Abstract
The field of human service is broad, but the key objective is exclusively tackling people’s needs through an interdisciplinary knowledge base while at the same time focusing on preventing and offering remedies to problems and developing a strong commitment to enhancing the general life quality of service population. Besides, the human service field promotes increased service delivery systems by aiming to improve coordination, accountability, and accessibility among agencies and professions, as well as addressing the quality of direct services. An example of a human service organization is WHO. This paper evaluates a human service agency or organization known as World Health Organization (WHO). The paper evaluates WHO by providing its history, current trends, strengths, weaknesses and proposes improvements to promote greater client success by removing service barriers.
Introduction
A human service agency or organization is a body that is responsible for offering public aid to the population they serve (Hasenfeld and Paton, 1983). They oversee the administration of several programs for public health services, social services, public assistance, mental health services, and rehabilitation. Furthermore, these organizations are committed to enhancing the overall life quality of the people (Shier et al., 2019). An important consideration for these organizations is having a strong desire to help others. Workers in these agencies should understand how to collaborate with people to weave together a wide range of community resources, natural supports, and specialized help to promote community membership, empowerment, and well-being. This paper evaluates WHO by describing its history, population served, and organizational design, History and Trends, strengths and barriers, and ways to improve service delivery and growth.
Description of WHO
WHO History
Brown et al. (2006) state that the 1800s were characterized by increased travel and trade with the East. As a result, epidemic disease and cholera outbreaks occurred in the process of traveling and trading. For example, cholera epidemics in 1830 and 1840 killed several Europeans. Thus, it necessitated the formation of the first International Sanitary Conference in 1851 in Paris to establish international cooperation and disease control and prevention mechanisms. The sanitary Conference was revised in 1926 to incorporate typhus and smallpox. The last International Sanitary Conference was held on the eve of WWII in 1938 in Paris. One of the most critical agendas discussed by diplomats during the United Nations (UN) formation in 1945 was to create a global health agency. Immediately after WWII in 1945, the UN conference on International Organizations decided to create a new global health agency.
During the Conference to establish the UN, representatives from China and Brazil proposed in April 1945 to set up a global health organization. The Conference to structure its establishment was convened on February 11, 1946, by the secretary-general (Brown et al., 2006). From March 18 to April 5, 1946, a technical preparatory committee converged in Paris, drafted the constitution’s proposals, and submitted them to the International Health Conference in New York City. Based on the submitted proposals, 51 UN member representatives and other ten nations signed the WHO’s constitution on July 22, 1946, after being drafted and adopted by the Conference. The Conference also formed an Interim Commission that was mandated to discharge some tasks performed by the existing health institutions before the formation of WHO. Article 69 of the WHO constitution proposed that WHO is part of the UN’s specialized agency. Article 80 mandates that WHO shall be fully operational after 26 UN member states ratify it. WHO thus came into force after 26 out of 61 states signed and ratified the constitution on April 7, 1948 (Fang, 2012). Delegations from 53 out of 55 member states attended the first health meeting held in Geneva on June 24, 1948. The Interim Commission was agreed to be abolished in the session on August 31, 1948, and WHO immediately took over.
Population Served
WHO serves the global population. As outlined in their constitution, WHO’s functions remain firmly rooted in the primary principles of well-being and the right to health for everyone globally (World Health Organization, 2006). WHO is guided by science dedicated to people’s well-being. It is at the forefront to lead international efforts to provide everyone everywhere an equal opportunity to live a healthy life. It is responsible for offering guidance on international health issues, articulating evidence-based options, setting standards and norms, shaping the health research agenda, assessing and monitoring health trends, and providing technical support to countries. Essentially, WHO ensures countries are safe from health-related complications. Thus, it plays an essential role in global public health policy. Besides, since infectious diseases are now possible to spread faster throughout the world due to globalization and transportation, WHO ensures citizens of every country are from any kind of sickness. The organization has been at the forefront of several breakthroughs in the healthcare sector since its inception. These breakthroughs have been described as the most outstanding humanitarian achievements of the 20th century. The main aim of forming WHO is to ensure everyone stays healthy and free from illnesses.
Organizational Design
Grad (2002) states that the main organs of WHO organization design is the director-general, Secretariat, the Executive Board, and the World Health Assembly. The World Health Assembly represents all WHO members who determine the organization’s policies and deal with administrative and budgetary issues. The World Health Assembly is the supreme decision-making body, and it governs how WHO should function. The Executive Board is tasked with preparing theWHO’s agenda. Since the agency functions in a rapidly changing and increasingly complex landscape, it responds to these changes using a six-point agenda: promoting development, fostering health security, strengthening health systems, harnessing research, evidence, and information, improving performance, and enhancing partnerships. Furthermore, the Executive Board gives effect to the policies and decisions made by the Health Assembly. The secretariat comprises the organization’s administrative and technical personal. After being nominated by the executive board, the World Health Assembly appoints a director-general to head the secretariat. The Secretariat helps implement strategies and conducts routine operations. WHO groups its member states into six regions, with each region having a regional office. The six regions include Africa, Europe, the Americas, Eastern Mediterranean, Western Pacific, and Southeast Asia. The organization joins forces with member states to offer on-the-ground planning, monitoring, and implementing healthcare programs. In addition to its headquarters in Geneva, the organization has five outposts offices operating across country borders.
Three Major Historical Events
The historical events that shaped WHO were aimed at helping nations fight against illnesses. One such example of WHO activity over the years is smallpox eradication (Schleiff et al., 2020). Smallpox is an acute contagious disease and was among the killer diseases known to humanity. It was believed to have existed for over 3000 years and killed several people before it was eradicated. WHO planned in 1959 to eradicate smallpox from the world. However, its mission was thwarted by a shortage of vaccine donations and lack of funds, personnel, and uncooperative countries. Despite their best efforts, smallpox regularly broke out in Asia, Africa, and South America, and it was still widespread in 1966. With a promise of renewed efforts, WHO launched another Intensified Eradication Program in 1967 that ensured laboratories worldwide manufactured several high-quality vaccines. Other factors such as mass vaccination, the establishment of a case surveillance system, and the development of bifurcated needles ensured the success of the intensified efforts. Smallpox was already eliminated from Europe in 1953 and North America in 1952 when the Intensified Eradication program was started. The last known case was identified in Somalia in 1977. The World Health Assembly officially confirmed on May 8, 1980, that the world is free from smallpox. The ten-year worldwide effort spearheaded by WHO saw an end to smallpox. This event remains to be the most profound and notable public health success historically.
Another milestone activity is polio eradication (Schleiff et al., 2020). Polio is a highly infectious viral disease affecting kids below age five. WHO in 1988 launched an initiative termed as Global Polio Eradication Initiative. WHO mainly spearheaded the initiative with other organizations such as UNICEF, U.S. Center for Disease Control and Prevention (CDC), Vaccine Alliance, Gavi, Bill & Melinda Gates Foundation, and Rotary International. Since the launch of the initiative, polio cases have significantly reduced by 99 percent. In 2019, reported polio cases stood at 175 globally from a higher figure of 350000 cases in over 125 endemic nations. Furthermore, out of the three strains of polio, polio type two was completely eradicated in 1999 and type 3 in 2012 after the last case was reported in Nigeria. WHO has officially announced the complete eradication of both type 2 and 3 of poliovirus. However, polio type 1 was still endemic in two countries, Afghanistan and Pakistan, as of 2020. Based on the historical data about polio, it is evident that WHO has managed to almost completely eradicate polio from all countries except two.
Another major event is the declaration of Alma-Ata (Galea and Kruk, 2019). WHO and UNICEF jointly organized the declaration to focus on nations improving primary healthcare. Alma-Ata declaration was considered a significant breakthrough of the 20th century in the public health domain. The key was to identify primary healthcare as a way of attaining global health. WHO considers health not be merely an absence of illness but is being in a complete state of social, mental, and physical well-being. Thus, according to WHO, health is an essential human right. It is an important social goal to attain the highest possible health level, but it requires actions from several other economic and social fields in addition to the healthcare field. Furthermore, healthcare inequalities should be a common concern in every nation, and it is economically, socially, and politically unacceptable. People have the right to jointly and individually participate in planning and implementing healthcare. The declaration targeted to achieve acceptable levels of healthcare for everyone by 2000 through better use of the world’s resources (World Health Organization, 2000)
Current Trends
One current trend that will impact the future of WHO is the increasing number of old people (Fidler, 1998). Every citizen in each country has the right to live a healthy and long life. However, environments highly influence the way people live – it can be healthy or harmful. Recently, the number of old people has been increasing. For instance, people aged 60 and above numbered 1 billion globally in 2019. It is projected that these numbers will increase to 14B in 2030 and 2.1B in 2050 (World Health Organization, n.d.). This unprecedented increase in number needs adaptations to how societies are structured in transportation, health and social care, and urban and housing planning. Increasing the old population means increased dependency and maybe increased sickness, thus affecting healthcare costs significantly. Old people are more likely to suffer from chronic diseases than young people, and thus they will require different healthcare requirements. As a result, the different needs will affect the demands placed on healthcare in the future. Therefore, WHO will have to develop new policies and strategies regarding healthcare operations worldwide to ensure the everyone, particularly the elderly people, receive quality healthcare as structured in its constitution (Gra, 2002).
Another current trend is the COVID-19 outbreak. COVID-19 showed how WHO was slow in responding to the pandemic (Sohrabi et al., 2020). WHO was underpowered, and it took too long (eight months) to review the evidence presented to it regarding the disease spread, responses, and actions. The pandemic was an avertable disaster because it had weak links in its preparedness and response strategies. According to the report commissioned by the WHO director-general, WHO is currently unfit to prevent another pandemic. The report further states that physicians in Wuhan quickly realized the unusual fast spread of a certain pathogen in late December 2019. However, there was a slow response to make formal notifications and emergency declarations as per the international health regulations. WHO could have declared COVID-19 a global emergency within the first week of January than it did on January 30. Furthermore, the report states that so many member states took a ‘wait and see approach after WHO declared the pandemic. February was considered a ‘lost month’ because WHO failed to mobilize countries to implement coordinated measures to contain and stop further spread. In the future, WHO needs to reconsider its approach to handling pandemics to prevent the reoccurrence of the same mistakes. It will intensify its powers to curb the further spread of highly infectious pathogens based on what it leaned on previous pandemic measures.
Advanced health for all is another current trend (World Health Organization, n.d.). There is a need to develop and use advanced healthcare to treat different sicknesses and improve service delivery. To achieve this, WHO will collaborate with different partners and organizations to help nations improve their systems to respond to disasters and diseases as well as deliver important health services needed by everyone. WHO has two vital initiatives to ensure advanced health for everyone: the UHC compendium and its new primary healthcare program. To further improve this task, WHO will conduct a worldwide campaign aimed at strengthening global health workers.
Strengths
WHO has a democratic structure that brings together member nations to tackle global public health concerns and develop policies and initiatives beyond their political differences (Sørensen, 2018). As aforementioned, the democratic structure is composed of the secretariat led by a director-general, executive board, and World Health Assembly. Even though the member countries differ politically and economically, WHO has managed to make these countries work jointly regarding many public health issues and prevent the further spread of diseases. A good example is the current Covid-19 pandemic, where member states have been instructed by WHO to implement measures to eliminate the pandemic. WHO develops international standards and norms for health based on available scientific knowledge and best practices. In this regard, the implementation of WHO’s efforts and measures in member states has successfully reduced, if not eliminated, COVID-19.
WHO has unique assets. Even though it is accused of favoring China, it has a neutral status of working effectively with nations worldwide (EPRS, 2020). Besides, it is capable of working with other international organizations and UN agencies. For example, it has cooperated well in dealing with infectious diseases from animal origins, such as Covid-19 and SARS, with other agencies such as UN’s FAO. Furthermore, the agency has the stature of attracting a very qualified technical workforce. It is also considered a trusted source of policy advice in developing countries since it is at the front to bring improved healthcare to poor people globally. Besides, WHO has formed unparalleled networks with different individuals and organizations such as NGOs, researchers, governments, and other healthcare personnel. The formation of such networks is key in enabling global cooperation. Therefore, WHO has unique assets in different domains that enable it to effectively conduct its mandate. WHO’s history has proven severally that its real strength lies in practical measures. WHO has managed to curb infectious sicknesses and assisted developing nations to establish primary healthcare services with fully functioning and highly trained healthcare staff. It has also managed to vaccinate people against deadly infectious diseases, thereby improving and safeguarding the lives of millions of people.WHO’s measures over the decades enhanced the health lives of children and mothers in developing countries. There have been noteworthy measures implemented by WHO, such as eradicating infectious diseases like smallpox and polio and, to some extent, containing some tropical illnesses like malaria.
Barriers
WHO’s regional offices enjoy excessive autonomy, which results in problems (Russell, 2020). As per its constitution, the Executive Board appoints regional office directors after being endorsed by the regional committee. However, this is not the case as the Executive Board always endorses those candidates selected by the representatives of regional governments. This causes institutional problems in that the regional directors tend to follow orders from the government that appointed them instead of WHO thereby making WHO functions as seven separate bodies (the headquarter and its six regional offices) rather than a single unit. This division creates further problems when regional offices decide to prioritize national interest first than WHO’s interest. A good example is during the Ebola crisis. West Africa feared the associated economic costs of declaring the disease a health emergency. It would significantly impact the economy of West Africa, especially the travel and trade sector. Therefore, there was a delayed response from WHO to declare the disease health concern. Some of the regional offices also act as ‘parking places’ for relatives and friends of regional politicians. Besides, the agency has a multi-level structure that greatly adds to the administrative expenses, almost a third of its budget.
There is also slow-decisions making that acts as an institutional barrier (Russell, 2020). Such a global organization finds it hard to build unanimity among its member nations. It is also difficult to coordinate several departments without overlapping duties, thus contributing to a slow decision-making process. A lot of time is spent when making decisions because every member’s input is required. Some members may also disagree on something, thereby further extending the implementation of the idea. Ideas are well-thought-out before implementation.
Another barrier to functioning effectively is a lack of funds. WHO mainly gets its sources of finance from two major areas: countries’ membership subscriptions (member countries paying their assessed contributions) and voluntary contributions from other partners, member states, private sources, intergovernmental organizations, philanthropic foundations, and other sources. The U.S. is the largest contributor to the WHO, and its recent withdrawal from the WHO definitely affected the agency’s operations. There could be repercussions regarding the resurgence of diseases because WHO does not have enough funds to control them. The U.S. has been WHO’s largest financier. It has helped the agency eradicate infectious diseases such as smallpox and prevent and control the spread of other diseases such as malaria, polio, and HIV in some vulnerable regions (Colarossi, 2020). Furthermore, WHO is a central information repository. In other words, it serves different roles, including collecting and watching the world for any disease. Besides, WHO creates beneficial policies and guidelines for the world, which mostly help developing nations. Therefore, if it experiences a shortage of funds, it will not be able to do its tasks as required, thus putting the world at great risk. Moreover, WHO and U.S. CDC work jointly and harmoniously to understand disease transmission, control and prevent disease, and develop policies, among other ways. Colarossi (2020) further states that this relationship will be affected if America withdraws its support for WHO. The collaborations of these two organizations are crucial to controlling diseases globally, and termination of the collaboration will likely result in the reemergence of some diseases.
Improvements
WHO must have the power to impose strong sanctions (Chaumont, 2020). Currently, the organization cannot assert authority and instead depends on soft power approaches to ensure member states cooperate. The governance approach adopted makes WHO receive many criticisms on how it conducts its operations. An example where it received criticism is during the Ebola and Covid crisis. According to the International Health Regulations, nations must report any global public health emergency and work jointly with WHO to implement measures. However, the agency lacks the legal ability to enforce this mandate on governments failing to report global health concerns. Therefore, there is a need to revisit regulations to enable WHO to impose enforceable sanctions against uncooperative nations. It should work similarly to World Trade Organization (WTO) since both are UN agencies. WTO has the power to give out sanctions to states that fail to follow its mandates.
Chaumont (2020) suggests WHO should have a wide range of technical expertise. Given the cross-cutting nature of health issues, WHO lacks enough expertise, particularly lawyers and economists. Insufficient expertise is one of the organization’s weaknesses because it cannot coordinate and create consensus among its members. Therefore, WHO should have the wide-ranging technical expertise to remove service barriers and help it grow. More expertise is required in several fields, including information technology professionals, logisticians, lawyers, economists, urban designers, and political scientists. Increasing the technical expertise ensures its diplomatic neutrality and legitimizes public health recommendations. Furthermore, a broad range of technical expertise expands its power on issues not related to public health domains but strongly influence public health, for example, social determinants of health or digital technologies.
Another improvement is to increase untied funding. Many experts have argued that the organization is failing in its operations and receiving criticism because of its limited budget (Brown et al., 2006). Its budget is less than the budget of several big American healthcare organizations. Furthermore, a limited budget is caused by little contribution from the members. Contributions from the member states comprise less than 20% of its entire budget. For several decades, there has been a downward trend in terms of its budget size. Therefore, the limited budget limits its capacity to entirely control its scope of work. A strong coalition among countries and a simple call for more funding are enough for WHO to ensure it effectively performs its work. Furthermore, the agency should explore innovative financing ways to increase untied money that is not linked to any project. For example, the agency can look into replenishment ways such as the ones employed by the Vaccine Alliance, The Global Fund Gavi (Chaumont, 2020). It can also consider collecting more taxes on international transactions, such as the one employed by UNITAID on airline tickets. Having a bigger and untied funding source will prevent WHO from pursuing a broad network of funding sources and enable it to maintain a narrow, planned focus and sustain vital worldwide events.
Other ways to improve services and grow the organization are having open governance and a narrow mandate. Alongside its budget, its governance should include alternative voices from civil societies to obtain the influence of private humanitarians.WHO’s has a very broad scope, and thus its obligations should be narrowed and clarified. Even though WHO aims to implement all activities that health of everyone globally, it should rather focus mainly on those actions that result in significant value.
Conclusion
The human service field is focused on meeting people’s needs. WHO, an example of a human service agency was formed in 1948, shortly after WWII, to coordinate health affairs, serve the vulnerable and keep the world safe from illnesses. Secretariat headed by the director-general, the World health assembly, and the executive board form the main organs of WHO organization designs. Some of the historical events that shaped WHO are the total eradication of smallpox and polio type 2 and 3, while type 1 is still endemic in Pakistan and Afghanistan. The declaration of Alma-Ata focused on improving primary healthcare to attain global health. Major trends that will impact WHO’s future include an increase in the population of elderly people, mishandling of COVID-19 pandemic, and achieving advanced health for everyone. WHO also has some strengths and barriers. Its strengths include its robust democratic structure, notable practical measures, and working well with other international organizations and UN agencies. Regional offices enjoying excessive autonomy, slow-decisions making process, and lack of funds act as institutional barriers. WHO should impose strong sanctions, employ a wide range of technical expertise and increase untied funding to help it grow and improve its services.
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