Daily Times

The World Health Organization observed its 75th birthday or Diamond Jubilee on April 7, 2023, with the theme of “Health For All,” which has remained its main thrust since its creation and approval of its constitution in 1948, while using the primary health care (PHC) approach articulated 45 years ago in 1978. WHO’s main objective or raison d’etre “is the attainment by all people of the highest possible standards of health.”

Ever since its inception and inheriting the infrastructure and assets of the Health Organization of the League of Nations, which was abolished in 1946, WHO underwent several paradigm shifts and emerged as the leading agency of the United Nations for Health with a major overarching role to play in global health and international public health. Currently, it has headquarters in Geneva, six Regional Offices and 150 Country Offices to cater to the health needs of 193 Member States of the UN.

During its 75-year old history, it has achieved certain singular successes, such as establishing epidemiological information service (1948), starting mass BCG inoculation drives for TB control (1950), undertaking a global initiative for the eradication of small pox (1958) and intensifying the same (1969) to achieve such a major target by 1979, support to noncommunicable diseases such as Diabetes and creation of the International Agency for Research on Cancer (1965), giving a huge impetus to childhood immunization (1974), research and capacity building on Tropical Diseases (1975), emphasizing on community-based disability prevention and rehabilitation (1976), launching the ambitious goal of Health for All (1978) and focus on essential medicines (1977), initiating UNAIDS (1986) and the Global Polio Eradication Initiative (1988), establishing a commission for eradication of Guinea worm disease (1995), outlining the need to reduce preventable infant deaths (1998), creation of the Stop TB Partnership (2000), launching the measles initiative (2001), commencing resource mobilization through GFATM (2002), revision of International Health regulations (2005), improved emergency response mechanisms following the Ebola outbreak (2016) and declaring and controlling the COVID-19 pandemic since 2020.

Towards the end of his tenure, President Trump made WHO the scapegoat without any specific evidence to cover up lapses in the country’s response to the pandemic.

The tenure of WHO’s third Director-General Dr Halfdan Mahler (1973-1988) was characterized by the greatest vision and action ever demonstrated in the organization’s history. It must not be assumed, however, that everything is hunky dory with the organization. It was amid a misguided WHO Reform in 2011, when caught napping during the Ebola crisis in 2014 and 2015 in West Africa and considerably tarnishing its image. There are serious charges of sexual harassment against a score of senior staff members involved in the response and only last month the Regional Director of the Western Pacific Region was sacked on charges of racism and abusive harassment raising concerns over how such a person could even be elected to assume such a high position. More importantly, the organization has been politicized following the COVID-19 pandemic, which has thus far claimed around 6.832 million lives of which over 1.155 million (nearly 17 per cent) are from the United States of America. Towards the end of his tenure, President Trump made WHO the scapegoat without any specific evidence to cover up lapses in the country’s response to the pandemic. Although President Biden has restored the US Government’s confidence in WHO, the global body will yet need to be very careful in extricating itself from this huge mess.

Viewed from a larger perspective, WHO needs to focus solely to retain its technical superiority over other UN agencies, in addition to donor agencies, to play a positive role in all ongoing global health activities while preempting any emerging outbreaks. Towards this end, it will also need to mobilize greater resources and not be overly dependent on donors themselves. It has also to ensure that only sufficiently senior and technically strong health professionals with a demonstrated track record are appointed to pivotal positions. Technical staff of a high calibre are the main assets of specialized agencies like WHO, as opposed to organizations like UNDP, which can procure technical expertise in the shape of consultants. On the other hand, WHO Reform was lowering its technical strength and vision. Thankfully, this march towards folly was reversed by the present Director General of WHO on assuming office in 2017.

Pakistan is the largest country in the Eastern Mediterranean Region of WHO comprising 23 countries, and its experiences have contributed enormously to the strategic depth of the organization. In addition to normal development work, the health response in the aftermath of massive disasters such as the earthquake of 2005, floods in 2010, 2011 and particularly in 2022 was and is even currently being mediated with extensive WHO support and coordination.

The theme of Health For All is particularly relevant at this crucial time with less than seven years left for attaining Universal Health Coverage and other targets encompassed in Sustainable Development Goal # 3 such as the elimination of TB, AIDS, Malaria and Diabetes. As in the case of WHO, the provincial governments in Pakistan have largely underfunded public health sectors, as evinced by the Economic Survey of Pakistan released in June 2022, indicating that health allocations in 2021-22 rose from 1.1% of GDP to 1.2%, that too to cope with the COVID-19 pandemic. So although the actual spending may have grown a little, it was mainly for epidemic response and to beat inflation. The overall health allocation of federal and provincial governments for health in Pakistan was PKR 657.185 billion out of which PKR 534.318 billion were from the recurrent budget and PKR 122.867 billion on the development side. With the insistence of the donors to reduce the recurrent or non-development budget, the health financing is not likely to improve in 2023-24 either.

The good news in this otherwise grim scenario is that the Sehat Sahulat Program was providing health insurance coverage to 44.6 million families (close to 154 million people) without any copayment or premium as of June 2022 to reduce out-of-pocket expenditure in case of hospitalization. Nevertheless, the overall low spending in the Health Sector will make it difficult to achieve the goals set out for it, including providing healthcare services as a basic human right particularly in peripheral rural populations. While the Government of Pakistan has developed a UHC Benefits Package for each level of care, it may not be possible to roll it out evenly across all districts of the country with such meagre financial resources.

Investing in a strong health system with sufficiently skilled nurses and midwives must be seen as the legitimate pathway to overall economic development. This realization is imperative for the policymakers in the provinces to ensure that progress is accelerated regarding health-related SDGs. Resources can also be mobilized by enhancing taxation on tobacco products and sugar-sweetened beverages, which are heavily consumed. Effective mobilization and support of the private health sector are also imperative to attain national targets. Meanwhile, I wish a Happy Diamond Jubilee to WHO with accelerated success in all its endeavours.

The writer is a senior international public health specialist in Pakistan and Editor in Chief of Public Health Action – a journal of the International Union Against TB and Lung Disease.