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THE ACTIVITIES OF WORLD HEALTH ORGANIZATION IN NIGERIA (1960-2012)

CHAPTER ONE

INTRODUCTION

The United Nations, since its inception, has been actively involved in promoting and protecting good health world wide. Leading that effort within the United Nations system is the World Health Organisation (WHO); an international agency concerned with world wide health and welfare. It is one of the agencies of the United Nations whose purpose is to aid in the attainment of the highest possible level of health by all people. Programs include; education for current health issues, proper food supply and nutrition, safe water and sanitation, maternal and child health immunization against major infectious diseases and prevention and control of disease. WHO is coordinating global strategies to control and prevent Acquired Immunodeficiency Syndrome. Its function include furnishing technical assistance, stimulating and advancing epidemiologic investigation of diseases, recommending health regulation promoting cooperation among scientific and professional health groups and providing information and counsel to health matters. Its headquarters is in Geneva, Switzerland. At the outset, it was decided that WHO’s top priorities would be malaria, women’s and children’s health, tuberculosis, venereal disease, nutrition and environmental sanitation. Many of those remain on WHO’s agenda today, in addition to such relatively new disease as HIV/AIDS. 

In 1948, WHO took over the responsibility for the international classification of disease, which has become the international standard for clinical and epidemiological purposes. Between 1952 and 1964, WHO’s efforts had reduced the global prevalent of Yaws – a crippling and disfiguring disease that afflicted some 50 million people in 1950 – by more than 95 percent. Between 1967 and 1979, WHO’s effort led to the eradication of small pox the only time a major infections disease has been completely eradicated. Since its global polio eradication initiative was launched in 1988, through 2008, the number of cases was reduced by more than 99 percent – from 350,000 per year to less than 2,000. 

WHO staff are at work on the ground in 147 countries worldwide. They advise ministries of health on technical issues and provide assistance on prevention, treatment and care services throughout the health sector. Six regional office coordinate and support these efforts, while giving special attention to adapting global HIV/AIDS policies to fit the specific needs of their region – for example in sub-Saharan Africa, where the epidemic is largely spread by heterosexual sex, as compare with eastern Europe, where injecting drug use is the primary mode of transmission. In short WHO intervention cover all areas of the global health – care spectrum, including crisis interventional and the response to humanitarian emergencies; establishing international health regulations, which countries must follow to identify diseases outbreaks and stop them from spreading; preventing chronic disease and working to achieve the health – related millennium development goals (MDGs). In the lead up to the millennium development goals summit, the secretary – General launched a global effort convening 40 keys leaders to define a collective strategy of accelerating progress on women’s and children’s health. 

But it would be misleading to suggest that the entire work of the UN system in support of global health rests with the WHO. On the contrary, many members of the UN family are engaged in the critical task. Many health related matters addressed directly by the General Assembly and the Economic and Social council, as well as through the efforts of the joint United Nations Programme on HIV/AIDS (UNAIDS); the work of the United Nations Population Fund (UNFPA) in support of reproductive, adolescent and material health, and the health related activities of the United Nations Children’s Fund (UNICEF).

In addition such members of the UN, system as the International Labour Organisation (ILO), the Food and Agriculture Organisation of the United Nation (FAO), the International Atomic Energy Agency (IAEA), the United Nations Environment Programmes (UNEP), the United Nations Office on Drugs and Crime (UNODC), and the World Bank, among others, all play a key role in promoting global health. Health – related decades now being observed internationally, as declared by the General assembly include the decade to roll back Malaria in developing countries, particularly in Africa (2001 – 2010) and the international Decade for action, “water for life” (from 22 march, 2005). Annual International observance relating to health, as proclaimed by the General Assembly, include World Water Day (22 March), World Autism awareness Day (2 April), World Health Day (7 April), World No-Tobacco Day (31 May), the international Day against Drug Abuse and illicit Trafficking (26 June), World Mental Day (10 October), World diabetes day (14 November) and World Aids Day (1 December).

The World Health Organisation (WHO) is a special agency of the United Nations (UN) that is concerned with international public health. It was launched to systematically improve health condition throughout the world. Some of the activities of WHO have been dramatic and have relieved well – deserved acclaim. For example, the prompt action in dealing with the cholera epidemic in Egypt and the typhus outbreak in Afghanistan in 1949; others have been less spectacular though equally important. 8 As a specialized agency of the United Nations, WHO is the central directing and coordination authority in international health work. It also provides advisory and pubic health services to member countries (124 countries were members in 1963), and central technical services. It has given major assistance to many countries in the fight against malaria, tuberculosis, poliomyelitis, venereal disease, influenza, small pox, leprosy, trachoma (an eye disease), filariasis (a disease caused by parasitic worms), bilharziasis (a disease communicated to man by water snails), and other communicable disease. In some cases, the results of the joint efforts have been most impressive. Malaria has been virtually wiped out in Europe and North America, and in many countries where it was once a prime killer, it has been reduced spectacularly. WHO in cooperation with UNICEF, has launched a long term program aimed at its total eradication.  

WHO has also given assistance to many countries in Public health administration, maternal and child health, nursing, social and occupational health, public health education and training, mental health, nutrition, sanitation, dental health, the development of community water supplies, the rehabilitation of physically handicapped children and Adults and medical research. It administers health and sanitary regulations, maintains a medical library and an international center for the compilation and analysis of medical and health statistics from all countries, established international standards of purity in medicines in current use, and issues a number of publications. 

In its charter, the UN is charged with promoting “solution of international economic, social, health and related problems”. Thus, the UN is vitally concerned with furtherance of human welfare social justice, and the aspirations of men for a better lot in life. The world Health Organisation (WHO) has given enormous sums to develop health services in various countries and to fight disease. By 1966, WHO had helped over twelve hundred projects in 152 different countries. In order of the United Nations to achieve its objective of world peace and security, it has to attend to situations that could trigger crisis. In fighting of the maintenance of peace, the UN’s job is to create the conditions of social stability and human satisfaction essential to a lasting peace. According to the United Nations Educational, scientific and cultural organisation (UNESCO), “since wars begin in the mind of men, it is in the minds of men that the defenses of peace must be constructed”. 

Health is a state of complete physical and social well being, and not merely the absence of diseases or infirmity. The enjoyment of the highest attainable standards of health is one of the fundamental right of every human being without destruction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependence upon the fullest cooperation of individuals and states. The achievement of any state in the promotion and protection of health is of value of all. WHO is an entity under the authority of the UN with a mission to promote the best possible health care for all the world’s citizens. 13 In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats. The organisation develops and promotes the use of evidence- based tools norms and standards to support member states to inform health policy options. It oversees the implementation of the international Health Regulations, and publishes a series of medical classification, of these, there are over reaching “reference classification” the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Intervention (ICHI), other international policy frameworks produced by WHO include the international code of marketing of Breast milk substitute (adopted in 1981), framework convention on Tobacco control (adopted in 2003) and the Global code of practice on the International Recruitment of Health Personnel (adopted in 2010). The WHO regularly publishes a World Health Report, its leading publication including an expert assessment of a specific global health topic. Other publications of WHO include the Bulletin of the World Health Organization, the Eastern Mediterranean Health Journal (overseen by EMRO), the Human Resources for health and the Pan American journal of Public Health (Overseen by PAHO – Pan American Health Organisation/ AMPO).

WHO runs the alliance for health policy and systems research, targeted at improving health policy and systems. WHO aims to improve access to health research and literature in developing countries such as through the HINARI network. The organisation has published tools for monitoring the capacity of national health system and health work forces.  The organisation relies on the expertise and experience of many world renowned scientist and professionals to inform its work, such as the WHO study group on inter professional education and collaborative practice. The WHO also promotes the development of capacities in member states to use and produce research that addresses national needs, by bolstering national health research system and promoting knowledge translation platforms such as the evidence informed policy Network (EVIPNET), WHO and its regional offices are working to develop regional polices on research for health – the first on being the Pan American Health Organisation/ Regional Office for the Americas (PAHO/AMRO) that had its policy on Research for Health approved in September 2009 by its 49th directing council document.  In addition, the WHO has also promoted road safety. Each year, the organisation marks World Health Day focusing on a specific Health promotion topic. 

The WHO’s suite of health studies is working to provide the needed health and well being evidence through a variety of data collection platforms, including the World Health Survey Covering almost 400,000 respondents from 70 countries, and the study on global ageing and Adult Health (SAGE) covering over 50, 000 person over 50 years old in 23 countries.  WHO has also worked on global initiatives in surgery, including emergency and essential surgical care trauma care and safe surgery. The WHO surgical safety checklist is in current use worldwide in the effort to improve safety in surgical patients. Also, the UN observer organizations International Committee of the Red Cross and International federation of Red Cross and Red Crescent societies have entered into “official relations” with WHO. 

The World Health Assembly (WHA) is the legislative and supreme body of WHO. Based in Geneva, it typically meets yearly in May. It appoints their Director General every five years, and votes on matters of policy and finance of WHO, including the proposed budget. It also reviews reports of the executive board and decides whether there are areas of work requiring further examination.  The regional division of WHO were created between 1949 and 1952, and are based on Article 44 of WHO’s constitution, which allowed World Health Assembly (WHA) to “establish a single regional organisation to meet the special needs of each defined area”. Each region has a regional committee, which generally meet once a year, normally in the autumn. Each regional office is headed by a regional director, who is elected by the Regional committee. Since 1999, Regional Directors serve for a once renewable five year term.  Each regional committee of the WHO consists of all the Health department heads, in all the governments of the countries that constitute the region. Aside from electing the Regional Director, the regional committee is also in charge of setting the guideline for the implementation, within the region of the health and other policies adopted by the World Health assembly. The regional committee also serves as a progressive review board for the actions of WHO within the region.

The Regional office of WHO in Africa has its headquarters in Brazzaville, republic of Congo which includes most of Africa with the exception of Egypt, Sudan, South Sudan, Tunisia, Libya, Somalia and Morocco which fall under East Mediterranean Regional Office (EMRO). The WHO operates 148 country and liaison offices in all its regions. The presence of a country office is generally motivated by a need, stated by the member state. There will generally be one WHO country office in the capital occasionally accompanied by satellite offices in the provinces or sub regions of the country in question. 
The country office is headed by a WHO representative (WR), who is an internationally experienced physical or other health professional, not a national of that country who holds diplomatic rank and is due privileges and immunities similar to those of an ambassador extraordinary and plenipotentiary. In most countries, the WR (like representative of other UN agencies) is de facto/ or de jure treated like an Ambassador. The distinction have being that instead of being an ambassador or one sovereign country to another; the WR is a senior UN civil servant, who serves as the “Ambassador” of the WHO to the country to which he or she is accredited. 
The main functions of the WHO country offices include being the primary adviser of that country’s government in matters of health and pharmaceutical policies. 

According to the World Health Organisation report 1996, “the WHO is geared towards fighting disease, fostering development”.The mission of the WHO Nigeria country office is to promote the attainment of the highest sustainable level of health by all people living in Nigeria through collaboration with the government and other partners in health development and the provision of technical and logistic support to country programmes. Nigeria became a member of the World Health Organization in 1960 and signed the Basic Agreement in 1962. Over the last four decades therefore, WHO has worked in close collaboration with the Nigerian Government, mainly with the federal ministry of health, to establish a wide array of collaborative programmes.   The main WHO country office is located in the United Nations House, Abuja the Federal capital territory (FCT). In addition, a network of offices has been established in each of the 36 states of the country and the FCT, to provide appropriate and accessible technical support to states and local government areas (LGA). This has improved collaboration with stakeholders and partners as well as the visibility of WHO at those levels. 

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