
The Early International Health Organizations
Pan American Sanitary Bureau- 1902
• World’s first international health agency
• To coordinate quarantine procedures in American States
• 1924- Pan American Sanitary Code signed
• 1947 –Pan American Sanitary Organization (PASO)
• 1949 –WHO Regional Office for the Americas
• 1958 –Pan American Health Organization (PAHO)
Office International D’Hygiene Publique- 1907
• Generally known as “Paris Office”
• To disseminate information on communicable diseases and supervise international quarantine measures
• First worldwide international health organization
• 1950 – Taken over by WHO
The Health Organization of the League of Nations - 1923
League of Nations formed after the First World War (1914-18)
Its Heath Organization – did creditable work – Quarantine regulations
– Epidemiological information – Epidemic disease problems
– Nutrition, housing, rural hygiene – Training of public health workers
– Standardization of biological preparations – Series of periodical epidemiological report – Laid down lines for technical studies
United Nations Relief and Rehabilitation Administration (UNRRA)- 1943
To organize recovery from effects of Second World War
Outstanding work in
–Prevention of Typhus and other diseases
–Assistance to malaria control in Greece and Italy –Campaign for eradication of malaria from Sardinia
Birth of WHO
– April 1945 - Conference held at San Fransisco to set up UN- Brazil and China suggested establishment of international health organization
– Constitution drawn up in 1946
– Came into formal existence on 7th April, 1948
– Culmination of efforts to establish a single worldwide inter-governmental health agency
OBJECTIVES OF INTERNATIONAL HEALTH AGENCIES
• Control of epidemics and communicable diseases affecting more than one country.
• International exchange of medical and dental health information.
• International standardization of biological preparations
• Combined research
• Help to under-developed countries.
• Advice to governments and health authorities on health questions.
• International control of drugs of addiction.
• International help in disasters.
2 kinds of agencies
Official Voluntary
Operated by federal, state or local governments.
Supported by public taxation.
Operated by groups of
interested citizens. Obtain money from fund raising appeals and other
voluntary private sources.
TYPES OF INTERNATIONAL
HEALTH AGENCIES
• Multilateral agencies
Funding comes from multiple governments and is distributed to many different countries. All part of the United Nations.
• Bilateral agencies
Governmental agencies in a single country which provide aid to developing countries.
• Non-governmental organizations (NGOs)
Also known as private voluntary organizations (PVOs).
MULTILATERAL HEALTH
AGENCIES
• Specialized, non-political, health agency of the United Nations.
• Worldwide inter-governmental health agency
• Headquarters at Geneva
WORLD HEALTH
ORGANIZATION (WHO)
• Constitution drafted by the “Technical Preparatory Committee” under the chairmanship of Rene Sand in 1946
• Approved by International Health Conference of 51 nations in New York in 1946
• Interim Commission set up
Constitution came into force on 7th April, 1948
• 7
thApril- World Health Day
A World Health day theme is chosen each year to focus attention on a specific aspect of public health.
– 1994 – Oral health for a healthy life.
– 2006 – Working together for health
Objective
• “the attainment by all peoples of the highest level of health”
• Current objective: Health for All by 2000 AD attainment by all people of the world by the
year 2000 AD of a level of health that will permit them to lead a socially and
economically productive life
• Two major policy developments have influenced WHO in recent years:
– Alma Ata Conference in 1978 on primary health care
– Global Strategy for Health for All by 2000
• Both WHO and UNICEF are striving towards the goal of HFA by the year 2000 through
health system based on primary health care
Membership
• Open to all countries
• 1948 - 56 members
• Currently- 193 Member States
2 Associate Members
(Puerto Rico and Tokelau)
• Each member state contributes yearly to the
budget and is entitled to the services and aid
organization can provide.
Structure
• The World Health Assembly
• The Executive Board
• The Secretariat
The World Health Assembly
• “Health Parliament” of Nations
• Supreme governing body of WHO
• Meets annually, usually in Geneva in May.
• Composed of delegates representing Member States
The World Health Assembly…
• Functions:
– determine the international health policy and programmes
– review work of past year
– approve budget needed for following year
– elect Member States to designate a person to serve for three years on the Executive Board
– Appoint Director-General on nomination of Executive Board.
• Dr. Margaret Chan is the Director-General of WHO, appointed by the World Health
Assembly on 9 November 2006.
Executive Board
• 34 members technically qualified in the field of health. Designated by but do not represent their governments.
• Members are elected for three-year terms.
• Meets at least twice a year, in January and May.
• Gives effect to the decisions and policies of the Assembly.
The Secretariat
• Primary function:
To provide Member States with technical and managerial support for their national health development programmes.
• Headed by the Director-General
• Staffed by some 8,500 health and other
experts and support staff
Regions
• To meet the special health needs of
different areas- 6 regional organizations
• Regional office is headed by the Regional Director
• Regional Committee composed of Member
States in the region
How is WHO funded?
• Has its own budget
• Members assessed on a scale based on population and income/head- periodically reviewed
United States pays- 32%
U.S.S.R- 12%
U.K.-7%
India-2%
• Besides its regular budget WHO receives voluntary contributions.
• The total WHO budget planned for 2006-2007 is roughly $US 3.3 billion.
28%
Assessed
contributions from Member States
Work of WHO
• Classical or inherited work
Epidemic intelligence, quarantine, standardization of biologicals
• Direct services to governments in the field
• Education and information
Training of doctors, nurses, sanitary engineers;
Studies, surveys; Courses, symposia, seminars Fellowship programmes; Publications
Work of WHO…
WHO’s first constitutional function :
To act as the directing and coordinating authority on all international health work.
– to identify collectively priority health problems throughout the world,
– to define collectively health policies and targets to cope with them,
– to give effect to these policies and to attain targets.
• Prevention and control of specific diseases
• Development of comprehensive health services
• Family health
• Environmental health
• Health Statistics
• Bio-Medical Research
• Health Literature and Information
• Cooperation with Other Organizations
Specific responsibilities
WHO Publications
• Basic Documents and Resolutions and Decisions.
• The monthly Chronicle – account of current activities
• Bulletin – scientific articles
• Monographs and Technical Report Series
• Public Health Papers
• International Digest of Health Legislation
• Series of weekly, monthly and annual Epidemiological Records
• World Health – a popular news sheet
1979
Eradication of small pox
1978
International conference on primary health care
1988
Global polio
eradication Initiative
2003
SARS identified and controlled
2003
WHO
Framework
Convention on Tobacco Control
2004
Adoption of
Global Strategy on Diet,
Physical Activity and Health
WHO Oral Health Unit
1956
• No specific programme till 1956
• Programme entitled Dental Health (DNH)
inaugurated
• 1967….
– Epidemiologist: Dr. D. E. Barmes
– Oral Health Surveys: Basic Methods manual -1971 – Global Oral Data Bank (GODB) - 1969
– Application of the International Classification of Diseases to Dentistry and Stomatology (ICD-DA )
completed as a companion to the ICD
– International Collaborative Study of Dental Manpower Systems (ICS I) commenced
– Programme name changed to Oral Health (ORH)
1974….
• Dr. D. E. Barmes became Chief
• Further additions of the Oral Health Surveys (1977) and ICD-DA manuals
• Pathfinder system for rapid and inexpensive data collection was developed
• New data collection method for periodontal disease indicators- CPITN index defined -1982.
1979 …
• Collaborative programmes established with NGO's (FDI, IADR, IFDH)
• The ICS I - completed and ICS II - nearing completion
• Intercountry Centres for Oral Health were established in Thailand, Syria, Nigeria and Belarus.
• Studies of different cost effective systems of oral health care delivery and low cost materials and equipment performed in Thailand, Indonesia and Zimbabwe.
• 1979
First measurable goal for the year 2000 announced- 3 DMFT at 12 years of age
• 1981- Global goals proposed for year 2000 by WHO and FDI
• 7 April,1994
WHO introduced ART as part of the World
Health Day and celebrations of the Year of
Oral Health
1995
"WHO Oral Health Country/Area Profile Programme”
(CAPP)
• Objective : to present information on dental diseases and oral health services for various countries/areas.
• Main server - located at WHO Collaborating Centre for Education, Training and Research at the Faculty of
Odontology, Malmö, Sweden.
• A server for Periodontal conditions is located at Niigata University, Japan
2003
• FDI, WHO and IADR presented new goals
for year 2020
UNITED NATIONS INTERNATIONAL CHILDREN’S EMERGENCY FUND
(UNICEF)
• Established by United Nations General Assembly in 1946.
• To deal with rehabilitation of children in war ravaged countries
• 1953 - “United Nation’s Children’s Fund”
• Headquarters: United Nations, New York
• Regional office of South Central Asian Region – New Delhi
• 30 member Executive Board
• Works in collaboration with WHO and other specialized agencies of UN
• MCH, nutrition, environmental sanitation
• WHOLE CHILD
Assistance to long term personal development and development of countries in which they live – “country health programming”
Content of services:
• Child health
• Child nutrition
• Family and child welfare
• Education – formal and non-formal
• GOBI
– G- Growth charts – O- Oral rehydration – B- Breast feeding – I- Immunization
• Urban Basic Services (UBS)
• UNICEF has worked closely with the Government and other partners in defluoridation programmes in India.
• In the 1980s, UNICEF supported the Government's Technology Mission.
• A number of demonstration projects have been initiated in fluorosis-affected areas, with emphasis on introducing household defluoridation.
• Has sponsored research and development on use of activated alumina.
UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP)
• Established in 1966
• Main source of funds for technical assistance.
• Basic objective: Help poorer nations
develop their natural and human resources
more fully.
THE FOOD AND AGRICULTURE ORGANIZATION (FAO)
• Formed in 1945
• Headquarters in Rome.
• Main functions:
Help nations raise living standards
Improve nutrition of people of all countries
Increase efficiency of farming, forestry and fishing
Better conditions of people in rural areas.
World Freedom from Hunger campaign to combat malnutrition
INTERNATIONAL LABOUR ORGANIZATION (ILO)
• Formed in 1919- affiliate of the League of Nations
• Headquarters in Geneva, Switzerland
• Main purpose: To improve the living and
working conditions of working population all over the world.
• Close collaboration between ILO and WHO
in field of health and labour.
THE WORLD BANK
• Specialized agency of the United Nations
• Purpose: To help less developed
countries raise living standards of their people.
• Gives loans for projects that will lead to
economic growth.
• Cooperative programmes between WHO and World Bank
– Projects for water supply – World Food Programme – Population Control
– Onchocerciasis programmme in West Africa
• Disease Control Priorities in Developing
Countries - A World Bank Initiative
BILATERAL HEALTH AGENCIES
UNITED STATES AGENCY FOR
INTERNATIONAL DEVELOPMENT (USAID)
• The US Government presently extends aid to India through three agencies:
– USAID established in 1961
– The public law 480 (Food for Peace) programme – The US Export-Import bank
• The US has been assisting India in:
– Malaria eradication – Medical education – Nursing education – Health education
– Water supply and sanitation
– Control of communicable diseases – Nutrition
– Family planning
THE COLOMBO PLAN
• Established in 1950 at a meeting of
Commonwealth Foreign Ministers at Colombo.
• Main objective: Cooperative economic
development in South and South East Asia
• 20 countries within the region and
6 non-regional members - Australia, Canada,
Japan, New Zealand, UK and USA
• Some support given to health promotion
• AIIMS, New Delhi- established with
financial assistance from New Zealand
• Canada- Cobalt Therapy Units in medical institutions in India
THE COLOMBO PLAN….
– Assisting National TB Control Programme since 1976
– Supporting partner to WHO for CAPP
Swedish International Development
Agency (SIDA)
Danish International Development Agency (DANIDA)
6 major DANIDA-supported programmes in health sector:
• Tamil Nadu Area Health Care Project (TNAHCP)
• Madhya Pradesh Basic Health Services Programme (MPBHSP)
• Pulse Polio Immunisation Programme (PPI)
• DANIDA supported National Leprosy Eradication Programme (DANLEP)
• Revised National Tuberculosis Control Programme (RNTCP)
• DANIDA supported National Blindness
Control Program (DANPCB)
• Tanzania-Danida Dental Health Programme (1981 to 1993)
169 Dental Therapists and 38 Assistant Dental Officers trained in Ministry of Health institutions in Tanzania during >10 years support from Danida
(Reference: Poulsen S, Fubusa F, Gemba PM, Lema PA, Mosha HJ, Ntabaye MK. Distribution of dental therapists and assistant dental officers trained under the Tanzania-Danida Dental Health Programme 1981-1993. Odontostomatol Trop.
1999 Jun;22(86):19-22.)
NON GOVERNMENTAL
AGENCIES
– John Rockefeller -1913
– Active in public health and medical education – Control of hookworm in Madras – 1920
– All India Institute of Hygiene and Public Health at Kolkata
– Training, fellowships, travel grants, grants-in- aid, development of medical college libraries
THE ROCKFELLER FOUNDATION
• Active in development of rural health services and family planning
• Work in India
– Orientation Training Centres
– Research and Action projects for environmental sanitation
– Rural Health Services – Establishment of NIHAE
– Family Planning Programme
THE FORD FOUNDATION
• Founded in North America in wake of Second World War in 1945
• World’s largest, independent, non-profit international relief and devlopment
organization
• Began operation in India in 1950
• Primary objective: Provide food for children in India in 6-11 years
Co-operative for Assistance Relief
Everywhere (CARE)
• Non-political, non-official international humanitarian organization
• Devoted to service of mankind in peace and war
• Founded by Henry Dunant, a Swiss businessman
INTERNATIONAL RED CROSS
International Red Cross…
• Work
– Humanitarian service to victims of war – Service to armed forces, war veterans, – Disaster service,
– First-aid and nursing – Health education
– Maternity and child welfare services
• The largest NGO devoted to international health in the United States
• Serving as a medical officer during World War II, Dr. William B. Walsh, was moved by the poor health conditions in South Pacific
• Project HOPE founded In 1958.
Project HOPE
(Health Opportunities for People Everywhere)
Project HOPE….
• SS HOPE, the first peacetime ship
• On voyages to Indonesia, Vietnam, Peru etc.
doctors, nurses, and technical staff provided
medical care and training to people in each
country visited.
• 1999
Dental health program in Bali, Indonesian island.
Over 15,000 elementary school children
received dental health care education. Also, training of 60 Indonesian dentists in modern day dental practices
Project HOPE….
• Worldwide, the most important NGO in long- term international health
• An international confederation, comprised of 13 independent non-government
organizations dedicated to fighting poverty and related injustice around the world.
Oxfam International
• Founded in 1971 as a nongovernmental organization
• Delivers emergency aid to people affected by armed conflict, epidemics, natural or man-made disasters, or exclusion from health care in more than 70
countries.
• Funds
– 80 % - general public
– 20% - international agencies and governments
Doctors Without Borders/
Médecins Sans Frontières (MSF)
FDI World Dental Federation
• Organization of national dental associations
• Founded in 1900 in Paris
• Early years- European organization- known as Federation Dentaire Internationale (French)
• Global expansion- Name changed to World Dental Federation
• Now represents over 150 national dental organizations and 35 other international organizations- 700,000
dentists
• Headquartered in London for years. Now based at Ferney-Voltaire, France
• Work- both scientific and political
• Its technical committees bring international experts together to develop state-of-the art reports and
recommendations for further action
• Politically - helpful in development of dental care services where the local profession has little
political clout.
Publishes
• International Dental Journal
• Developing Dentistry
• Community Dental Health
• European Journal of Prosthodontics
• Journal of the International Academy of
Periodontology
• Unilever and the FDI have created a unique
partnership -Live.Learn.Laugh - with the aim of increasing oral health education and promotion in countries around the world.
• The World Dental Development Fund supports oral health projects worldwide with a strong focus on education. The Fund was established in 1999 and has since then given grants to 7 projects.
• Current Projects
– Improving oral health of handicapped children in Senegal – Capacity building in Africa
– Integrating oral health in Primary Health Care in northern Pakistan
– Smiling Schools of Namibia – Oral health in rural India
– Oral health survey in Rwanda
– Oral Cancer Awareness for dentists in Latin America
– HIV/AIDS awareness training for dentists in Latin America – Community oral health in Lomé, Togo
Oral health in rural India
• The project is based in town of Chitrakoot, a poor rural area in India.
• In collaboration with a UK based NGO a dental clinic was provided to an existing hospital belonging to the project.
• The equipment provided allowed to expand the local healthcare facilities, to offer dental treatment and
education in oral health to a community of about 150,000 people.
• Advocacy Activities
– Nairobi Conference on Oral Health in Africa – Professionals and Tobacco Control
– Global Oral Health Planning Workshop – Global Goals for Oral Health
– Sessions during Annual World Dental Congresses – Rwanda Oral Health Policy
– Oral Health through Fluoride
International Association for Dental Research (IADR)
• Founded in December,1920
• Has about 10,000 members in about 100 countries- research workers in various
fields of dentistry
IADR…..
• Aim:
– To advance research and increase knowledge for the improvement of oral health worldwide.
– To support and represent the oral health research community.
– To facilitate the communication and application of research findings.
Publications:
• Journal of Dental Research
– monthly publication,
– has the highest Scientific Impact Factor of any dental journal in the world.
• Advances in Dental Research
IADR…..
International Federation of Dental Hygienists (IFDH)
• Formed on June 28, 1986 in Oslo, Norway.
• International, non-governmental, non-profit organization.
• Unites dental hygiene associations from around the
world in their common cause of promoting dental health.
• Publication: Supports International Journal of Dental Hygiene
VOLUNTARY HEALTH AGENCIES IN INDIA
1. Voluntary Agencies Involved with Maternal and Child Health
– Indian Council of Child Welfare.
– Family Planning Association of India.
– Kasturba Memorial Fund.
2. Voluntary Agencies Involved with the Control of Specific Diseases or
Problems
– Tuberculosis Association of India.
– Hind Kusht Nivaran Sangh.
– The Indian Cancer Society.
– The Indian Blind Relief Society.
3. Professional Bodies involved with Voluntary health work
– The Indian Dental Association
– The Indian Medical Association
– The Trained Nurses Association
4. Voluntary Agencies Involved with General Health Care
– The Red Cross Society of India
– The All India Women’s Conference – The Central Social Welfare Board
– The Voluntary Health Association of
India
• Several agencies around the world working towards the ultimate goal to achieve better heath of the community.
• Primarily established for the control of
spread for communicable diseases, attention has now begun to be given to non-
communicable diseases including oral diseases.
CONCLUSION
• No single country can solve the growing list of health challenges the world faces today.
• The continued international cooperation is
important to achieve the goal “Health for All”.
REFERENCES
• Park K. Park’s textbook of preventive and social medicine. 18th ed. Banarasidas Bhanot publishers.Jabalpur, India. 2005. p.
704-11.
• Peter S. Health agencies around the world. In: Peter S. Editor.
Essentials of preventive and community dentistry. 2nd ed. Arya (medi) publishing house. New Delhi. 2003. p. 723-43.
• Chandra S, Chandra S. Indian Dental Association and organizations of health and dental health. In: Chandra S,
Chandra S. Textbook of community dentistry. Jaypee Brothers, New Delhi. 2000. p.442-459.
• Poulsen S, Fubusa F, Gemba PM, Lema PA, Mosha HJ, Ntabaye MK. Distribution of dental therapists
and assistant dental officers trained under the
Tanzania-Danida Dental Health Programme 1981- 1993. Odontostomatol Trop. 1999 Jun;22(86):19-22.
• The Major International Health Organizations.
www.imva.org/Pages/orgbio.htm
• www.who.int
• www.who.int/oral_health/en/
• www.unicef.org/wes/fluoride.pdf
• http://www.ambnewdelhi.um.dk/en/menu/Danida/Health/
• http://www.oxfam.org/en/
• www.fdiworldental.org/
