WHO, UNICEF & CARE - Detailed SPM Exam Notes

(Based on Park's Textbook of Preventive & Social Medicine)

WORLD HEALTH ORGANIZATION (WHO)

Historical Background

• Origin: April 1945 conference in San Francisco to set up the United Nations; proposal by Brazil and China to create an international health organization
• Constitution drafted by the "Technical Preparatory Committee" under chairmanship of Rene Sand (1946)
• Constitution approved by International Health Conference of 51 nations in New York, 1946
• Constitution came into force on 7th April 1948 -- celebrated every year as "World Health Day"
• WHO is a specialized, non-political, health agency of the United Nations
• Headquarters: Geneva, Switzerland
• WHO has its own constitution, own governing bodies, own membership and own budget -- part of, but NOT subordinate to, the United Nations

Objective of WHO

• Health = "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"
• Highest attainable standard of health is a fundamental right of every human being (without distinction of race, religion, political belief, economic and social condition)
• Health of all peoples is fundamental to attainment of peace and security
• Unequal development in countries in health promotion, especially communicable diseases, is a common danger
• Healthy development of the child is of basic importance
• Governments have a responsibility for the health of their peoples

Membership

• Membership open to all countries
• Switzerland is a member of WHO but NOT the UN (example of difference)
• Territories not responsible for their own international relations admitted as Associate Members (no vote)
• Each member state contributes yearly to the budget
• In 1948: 56 members; currently 194 member states and 2 associate members

Structure of WHO

(a) World Health Assembly (WHA)

• "Health Parliament of Nations" -- the supreme governing body
• Meets annually in May, usually at Geneva
• Each member state has one vote
• Functions:
  1. Determine international health policy and programmes
  2. Review work of the past year
  3. Approve the budget for the following year
  4. Elect Member States to designate persons to serve on Executive Board
  5. Appoints the Director General on nomination of Executive Board
• "Technical discussions" organized at each Health Assembly on topics of world interest

(b) Executive Board

• Originally 18 members; raised to 24, then 30, 31 (1976); now 34 members
• Members are "technically qualified in the field of health" -- represent themselves, not their governments
• One-third renewed every year
• Meets at least twice a year (January, and shortly after WHA in May)
• Main work: give effect to decisions and policies of the Assembly
• Can take emergency action (epidemics, earthquakes, floods) on its own

(c) Secretariat

• Headed by the Director General -- chief technical and administrative officer
• Primary function: provide Member States with technical and managerial support for national health development programmes
• 1948: 250 staff; 1985: 4475 international public servants; 2010: ~8000 staff
• At Geneva HQ: 5 Assistant Director Generals

Work of WHO (Constitutional Functions)

1. Prevention and Control of Specific Diseases

• Global eradication of smallpox -- outstanding example of international cooperation
• Directing global battle against poliomyelitis
• Epidemiological surveillance of communicable diseases
• Disseminates info through:
  • ATRS (Automatic Telex Reply Service)
  • WER (Weekly Epidemiological Record)
• WHO Emergency Scheme for Epidemics available to member states
• International Health Regulations (IHR): ensure maximum security against international spread of diseases with minimum interference with world traffic
• Non-communicable diseases: cancer, cardiovascular disease, genetic disorders, diabetes, blindness, mental disorders, drug addiction, dental diseases
• EPI (Expanded Programme on Immunization) -- priority programme
• Vector biology and control; quality control of drugs and biologicals

2. Development of Comprehensive Health Services

• Promote and support national health policy development
• Organizing health systems based on primary health care (PHC)
• Development of health manpower
• Building long-term national capability

3. Promotion and Coordination of Biomedical and Health Services Research

• Supports international collaborative research
• Coordinates research across member states

4. Developing, Establishing and Promoting International Standards

• International pharmacopoeia
• Nomenclature of diseases (ICD -- International Classification of Diseases)
• Biological standards for vaccines and sera
• Food standards (with FAO/Codex Alimentarius)

5. Promotion of Environmental Health

• Drinking water quality, sanitation, food safety, occupational health

6. Provision of Information and Managerial Support

• Health statistics, epidemiological data, publications
• Health education and public information

7. Training and Education of Health Personnel

• Fellowships for training abroad
• Visiting expert programmes
• Support for medical schools

8. Cooperation with Other Organizations

• Collaborates with UN and other specialized agencies (UNICEF, FAO, UNESCO, UNDP, ILO)
• Working relationships with inter-governmental organizations

Regional Offices of WHO (6 Regions)

• India joined: 1948; SEARO activities include malaria eradication, TB control, MCH, nursing, environmental health, mental health, nutrition, medical education

UNICEF

Origin & History

• Full form: United Nations International Children's Emergency Fund
• Established: 1946 by the United Nations General Assembly
• Purpose (1946): Deal with rehabilitation of children in war ravaged countries (post-WWII)
• 1953: Emergency functions over; renamed "U.N. Children's Fund" but retained initials UNICEF
• Headquarters: United Nations, New York
• Regional office for South Asia: Kathmandu, Nepal (South Central Asian Region, covering Afghanistan, Sri Lanka, India, Maldives, Pakistan, Bhutan, Bangladesh, Nepal)
• Governed by a 36-nation Executive Board (as of 2010)

Relationship with Other Agencies

• Works in close collaboration with WHO, UNDP, FAO and UNESCO
• Early joint work with WHO on: malaria, tuberculosis, venereal diseases

Evolution of Focus

• Early phase: Assistance for maternal and child health, nutrition, environmental sanitation (safe water supply), health centres, health education
• Shift (1950s onwards): Away from campaigns for eradication of specific diseases unless directly benefiting mothers and children
• Current concept: "Whole child" -- assistance geared not only to health and nutrition but also to long-term personal development and country development
• Also known as "country health programming"

Content of Services (Activities in India)

• Substantial aid for production of vaccines and sera
• Supported India's BCG vaccination programme from its inception
• Assisted erection of a penicillin plant near Pune
• Donated a DDT plant
• Two plants for manufacture of triple vaccine and iodized salt
• Environmental sanitation: safe water supply for rural areas
• Currently focusing on Primary Health Care (PHC) for mothers and children
• Emphasis on: immunization; infant and young child care; family planning; safe water and sanitation

• High priority to improving child nutrition
• Supplementary child feeding; development of low-cost protein-rich food mixtures
• Collaboration with FAO: "Applied Nutrition Programmes" through community development, agriculture, schools, and health services
• Supplied equipment for modern dairy plants in Maharashtra, Gujarat, Karnataka, UP, West Bengal, Andhra Pradesh
• Interventions against nutritional deficiency diseases:
  • Large doses of Vitamin A (xerophthalmia-prone areas)
  • Enrichment of salt with iodine (endemic goitre areas)
  • Iron and folate supplements (combating anaemia)
• FAO, UNICEF and WHO encouraging development of national food and nutrition policies

• Improve care of children within and outside homes
• Parent education; day-care centres; child welfare and youth agencies; women's clubs
• Carried out as part of health, nutrition and education or home economics extension programmes

• Collaboration with UNESCO: expansion and improvement of science teaching in India
• Providing science laboratory equipment, workshop tools, library books, audiovisual aids to educational institutions

CARE

Full Form

Origin

• Founded in North America in the wake of Second World War in 1945
• One of the world's largest independent, non-profit, non-sectarian international relief and development organizations
• Provides emergency aid AND long-term development assistance

CARE in India

• Began operations in India in 1950
• Till end of 1980s: Primary objective was to provide food for children in the age group 6-11 years
• From mid-1980s: Focused food support in ICDS (Integrated Child Development Services) programme and programmes in health and income supplementation

Current Projects (CARE-India)

1. Integrated Nutrition and Health Project
2. Better Health and Nutrition Project
3. Anaemia Control Project
4. Improving Women's Health Project
5. Improved Health Care for Adolescent Girls Project
6. Child Survival Project
7. Improving Women's Reproductive Health and Family Spacing Project
8. Konkan Integrated Development Project

Partners

• CARE-India works in partnership with:
  • Government of India
  • State Governments
  • NGOs
• States of operation: Andhra Pradesh, Bihar, Madhya Pradesh, Maharashtra, Orissa, Rajasthan, Uttar Pradesh, West Bengal

Quick Exam Comparison Table

Key One-Liners for Exam (Park's)

• WHO constitution in force: 7th April 1948 = World Health Day
• WHO HQ: Geneva, Switzerland
• WHO members: 194 member states
• WHO SEARO HQ in India: New Delhi (Indraprastha Estate)
• UNICEF established: 1946 | renamed 1953 (kept initials)
• UNICEF HQ: New York | South Asia regional office: Kathmandu
• UNICEF governing body: 36-nation Executive Board
• CARE = Cooperative for Assistance and Relief Everywhere
• CARE founded: 1945 in North America
• CARE India started: 1950; shifted to ICDS support from mid-1980s
• CARE: non-profit, non-sectarian, independent organization
• WHO definition of health: "complete physical, mental and social well-being..."
• WHO's 3 organs: World Health Assembly, Executive Board, Secretariat
• WHA meets: annually in May at Geneva
• Executive Board: 34 members, meets at least twice a year
• WHO eradicated smallpox; currently targeting poliomyelitis
• UNICEF supported India's BCG programme from its inception

Bilateral Health Agencies - Detailed SPM Exam Notes

(Park's Textbook of Preventive & Social Medicine)

Important Note for Exam: In SPM, the correct term is BILATERAL agencies (not unilateral). Bilateral = one country directly assisting another country. These are distinct from multilateral agencies (WHO, UNICEF) where many countries pool resources together.

What Are Bilateral Agencies?

USAID (United States Agency for International Development)

Background

• The US Government extends aid to India through three channels:
  1. USAID - United States Agency for International Development
  2. Public Law 480 (PL 480) - "Food for Peace" Programme
  3. US Export-Import Bank
• USAID was created in 1961
• It took over activities previously administered by the Technical Cooperation Mission (TCM)
• A USAID mission functions in New Delhi
• Both grants and loans are extended by the agency

Projects Assisted in India (8 key areas):

1. Malaria eradication
2. Medical education
3. Nursing education
4. Health education
5. Water supply and sanitation
6. Control of communicable diseases
7. Nutrition
8. Family planning

Recent Trend:

• Assistance is increasingly shifting to agricultural and family planning programmes
• Reduction in aid in the general public health field

The Colombo Plan

Origin

• Meeting of Commonwealth Foreign Ministers at Colombo in January 1950
• Programme drawn up for cooperative economic development in South and South East Asia

Membership

• 20 developing countries within the region
• 6 non-regional members: Australia, Canada, Japan, New Zealand, UK, USA

Work / Assistance

• Bulk of assistance goes into industrial and agricultural development
• Health promotion support mostly through fellowships
• Provides visits by expert consultants to advise on local problems and train local personnel
• Seeks to improve living standards by reviewing development plans and coordinating development assistance

Specific Contributions to India:

• AIIMS (All India Institute of Medical Sciences), New Delhi -- established with financial assistance from New Zealand under the Colombo Plan
• Canada supplied Cobalt Therapy Units to medical institutions in India

SIDA (Swedish International Development Agency)

• Assisting India's National Tuberculosis Control Programme since 1979
• Assistance mainly spent on procurement of:
  • X-ray units
  • Microscopes
  • Anti-tuberculosis drugs

DANIDA (Danish International Development Agency)

• Government of Denmark providing assistance
• Focus: National Blindness Control Programme
• Assistance since 1978

UNDP (United Nations Development Programme)

• Member states make voluntary contributions to UNDP
• Basic objective: Help poorer nations develop their human and natural resources more fully
• Projects cover virtually every economic and social sector:
  • Agriculture, industry, education & science, health, social welfare

UNFPA (UN Fund for Population Activities)

• Providing assistance to India since 1974
• Funds national level schemes + Area Projects for intensive development of health and family welfare in rural areas
• Projects in 11 districts of Bihar and 4 districts of Rajasthan
• UNFPA inputs designed to:
  • Develop national capability for manufacture of contraceptives
  • Develop population education programmes
  • Undertake organized sector projects
  • Strengthen programme management
  • Improve output of grass-root level health workers
  • Introduce innovative approaches to family planning and MCH care

Non-Governmental Bilateral/Other Organizations

Rockefeller Foundation

• Chartered in 1913; endowed by Mr. John D. Rockefeller
• Purpose: promote the well-being of mankind throughout the world
• Early focus: public health and medical education
• Later expanded to: life sciences, social sciences, humanities, agricultural sciences
• Work in India began in 1920 (hookworm disease control in then Madras Presidency)
• Contributions to India:
  • All India Institute of Hygiene and Public Health, Kolkata established in large measure through Rockefeller cooperation
  • Supported training of teachers and research workers
  • Fellowships and travel grants abroad
  • Sponsoring visits of US medical specialists
  • Grants-in-aid to institutions
  • Development of medical college libraries
  • Population studies
  • Assisted National Institute of Virology, Pune
  • Field demonstration area at Ballabhgarh (PSM dept of AIIMS)
• Currently directing support to: agriculture improvement, family planning, rural training centres, medical education

Ford Foundation

• While Rockefeller concentrated on universities and post-graduate institutions, Ford Foundation focused on:
  • Development of rural health services
  • Family planning

Quick Comparison Table

SPM Exam One-Liners

• Bilateral assistance = most important source of external aid (Park)
• USAID created: 1961; replaced TCM; located in New Delhi
• USAID gives both grants and loans
• USAID assists India in 8 areas (malaria, med education, nursing, health education, water/sanitation, communicable disease, nutrition, FP)
• Colombo Plan: Commonwealth Foreign Ministers met at Colombo, January 1950
• AIIMS New Delhi = Colombo Plan (New Zealand)
• Cobalt Therapy Units to India = Canada (Colombo Plan)
• SIDA = Sweden = National TB Control Programme (since 1979)
• DANIDA = Denmark = National Blindness Control Programme (since 1978)
• Rockefeller Foundation founded: 1913 by John D. Rockefeller
• Rockefeller in India: started 1920 (hookworm, Madras Presidency)
• AIIH&PH, Kolkata = Rockefeller Foundation
• Ballabhgarh field demonstration area = Rockefeller + AIIMS (PSM dept)
• UNFPA assisting India since: 1974