Has the WHO lost its authority? Does the WHO no longer play the role it used to play? This is one of the many exciting issues we have debated during the first weeks at Global Health. This, I find of particular interest, as I did an internship in Copenhagen at WHO’s Regional Office for Europe.
Some researchers claim that the WHO has lost its authority in the 1980s, and that the organization from the ‘90s and onwards was increasingly controlled by the interests of a small number of Member States (Walt, Buse, Harmer, 2012). However, giving the WHO has an expiration date, like milk products, is simplifying what is a rather complex picture. Maybe you get a sour taste in your mouth, discovering that ¾ of WHO’s budget is made up of (mostly ear-marked) voluntary funding, and thus highly affected by their donors’ interests. I don’t want to be cynical, but there is no such thing as a free lunch. But what if the alternative would be extremely limited funding and inability to play any global health role at all? WHO’s biannual budget has increased to $400 million, and the number of Member States have highly expanded since 1948 (from 55 Member States to 194 in 2014), meaning that the budget and number of Member States has never before have had the same dimensions (Walt, Buse, Harmer, 2012). In a world with conflicts in Ukraine-Russia, Syria, Palestine, etc., I believe it is remarkable that countries, despite political disputes, gather to discuss evolving global health dilemmas.
WHO’s Regional Office for Europe has 53 Member States ranging from Russia and former Soviet members in the East, to Portugal in the West. With such a high diversity, agreeing on health treaties and strategies pose a dilemma.
Last week the European Region had its Regional Committee, at which (among many other activities) a new strategy for child and adolescent health, Investing in children: child and adolescent health strategy for Europe 2015 – 2020, was presented for endorsement and passed. I worked on giving the strategy a human face, and was surprised to discover how the strategy evolved (shrunk might be a better term) within a couple of months. In the beginning it had a 10-year duration period and measurable targets for each of the priority areas, but in the end all that was left was a 5-year-period without any quantifiable targets. To me, it seems like the importance of the strategy has been downplayed.
I keep questioning whether global health diplomacy is all about lowering the bar until you reach a position everybody can agree upon. With 53 very different countries in the European Region, agreement is an act of balancing. However, even though final strategies and policies might have less specific goals than the drafts, the value of having all the Member States sign is priceless for creating a momentum. A broad, unspecific strategy may also be easier to adapt to local contexts.
Let me provide you with an example of how actors can shape a policy to their own values using bottom-up methods. I experienced, during a field study in Ghana this year, how the United Nations’ Millennium Development Goals were not just development goals to the health care workers I spoke to. In the process of integrating them in their organizational structure, the goals had been transformed to Christian and highly personal values. They believed the goals fitted to their Christian values, and to them it was not only women and children dying, but mothers, sisters and their own children. My point is that the success of international treaties might actually depend on how broad they are. A policy, which is not only a top-down process – people from above telling others what to do, but a policy which is open for interpretation at a local level, can increase the likelihood of implementation.
This was also the experience of an organization I spoke to during my internship at the WHO; Sure Start Children’s Centers were a national British program I interviewed as an example on how to successfully support early childhood development – this child and health strategy also focuses on, for instance, youth friendly health services. The centers provide support to all families with children under the age of 4, and have gathered professionals who give advice on parenting practices, employment, social benefits and health at a center in the local neighborhood. Naomi Eisenstadt, former director of Sure Start, explained to me that one of the main reasons for Sure Start’s great success are that the local community have been involved in the design of the Sure Start Centers to make them fit local needs.
However, when everybody, due to different contextual factors, has their own way of translating the policy into action, measuring results in a standardized way is very difficult, which was also a dilemma for Sure Start. How do you compare what results when the set-up is completely different? Maybe the WHO does not strive for measurable results that it can take credit for? WHO’s strategies might seem very unspecific and broad, and the organization might seem more invisible than before, but maybe the WHO is, in fact, making a difference for global health by giving away some of its own leadership to its many Member States.