1

INTERNATIONAL HEALTH AGENCIES

Presented by: Ramvilas Reddy Jaidupally

2

CONTENTS• INTRODUCTION

• HISTORY

• FIRST INTERNATIONAL SANITARY CONFERENCE

• PAN AMERICAN SANITARY BUREAU

• OFFICE OF INTERNATIONAL D’HYGIENE PUBLIQUE

• THE HEALTH ORGANIZATION OF THE LEAGUE OF NATIONS

3

• THE UNITED NATIONS RELIEF AND REHABILITATION ADMINISTRATION

• WORLD HEALTH ORGANIZATION (WHO)

• UNITED NATIONS INTERNATIONAL CHILDREN’S EMERGENCY FUND (UNICEF)

• UNITED NATIONS DEVELOPMENT PROGRAM (UNDP)

• UNITED NATIONS FUND FOR POPULATION ACTIVITIES (UNFPA)

4

• FOOD AND AGRICULTURE ORGANIZATION (FAO)• INTERNATIONAL LABOR ORGANIZATION (ILO)• WORLD BANK• UNITED STATES AGENCY FOR INTERNATIONAL

DEVELOPMENT (USAID)• THE COLOMBO PLAN• SWEDISH INTERNATIONAL DEVELOPMENT AGENCY

(SIDA)• NON-GOVERNMENTAL AND OTHER AGENCIES

• ROCKEFELLER FOUNDATIONS

5

• FORD FOUNDATION • COOPERATIVE FOR ASSISTANCE AND RELIEF

EVERYWHERE (CARE)• INTERNATIONAL RED CROSS

• CONCLUSION • REFERENCES

6

introduction • Health and disease have no political or geographical

boundaries.

• Disease in any part of the world is a constant threat to other parts.

• History is replete with plague and cholera, along trade routes.

• In order to protect against the spread of the disease from one country to another, many attempts were made in the past by individual rulers and state the barriers against infection.

7

• Issues like the global spread of infectious diseases, the consequences of the HIV/AIDS, the growing antibiotic resistance, and the increasing the strengthening of the fight against poverty related diseases, have led to an increasing importance of health issues both at national and international level.

• International conferences were held and organizations were set up for discussion, agreement and cooperation on matters of international health.

8

HISTORY• The moves behind international involvement in health

matters have been varied and complex over the centuries, starting around the 1300s.

– Preventing plague– Safeguarding global commerce & the slave trade– Protecting soldiers and colonists overseas– Protecting workers and improving colonial relations– Religious, humanistic & social justice motivations

9

Pre-1800s

Bubonic plague (mid‐1300s,1630s), cholera, smallpox were prevailing. Disease spread due to increasing global commerce. Bubonic plague killed 20‐50% of affected populations. Quarantine first created in Venice in 1348 requiring ships to wait 40 days before entering port.

10

• Quarantine failed in its objective because of the lack of scientific knowledge regarding the causation and mode of spread of disease.

• Quarantine was opposed because the detention of the ships obstructed and caused serious inconveniences to international trade and travel.

• It became necessary for international agreement and cooperation on quarantine matters to control communicable diseases.

11

Flag for quarantine

12

Types of quarantine• "Mandatory quarantine" separates (by legal order)

people who may have been exposed to the virus from others who have not.

• "Voluntary quarantine" refers to members of the public who voluntarily follow restrictions on activities as recommended by their federal, provincial or local health department.

13

• Self-Quarantine – In a pandemic, many people or families may choose to "self-quarantine" by staying at home (not go school and work). They will also avoid social contacts such as groups or sports events. Self-quarantine is an effective way to reduce individual and family risk.

• Sequestering - Because limiting face-to-face contact is also a proven way to reduce the spread of disease, businesses may consider the unusual option of having groups of essential "core" staff live temporarily either at the workplace or at a nearby hotel.

14

1800- mid 1900’s• Industrial revolution further increased the trade and

commerce, with parallel increase in the spread of communicable diseases.

• Imperial conquests led to colonization and exploitation;• Invaders brought smallpox measles, TB,etc., and in turn

were felled by malaria, dysenteries, sleeping sickness. • Slave trade became extensive with high mortality rates.• Efforts to protect health of colonists, workers,

missionaries has been started.

15

• International conferences were held and organizations were set up for discussion, agreement and cooperation on matters of international health.

16

First international sanitary conference

• Was held during 1851, lead to the origin of international health cooperation.

• The conference was attended mainly by European countries.

• The objective was to introduce order and uniformity in the quarantine laws, which varied from country to country.

• The conference lasted for six months with no lasting results.

17

• Despite the many difficulties involved, an international sanitary code was prepared comprised of 137 articles dealing with cholera, plague and yellow fever.

• It was ratified by only three countries- France, Portugal and Sardinia of which Portugal and Sardinia withdrew in 1865.

• This conference was followed in rapid succession between 1851-1902 but they were equally unable to reach an agreement on quarantine measures.

18

Pan American sanitary bureau (Pasb)

• Establishment of PASB in America during the year 1902 was important milestone in the international health work.

• In 1924 an important document was signed by the American Republic namely “The Pan American Sanitary Code” which is in force between the states.

• In 1947, the bureau was recognized and the organization was called the Pan American Sanitary Organization (PASO).

19

• Now the PAHO has grown from a small information center to a major health agency with its headquarters in Washington.

• The PASB was the world’s first international health agency.

20

Office international d’hygiene publique

• In the year 1907, the “Office International d’hygiene Publique” (OIHP), generally known as Paris office was created to disseminate information on communicable diseases and to supervise international quarantine measures.

• It was predominantly European, but later on a considerable degree of cooperation grew up between OIHP and PASB.

• 60 countries including British India joined, giving the office an international character.

21

• In spite of no field staff to investigate the epidemics it did a remarkable work in disseminating knowledge of communicable diseases and their control.

• The OIHP continued to exist until 1950, by that time its responsibilities had been taken over by WHO.

22

The health organization of the league of nations

• After the world war I, the league of nations was established to build a better world and to take steps in matters of international concern for the prevention of disease.

• It was established during the year 1923.

• It branched out into nutrition, housing, rural hygiene, the training of public health workers and standardization of certain biological preparations.

23

• This league analyzed the epidemiological information received, and started the series of periodical epidemiological reports.

• One more eastern bureau was established at Singapore.

• It had laid down regulations for studies (expert committee reviews) which are substantially followed by the WHO.

• In 1939, the league of nations was dissolved but its health organization in Geneva continued.

24

The united nations relief and rehabilitation administration (unrra)

• It was set up in 1943 with a purpose of organizing recovery from the effects world war II.

• This organization had done an outstanding work in preventing typhus and other diseases.

• It has assisted in malaria control in Greece and Italy, where war had disrupted peace time and anti-malaria services.

25

• The renowned anti-malarial campaign was a joint effort of UNRRA, the Rockefeller foundation and the Italian government.

26

World health organization

• The WHO has its origin in April 1945, during the conference held at San Francisco to set up the United Nations.

• The constitution was drawn up at an international health conference in New York in 1946.

• The ratifications were secured by April 1948; the formal existence of the WHO as a specialized agency began on that date.

27

• WHO is the specialized, non-political, health agency of the United Nations, with headquarters at Geneva.

• In 1946, the constitution was drafted by the “Technical Preparatory Committee” under the chairmanship of Rane Sand, and was approved by an International Health Conference of 51 nations in New York.

• A World Health Day theme is chosen every year to focus attention on a specific aspect of public health.

28

objective• Is “attainment by all people’s of the highest level of

health”

• The current objective is “ attainment by all people of the world a level of health that will permit them to lead a socially and economically productive life.

• The preamble of the constitution states that;-• Health is a state of complete physical, mental and social

well-being and not merely the absence of disease or infirmity.

29

• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic and social condition.

• The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and states.

30

• Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.

• Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.

• The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.

31

• Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.

32

membership• Membership is open to all countries, most of the

countries are members of both the UN and WHO except few differences.

• For example, Switzerland is a member of WHO, but not of the united nations.

• Territories which are not responsible for the conduct of their international relationships may be admitted as associate members.

33

Work of who1. Prevention and control of specific diseases.

• The global eradication of smallpox is an outstanding example of international health cooperation.

• WHO is now directing the global battle against AIDS.

• An important activity of WHO is epidemiological surveillance of communicable diseases.

34

• Member States can also make use of the "WHO Emergency Scheme for epidemics" whenever necessary.

• The aim of International health Regulations is to ensure maximum security against international spread of diseases with the minimum interference with world traffic.

• Immunization against common diseases of childhood expanded (Program on Immunization) is now a priority program of the WHO.

35

Development of comprehensive services

• To promote and support national health policy development and the development of comprehensive national health programs.

• This includes wide variety of activities such as organizing health systems based on primary health care, the development of health manpower and utilization, building of long-term national capability, particularly in the areas of health infrastructure development and health services research.

36

• Appropriate Technology for Health (ATH) is another new program launched by the WHO to encourage self-sufficiency in solving health problems.

• The new program is part of WHO's efforts to build up primary health care.

37

Family health• Family health is one of the major program activities of

WHO since 1970, and is broadly subdivided into maternal and child health care, human reproduction, nutrition and health education.

• The chief concern is improvement of the quality of life of the family as a unit.

38

Environmental health• WHO advises governments on national program for

the provision of basic sanitary services.

• A number of programs have been developed such as the 'WHO Environmental Health Criteria Program and WHO Environmental Health Monitoring Program towards improving environmental health.

39

Health statistics• From 1947, WHO has been concerned with the

dissemination of a wide variety of morbidity and mortality statistics relating to health problems

• The data is published in the (a) Weekly Epidemiological Record (b) World Health Statistics Quarterly and (c) World Health Statistics Annual.

40

Biomedical research• It has established a world-wide network of WHO

collaborating centers, besides awarding grants to research workers and research institutions for promoting research.

• There are Regional Advisory Committees on health research which define regional health research priorities and a Global Advisory Committee, which in close collaboration with the regional committee deals with policy issues of global import.

41

Health literature and information

• WHO acts as a clearing house for information on health problems.

• Its publications comprise hundreds of titles on a wide variety of health subjects.

• The WHO library is one of the satellite centers of the Medical Literature Analysis and Retrieval System (MEDLARS) of the U.S. National Library of Medicine.

• The WHO has also a public information service both at headquarters and each of the six regional offices.

42

Cooperation with other organization

• WHO collaborates with the UN and with the other specialized agencies, and maintains various degrees of working relationships.

• Besides, WHO has also established relations with a number of international governmental organizations.

43

structure• The WHO consists of three principal organs :

1) World Health Assembly2) Executive Board and 3) Secretariat.

44

World health assembly• This is the "Health Parliament" of Nations and the

supreme governing body of the organization.

• It meets annually, usually in May, and generally at the headquarters in Geneva, but from time to time in other countries. (The 14th World Health Assembly met in New Delhi in 196I).

• The Assembly is composed of delegates representing Member States, each of which has one vote.

45

• The main functions of the Health Assembly are :

(I) to determine international health policy and programs

(ii) to review the work of the past year

(iii) to approve the budget needed for the following year

(iv) to elect Member States

(v) to designate a person to serve for three years on the Executive Board, and to replace the retiring members.

46

The executive board• The Board had originally 18 members, each designated by a

Member State.

• Subsequently, the number was raised to 24 and 30. The Health Assembly (I976) increased the membership from 30 to 31, providing that no fewer than three are to be elected from each of the WHO regions

• The main work of the Board is to give effect to the decisions and policies of the Assembly. The Board also has power to take action itself in an emergency, such as epidemics, earthquakes and floods where immediate action is needed.

47

The secretariat• The secretariat is headed by the Director General who is

the chief technical and administrative officer of the Organization.

• The primary function of the WHO secretariat is to provide Member States with technical and managerial support for their national health development programs.

• At WHO headquarters in Geneva, there are 5 Assistant Director Generals each of whom is responsible for the work of such divisions as may from time to time be assigned to him by the Director General. On 31st December, 1,985.

48

• Division of epidemiological surveillance and health situation and trend assessment.

• Division of communicable diseases.

• Division of vector biology and control.

• Division of environmental health.

• Division of public information and education for health

• Division of mental health.

49

• Division of diagnostic, therapeutic and rehabilitative technology.

• Division of strengthening of health services.• Division of family health. • Division of non-communicable diseases.• Division of health manpower development. • Division of information systems support. • Division of personnel and general services.• Division of budget and finance.

50

regions

South east Asia (New Delhi,

India)

Africa (Brazzaville

Congo)

The Americas (Washington

D.C, USA)

Europe (Copenhagen,

Denmark)

Eastern Mediterranean

(Alexandria, Egypt)

Western Pacific (Manila,

Philippines)

51

• These regional committees meet once a year to review health work in the region and plan its continuation and development.

• Regional plans are amalgamated into overall plans for the organization by the Director General at WHO’s headquarters in Geneva.

52

The south east Asia region

• The headquarters of the South East Asia Regional Office (SEARO) is in New Delhi, the official address being World Health House, Indraprastha Estate, Delhi. The Region has now 11 members.

53

• WHO's emblem was chosen by the first World Health Assembly in 1948. The emblem consists of the United Nations symbol surmounted by a staff with a snake coiling round it.

54

United nations international children’s emergency fund

• It was established in 1946 by the United Nations General Assembly to deal with rehabilitation of children in war ravaged countries

• In 1953, when the emergency functions were over, the General Assembly gave it a new name "U.N. Children's Fund" but retained the initials, UNICEF.

• UNICEF's regional office is in New Delhi; the region 's known as the South Central Asian Region which covers Afghanistan, Sri Lanka, India, the Maldives, Mongolia and Nepal.

55

• UNICEF works in close collaboration with WHO, and the other specialized agencies of the United Nations like UNDP, FAO and UNESCO.

• In the early years, UNICEF and WHO worked together on problems such as malaria, tuberculosis and venereal diseases.

• More recent times UNICEF had turn away from campaigns for the eradication of specific diseases unless they are of direct benefit to mothers and children.

56

• UNICEF is giving greater attention to the concept of the "whole child”.

• This approach is also known as ‘country health programming' in which UNICEF is currently interested so as to meet the needs of children as an integral part of the country's development effort.

• Its headquarters is located in New York.

57

Emblem of unicef

58

Services by UNIcefCHILD HEALTH

• UNICEF has provided substantial aid for production of vaccines and has supported BCG vaccination program in India.

• It has also assisted in building a penicillin plant near Pune.

• Assisted environmental sanitation programs emphasizing safe and sufficient water for drinking and household use in rural areas.

• The purpose is not only to reduce child illness and death, but to improve the quality of life in the villages.

59

Child nutrition • It gives high priority to improving child nutrition.

• In collaboration with FAO, UNICEF also began aiding "applied nutrition" programs through such channels as community development, agricultural extension, schools and health services so as to stimulate and help the rural population to grow and eat the foods it required for better child nutrition.

• Supplied equipment for modern dairy plants in various parts of India, viz. Maharashtra, Gujarat, Karnataka, Uttar Pradesh, West Bengal, Andhra Pradesh

60

Family and child welfare

• The purpose is to improve the care of children, both within and outside their homes through such means as parent education, day-care centers, child welfare and youth agencies and women's clubs.

• These services are carried out not as separate projects but as part of health, nutrition and education or home economics extension programs.

61

Education • In collaboration with UNESCO, UNICEF is assisting

India in the expansion and improvement of teaching science in India. Science laboratories' equipment, workshop tools, library books, audiovisual aids are being made available to educational institutions.

• Emphasis is placed on the kind of schooling relevant to the environment and future life of the children.

62

Currently, UNICEF is promoting a campaign known as GOBI campaign to encourage 4 strategies for a "child health revolution”

G for growth charts to better monitor child development

O for oral rehydration to treat all mild and moderate dehydration

B for breast feeding, and

I for immunization against measles, diphtheria, polio, pertussis, tetanus and tuberculosis.

63

• Since 1976, UNICEF has been participating in Urban Basic Services (UBS).

• The aim of the UBS projects is to upgrade basic services (e.g., health, nutrition, water supply, sanitation and education) especially for children and women - in selected cities and towns.

• The overall objective is to improve the degree and quality of survival and development of the children of urban low-income families.

64

undp• The United Nations Development Program (UNDP)

was established in 1966 and is the main source of funds for technical assistance..

65

United nations fund for population activities (UNFPA)

• The United Nations Fund for Population Activities (UNFPA) has been providing assistance to India since I974.

• The UNFPA inputs are designed to develop national capability for the manufacture of contraceptives, to develop population education programs, to undertake organized sector projects, to strengthen program management as well as to improve output of grass-root level health workers and introduction of innovative approaches to family planning and MCH care

66

67

Food and agriculture organization (FAO)

• was formed in 1945 with headquarters in Rome

• The chief aims of FAO are :

(1) to help nations raise living standards

(2) to improve nutrition of the people of all countries

(3) to increase the efficiency of farming, forestry and fisheries

(4) to better the condition of rural people and, through all these means, to widen the opportunity of all people for productive work.

68

• FAO's prime concern is the increased production of food to keep pace with the ever-growing world population.

• FAO has organized a world Freedom from Hunger Campaign (FFHC) in 1960. The main object of the Campaign is to combat malnutrition and to disseminate information and education.

• The joint WHO/FAO expert committees have provided the basis for many cooperative activities - nutritional surveys. training courses, seminars and the coordination of research programs on brucellosis and other zoonosis

69

70

International labor organization (ILO)

• In 1919, the International Labor Organization (lLO) was established as an affiliate of the League of Nations to improve the working and living conditions of the working population all over the world.

• The purposes of ILO are : to contribute to the establishment of lasting peace by

promoting social justice. to improve, through international action, labor conditions, and

living standards. to promote economic and social stability.

71

• The International Labor Code is a collection of international minimum standards related to health, welfare, living and working conditions of workers all over the world.

• There is a close collaboration between ILO and WHO in the field of health and labor.

• The headquarters of ILO is in Geneva, Switzerland.

72

73

WOrlD bANK • It was established with the purpose of helping less

developed countries raise their living standards.

• The powers of bank are vested in a Board of Governors.

• Health and environmental components have been added to many projects. Cooperation programs exist between WHO and the Bank. e.g.. projects for water supply, World Food Program, Population Control, and the control of onchocerciasis program in West Africa

74

75

United States Agency for Internationa. Development (USAID)

• The US Government presently extends aid to India through three agencies (1) United States Agency for International Development (USAID) (2) The Public Law 480 (Food for Peace) Program (3) The US Export-Import Bank.

• USAID was created in 1961, it is in charge of 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.

76

• The US has been assisting in a number of projects designed to improve the health of Indian population.

• The recent trend in assistance from the USA is increasingly in the support of agricultural and family planning programs, with some reduction in aid in the general public health field.

77

78

THE Colombo plan • The bulk of Colombo Plan assistance goes into industrial

and agricultural development but some support has also been given to health development, mostly through fellowships.

• The All India Institute of Medical Sciences at New Delhi was established with a assistance from New Zealand.

• The Plan provides visits to countries by experts who can offer advice on local problems and train the local people.

• Colombo plan seeks to improve living standards of the people of the area by reviewing developmental plans and coordinating development assistance.

79

Swedish international development agnecy (SIDA)

• Assisting the National Tuberculosis Control Program since I979.

• The SIDA assistance is usually spent on procurement of supplies like X-ray unit, microscopes and anti-tuberculosis drugs.

• SIDA authorities are also supporting the Short Course Chemotherapy.

80

Danish international developmental agency (DANIDA)

• The Government of Denmark is providing assistance for the development of services under National Blindness Control Program since 1978.

81

Rockefeller foundation

• The Foundation was active chiefly in public health and medical education. Subsequently, its interest was expanded to include the advancement of life sciences, the social sciences, the humanities and the agricultural sciences.

• The work of the Rockefeller Foundation in India began in 1920 with a scheme for the control of hookworm disease in the then Madras Presidency.

82

• The establishment of the All India Institute of Hygiene and Public Health at Kolkata was in a large measure due to the cooperation of the Rockefeller Foundation.

• At present the Foundation is directing its support to the improvement of agriculture, family planning and rural training centers as well as to medical education

83

Ford foundation• The Foundation has been active in the development of

rural health services and family planning.

• The Ford Foundation has helped India in the following projects

• Orientation training centers • Research-cum-action projects• Pilot project in rural health services, Gandhigram Tamil

Nadu) : Among a rural population of 100,000 people, an attempt was made to develop and operate a coordinated type of health service which will provide a useful model for health administrators in the country.

84

• Establishment of NIHAE

• Calcutta water supply and drainage scheme

• Family planning program : The Foundation is supporting research in reproductive biology and in the family planning fellowship programs.

85

CARE • CARE (Co-operative for Assistance and Relief

Everywhere) was founded in North America in the wake of the Second World War in the year 1945.

• It is one of the world's largest independent, non-profit, non-sectarian international relief and development organization.

• It provides emergency aid and long term development assistance.

86

• CARE began its operation in India in 1950, till the end of 1980s, the primary objective of CARE - India was to provide food for children in the age group of 6-11 years.

• CARE-India works in partnership with the Government of India, State Governments, NGOs etc. Currently it has projects in Andhra Pradesh, Bihar, Madhya Pradesh, Maharashtra, Orissa, Rajasthan, Uttar Pradesh and West Bengal.

87

Red Cross • The Red Cross is a non-political non-official

international humanitarian organization devoted to the service of mankind in peace and war.

• In the book "Un Souvenir de Solferine" and in countless interviews with eminent persons, throughout Europe, Dunant urged that voluntary national societies be founded "which in time of war would render aid to the wounded without distinction of nationality".

88

• The First Geneva Convention took place in 1864 and a treaty was signed for the relief of the wounded and the sick of the armies in the field.

• Thus came into being the International Committee of the Red Cross (ICRC), an independent, neutral institution, the founder organization of the Red Cross

89

Role of Red Cross • The work of the Red Cross was extended to other

programs which would prevent human suffering. These comprise service to armed forces, service to war veterans, disaster service, first aid and nursing, health education and maternity and child welfare services.

90

Red cross emblem

91

conclusion• Health has long been an important part of

development assistance, foreign policy and education- but motivations priorities and mechanisms have changed over time.

• Development assistance accomplishments over most of the past 60 years have generally disappointing.

• Since the latter 1990s there has been a rapid rise in the number, variety and capabilities of organizations involved in and funding available for improving global health.

92

• New assistance approaches can program development in the future. These collaborative partnerships are seeking better, more transparent ways to set priorities.

93

References • Park K. International Health. In: Preventive And Social

Medicine. 23rd ed. Jabalpur: Banarsidas Bhanot; 2015.p.916-923.

• http://www.ccohs.ca/pandemic/documents/quarantine.html. Last accessed on 3rd January 2016.

• http://www.who.int/about/licensing/emblem/en/. Last accessed on 3rd January 2016.

• Hall TL, Gundersen ET, Jensen TP. Global Health Actors and Their Programs. Consortium of Universities For Global Health.

94

• Hiremath SS. International and National Health Agencies. In: Textbook of Preventive and Community Dentistry.2nd ed. New Delhi: Elsevier; 2011. p. 97-111.

• Kohlmorgen L. International Organizations and Global Health Governance. The Role of WHO,WB,UNAIDS.

95