The role of WHO in Global healthThe role of WHO in Global health

Universiteit Hasselt, Universiteit Hasselt, BelgiumBelgium

12 March 201312 March 2013

Dr Mike Mbizvo, ex-DirectorDr Mike Mbizvo, ex-DirectorDepartment of Reproductive Health and Research (RHR), WHODepartment of Reproductive Health and Research (RHR), WHO

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WHO Governance and StructureWHO Governance and Structure

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

Source: WHO’s Constitution

WHO's definition of healthWHO's definition of health

““The mission of WHO is the attainment by all peoples of The mission of WHO is the attainment by all peoples of the highest possible level of health”the highest possible level of health”

WHO’s mission is global and permanentWHO’s mission is global and permanent

Source: WHO’s Constitution

The Core Functions of WHOThe Core Functions of WHO

providing leadership on matters critical to health and engaging in partnerships where joint action is needed

shaping the research agenda, and stimulating the generation, dissemination and application of valuable knowledge

setting norms and standards, and promoting and monitoring their implementation

articulating ethical and evidence-based policy options

providing technical support, catalysing change and building sustainable institutional capacity

monitoring the health situation and assessing health trends.

World Health Assembly (WHA) appoints the Director-General upon the recommendation of the Executive Board

Reviews and approves the proposed Programme Budget

Considers reports of the Executive Board (EB) on technical and health matters, in addition to programme budgetary matters

Comprises delegates from all 193 Member States. Many Ministers of Health attend.

The World Health Assembly is WHO's supreme The World Health Assembly is WHO's supreme decision-making body decision-making body

Headquarters – Global Service Centre– Director General = "DG"

Regional Offices– Regional Director = "RD"

Country Offices– WHO Country Representatives =

"WR"

ONE WHO - three levels of actionONE WHO - three levels of action

WHO's Global PresenceWHO's Global Presence

•♦

•♦Global Service Centre

Last but not least, WHO is people.

Over 7000 public health experts

including doctors, epidemiologists, scientists, managers, administrators

and other professionals from all

over the world work for WHO in 150

country offices, six regional offices

and at the headquarters in Geneva,

Switzerland.

Headquarters Office (HQ)– Cluster– Department– Team (some exceptions in GMG)

Regional Offices (RO)– Division– Team

Country Offices

Hierarchy levelsHierarchy levels

Regional Committee governs the work of each region

"RD" Regional Director

WHO's Regional Offices (RO)WHO's Regional Offices (RO)

150 Country offices

“WR” = WHO Representative is responsible for WHO’s activities in the countries by supporting the government in the planning and management of national health programmes

HWCO = Heads of WHO Country Offices

WHO is present in many countriesWHO is present in many countries

HQ Headquarters

Seven "Clusters" in HQSeven "Clusters" in HQ

HQ/ODG Office of the Director-General

HQ/ General Management Cluster

HQ/FWC Family, Women's and Children's Health

HQ/HIS Health Systems and Innovation

HQ/HSE Health Security and Environment

HQ/HTM HIV/AIDS, TB Malaria and Neglected Tropical Diseases

HQ/NMH Noncommunicable Diseases and Mental Health

HQ/IER Information, Evidence and Research

HQ/PEC Polio, Emergencies and Country Collaboration

HQ/FWC HQ/FWC Family, Women's and Children's Health

HQ/ALC Ageing and Life Course

HQ/MCA Maternal, newborn, child and adolescent health

HQ/IVB Immunization, Vaccines and Biologicals

HQ/RHR Reproductive Health and Research

HRP

IVR

HQ/FWC Family, Women's and Children's Health PMNCH

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““REQUESTS the Director-General to develop REQUESTS the Director-General to develop further the programme proposed:further the programme proposed:

(a)(a) in the fields of reference services, studies in the fields of reference services, studies on medical aspects of sterility and fertility on medical aspects of sterility and fertility control methods and health aspects of control methods and health aspects of population dynamics; …”population dynamics; …”

(WHA Resolution 18.49; 1965)(WHA Resolution 18.49; 1965)

How it began … World Health AssemblyHow it began … World Health Assembly

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1965:1965: Human Reproduction Unit withinHuman Reproduction Unit withinexisting Division of Family Healthexisting Division of Family Health(WHA Resolution 18.49; 1965)(WHA Resolution 18.49; 1965)

1972-1988:1972-1988: WHO (Expanded) Special Programme of WHO (Expanded) Special Programme of Research, Development and Research Training Research, Development and Research Training in Human Reproductionin Human Reproduction

1988-2012:1988-2012: UNDP/UNFPA/WHO/World Bank UNDP/UNFPA/WHO/World Bank cosponsored Special cosponsored Special ProgrammeProgramme(WHA Resolution 41.9; 1988)(WHA Resolution 41.9; 1988)

2012-present2012-present UNDP/UNFPA/UNDP/UNFPA/UNICEFUNICEF/WHO/World/WHO/World Bank Bank cosponsored Special Programmecosponsored Special Programme

UNAIDS becomes PCC permanent memberUNAIDS becomes PCC permanent member

How it has evolvedHow it has evolved

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HRP’s governanceHRP’s governance

15-18 members15-18 members

ex-officioex-officio members members(GAP, RAPs, RP2 (GAP, RAPs, RP2 and PCC Chairs)and PCC Chairs)

Temporary advisersTemporary advisers

PCC

Scientific and Technical Advisory GroupSTAG

Standing Committee

STAG mandateSTAG mandate

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Review, from a scientific and technical standpoint, the content, scope and dimensions of the Special Programme, including the research areas covered and approaches to be adopted

Recommend priorities within the Special Programme, including the establishment and disestablishment of task forces, and all scientific and technical activities related to the Special Programme cont'd…

STAG mandateSTAG mandate

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Provide PCC and the Standing Committee with a continuous and independent evaluation of the scientific and technical aspects of all activities of the Special Programme

Review the plans of action and the budget for financial periods prepared by the Executing Agency and make proposals to the Standing Committee for possible reallocation of resources within the scientific and technical component of the Special Programme during each financial period

…cont'd

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STAG18+ experts

Gender and Rights Gender and Rights Advisory Panel (GAP)Advisory Panel (GAP)

Scientific and EthicalScientific and EthicalReview Group (SERG) Review Group (SERG) + Specialist Panels+ Specialist Panels

Research Proposal Research Proposal Review Panel (RP2)Review Panel (RP2)

Toxicology PanelToxicology Panel

HRP’s scientific andHRP’s scientific andtechnical advisory bodiestechnical advisory bodies

Regional Advisory PanelsRegional Advisory Panels::

- African and Eastern Mediterranean Regions- African and Eastern Mediterranean Regions- Americas- Americas- Eastern Europe and Central Asian Republics- Eastern Europe and Central Asian Republics- Asia and Western PacificAsia and Western Pacific

Scope of STAG mandate and Scope of STAG mandate and membershipmembership

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In 1999, PCC endorsed the recommendation of STAG to expand its mandate to review the activities of RHR as a whole, rather than just HRP (provided no financial implications to HRP)

Membership: Temporary advisor status 3 years if approved by SC and PCC 3 final years if approved by SC and PCC Regional, expertise and gender balance

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"Because of the good credibility of the Programme and WHO in general, HRP's research results have a greater influence on reproductive health policies and standards than the research of any other organization."

(External Evaluation of HRP, Final Report, 2008)

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Department of Reproductive Health and Department of Reproductive Health and Research (RHR)Research (RHR)

Created in November 1998Created in November 1998

Composed of two pre-existing entitiesComposed of two pre-existing entities

UNDP/UNFPA/WHO/World Bank Special UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Programme of Research, Development and Research Training in Human Reproduction (HRP) Research Training in Human Reproduction (HRP)

WHO Division of Reproductive Health (Technical WHO Division of Reproductive Health (Technical Support) (RHT)Support) (RHT)

RHR = HRP+RHT (PDRH)RHR = HRP+RHT (PDRH)

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To help people lead healthy To help people lead healthy

sexual and reproductive livessexual and reproductive lives

Mission of HRPMission of HRP

The attainment by all peoples The attainment by all peoples

of the highest possible level of of the highest possible level of

sexual and reproductive healthsexual and reproductive health

Vision statementVision statement

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The WHO global reproductive The WHO global reproductive health strategy adopted by WHO's health strategy adopted by WHO's 192 Member States in May 2004192 Member States in May 2004

(Resolution WHA 57.12)(Resolution WHA 57.12)

UN Secretary General's Global Strategy for UN Secretary General's Global Strategy for Women's and Children's HealthWomen's and Children's Health

Components Country-led health plans Comprehensive,

integrated package of essential interventions and services

Integrated care Health systems

strengthening Health workforce capacity

building Coordinated research and

innovation

Role of UN agencies Define norms, regulations and guidance to

underpin efforts Help countries align their national practices Work together and with others to strengthen

technical assistance to scale-up Encourage links between sectors and

integration with other international efforts Support systems that track progress and

identify funding gaps Generate and synthesize research-derived

evidence and provide a platform for sharing best practices, evidence on cost-effective interventions and research findings

OpportunityOpportunity

RHR/HRP core functionsRHR/HRP core functions

Identifying gaps and priorities and shaping the global SRH Identifying gaps and priorities and shaping the global SRH research agendaresearch agenda

Providing leadership on matters critical to improving SRH Providing leadership on matters critical to improving SRH through knowledge generation, synthesis and managementthrough knowledge generation, synthesis and management

Supporting national research, research and technical capacity Supporting national research, research and technical capacity strengthening and engaging in relevant partnershipsstrengthening and engaging in relevant partnerships

Development of clinical standards, norms and related policy Development of clinical standards, norms and related policy and technical guidance documentsand technical guidance documents

Articulating ethical and evidence-based options for policy Articulating ethical and evidence-based options for policy formulation and programme development to improve SRH, in formulation and programme development to improve SRH, in collaboration with regional and country officescollaboration with regional and country offices

Monitoring and evaluation of SRH situations and trends, Monitoring and evaluation of SRH situations and trends, advocacy, catalysing change and supporting intervention advocacy, catalysing change and supporting intervention deliverydelivery

HRP ObjectivesHRP Objectives

Generating new knowledge in SRHGenerating new knowledge in SRH

Synthesizing research evidenceSynthesizing research evidence

Strengthening research capacityStrengthening research capacity

Developing evidence-based guidelinesDeveloping evidence-based guidelines

Strengthening research policy dialogueStrengthening research policy dialogue

RHR/HRP functions within RHR/HRP functions within thematic areas of the WHO Global thematic areas of the WHO Global Reproductive Health StrategyReproductive Health Strategy

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Improving quality of and access toImproving quality of and access toFamily planningFamily planning

Document needs and preferences of Document needs and preferences of users and potential usersusers and potential users

Develop new and improved methods Develop new and improved methods

Assess safety and efficacy of existing Assess safety and efficacy of existing methodsmethods

Develop, keep up-to-date and promote Develop, keep up-to-date and promote evidence-based practice guides for evidence-based practice guides for family planning including infertilityfamily planning including infertility

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Improving Improving maternal and perinatal healthmaternal and perinatal health

Improve knowledge on magnitude/burden of Improve knowledge on magnitude/burden of leading causes of mortality and morbidity leading causes of mortality and morbidity

Identify, develop, adapt and evaluate best Identify, develop, adapt and evaluate best practices in maternal and perinatal health practices in maternal and perinatal health

Conduct research to improve quality of Conduct research to improve quality of maternal and newborn care and promote maternal and newborn care and promote utilization of findingsutilization of findings

Develop, keep up-to-date and promote Develop, keep up-to-date and promote evidence-based clinical practice guides for evidence-based clinical practice guides for maternal and perinatal healthmaternal and perinatal health

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Eliminating unsafe abortion Eliminating unsafe abortion and improving postabortion careand improving postabortion care

Generate and synthesize scientifically sound evidence Generate and synthesize scientifically sound evidence on the prevalence of, and mortality related to, unsafe on the prevalence of, and mortality related to, unsafe abortion to assist programmes/policiesabortion to assist programmes/policies

Support research to identify interventions for the Support research to identify interventions for the prevention of unsafe abortion and for postabortion prevention of unsafe abortion and for postabortion carecare

Undertake research to improve methods of safe Undertake research to improve methods of safe abortion and promote quality of careabortion and promote quality of care

Develop, keep up-to-date and promote guidelines for Develop, keep up-to-date and promote guidelines for provision of safe abortion, management of abortion provision of safe abortion, management of abortion complications and provision of postabortion care complications and provision of postabortion care

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Combating STIs / RTIsCombating STIs / RTIs

Establish and disseminate evidence for new and Establish and disseminate evidence for new and improved STI and RTI prevention and control strategiesimproved STI and RTI prevention and control strategies

Facilitate microbicide testing, registration (and Facilitate microbicide testing, registration (and introduction)introduction)

Conduct research on prevention of MTCT of HIV and Conduct research on prevention of MTCT of HIV and other STIs, on cervical cancer screening and on other STIs, on cervical cancer screening and on introduction of HPV vaccinesintroduction of HPV vaccines

Develop, keep up-to-date and promote implementation of Develop, keep up-to-date and promote implementation of guidelines and tools for STI and RTI policy, programmes, guidelines and tools for STI and RTI policy, programmes, care and surveillancecare and surveillance

Ensure linkages with HIV prevention (e.g. STI control, Ensure linkages with HIV prevention (e.g. STI control, male circumcision, prevention of MTCT of HIV and male circumcision, prevention of MTCT of HIV and syphilis)syphilis)

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Promoting adolescent sexual and Promoting adolescent sexual and reproductive healthreproductive health

Support research on factors that affect sexual and Support research on factors that affect sexual and reproductive health outcomes, including operations reproductive health outcomes, including operations research on the optimal provision of information and research on the optimal provision of information and services to adolescentsservices to adolescents

Strengthen research capacity and attention to Strengthen research capacity and attention to implementation of findingsimplementation of findings

Ensure that technical and managerial tools and Ensure that technical and managerial tools and advocacy materials produced by the Department also advocacy materials produced by the Department also address the unique sexual and reproductive health address the unique sexual and reproductive health needs of adolescents (“mainstreaming”)needs of adolescents (“mainstreaming”)

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Addressing gender issues and Addressing gender issues and reproductive rightsreproductive rights

Assess laws, policies, practicesAssess laws, policies, practices rights-based approach to maternal and newborn health rights-based approach to maternal and newborn health assist countries to improve the legal, policy and regulatory assist countries to improve the legal, policy and regulatory

environment for sexual and reproductive healthenvironment for sexual and reproductive health Coordinate multinational research aimed at abandonment of Coordinate multinational research aimed at abandonment of

female genital mutilation and vaginal practicesfemale genital mutilation and vaginal practices Continue analyses of data from multicountry study on violence Continue analyses of data from multicountry study on violence

against womenagainst women Mainstream gender and reproductive rights issues in the Mainstream gender and reproductive rights issues in the

Department’s workDepartment’s work Develop guidance for health sector on response to violence Develop guidance for health sector on response to violence

against womenagainst women Contribute to understanding of relationship between human rights Contribute to understanding of relationship between human rights

and sexuality and sexual healthand sexuality and sexual health

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Research capacity strengthening Research capacity strengthening

Strengthen the research capacity of investigators and infrastructure in developing countries

Support researchers to conduct studies based on national priorities in SRH and facilitating their participation in regional and global research

Promote dissemination and utilization of research results and evidence-based guidelines in SRH programmes and services

Develop strategies to plan, implement, monitor and evaluate programmes to advance SRH

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Strengthening national research and technical capacity:Strengthening national research and technical capacity:an ongoing HRP commitmentan ongoing HRP commitment

Resource Maintenanceand

Capital grant

Resource Maintenanceand

Capital grant

Small Suppliesgrant

Small Suppliesgrant

CompetitiveIntra-regional

Research grant

CompetitiveIntra-regional

Research grant

Re-entry grantRe-entry grantRCSRCS

Long-term InstitutionalDevelopment grant

Long-term InstitutionalDevelopment grant

Service GuidanceCentre grant

Service GuidanceCentre grant

RCSRCS

Research Traininggrant

Research Traininggrant

CompetitiveIntra-regional

Research grant

CompetitiveIntra-regional

Research grant

Re-entry grantRe-entry grantRCSRCS

Long-term InstitutionalDevelopment grant (LID)

Long-term InstitutionalDevelopment grant (LID)

Service GuidanceCentre grant

Service GuidanceCentre grant

RCSRCS

Research TrainingGrant (RTG)

Research TrainingGrant (RTG)

Courses, Workshops, Seminars grant

Courses, Workshops, Seminars grant

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Thank youThank you

http://www.who.int/reproductivehealth/en/http://www.who.int/reproductivehealth/en/

"Societies and the political leaders "Societies and the political leaders who govern them must first decide who govern them must first decide that the health of women matters. that the health of women matters. Public health can do something of Public health can do something of course. We can promote better course. We can promote better access to sexual and reproductive access to sexual and reproductive health serviceshealth services … we can map out … we can map out technical strategies for reducing technical strategies for reducing maternal deaths"maternal deaths"

Margaret Chan, Director-General, WHOMargaret Chan, Director-General, WHO