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December 4, 2018

The High Level Impact of the World Health Organization

By Robert Treval

Students at Georgetown like to say that global bureaucratic institutions do not work well, that no one reads their reports, or that high-level meetings are ineffective. While there may be some truth in those statements, following the World Health Organization (WHO) over the past few weeks has made me think twice about these criticisms. The WHO recently published three documents that honor several promises made by Tedros Adhanom Ghebreyesus, director-general of the WHO, for improving the organization and finding better health solutions. The documents include the World Malaria Report 2018, the 13th General Programme of Work (GPW13) WHO Impact Framework, and the Declaration of Astana. Together, they recognize the global trend towards country agency and a need for primary care, even in the context of infectious disease control.

In his first speech as director-general in front of the World Health Assembly earlier this year, Tedros affirmed his original commitments and made clear statements on their status and his vision for the coming years. Highlighting the importance of an integrated approach to health, Tedros said, “The best thing we can do to prevent future outbreaks is to strengthen health systems everywhere.” This same notion, he goes on, led to the creation of a high-level commission on noncommunicable diseases, an initiative on climate change, and a hastened review of the GPW13. In this address, he also called out earmarking, saying that it “creates silos and fuels internal competition for funds” instead of bringing people together. Evidently, he has wanted to address and change the way that the WHO interacts with recipient countries and expand the definition of health interventions. In the recent documents, some of those goals have been crystalized in clear interventions and indicators.

The malaria report was released most recently, on November 19. It highlights that the 10 highest burden African countries experienced a 3.5 billion increase in malaria cases from 2016 to 2017 and that funding has plateaued. Because of these findings and slowed progress, the WHO announced that “WHO and partners are joining a new country-led response, launched today, to scale up prevention and treatment, and increase investment, to protect vulnerable people from the deadly disease.” The focus on country-led responses and protection of vulnerable people are two essential elements of this newly announced program, and it promises country agency and system integration for the WHO’s malaria initiative.

The next document, the GPW13 WHO Impact Framework, was published October 29. This document reflects Tedros’ desire to accelerate the development of the GPW and includes 46 targets and indicators that clarify the mission for 2019 to 2023. The levels of measurement in the Impact Framework include a general healthy life expectancy indicator for measuring the total change in health burden, the triple billion targets of 1 billion more people with universal health coverage, 1 billion better protected from health emergencies, 1 billion enjoying better health and well-being, and the 46 targets. This document serves to operationalize the promises of the GPW13 and its promises to put countries at the center of its work, tailor needs to the countries contexts, and work at the local level.

Third, on October 25, the WHO reaffirmed the commitment to the Declaration of Alma-Ata in the Declaration of Astana. Among other things, the new declaration recognizes a failure to fully implement the original goals of the Declaration of Alma-Ata, affirms the necessity for a horizontal, or integrated, approach to health interventions, and reasserts the importance of primary health in global interventions. This declaration, signed by all member countries, shows that Tedros has a broad base of support for his initiatives and that the global culture and conversation is strengthening around system-wide, primary health-focused interventions.

Together, these documents show that the thinking on health interventions is definitely changing at a high level and that Tedros and his administration are following on their original commitments. Between the Impact Framework, the Declaration of Astana, and the World Malaria Report 2018 lies an updated version of the WHO and a more integrated approach to global health.

Robert Treval (SFS'19), is a senior in the Walsh School of Foreign Service studying science, technology, and international affairs with a focus on global health, and a student fellow with the Global Health Initiative.