INTERNATIONAL HEALTH

AGENCIES

Dr. Neha Agrawal

 CONTENTS

• History and development

• Objectives
• Types of international health agencies
• Multilateral agencies
• Bilateral agencies
• Non-governmental agencies
• Conclusion
HISTORY AND DEVELOPMENT

“Nothing on earth is more international than

disease”
(Paul Russel)
Spread of epidemics

• Plague of Athens in 430 BC

• The Black Death
• Yellow fever in West Indies and Panama Canal area
• Epidemics in Russia after 1918

The Black Death

• Communities isolated themselves or the infected
communities

• 14th century – Europe

Ships, travellers, cargoes detained for 40 days

• Practice of isolation for a limited period- ‘Quarantine’

• Quarantine became an established practice
in many countries

• Became necessary for international

agreement and cooperation on quarantine
matters

ORIGIN OF INTERNATIONAL HEALTH WORK

• First International Sanitary Conference,1851
in Paris
– to introduce uniformity into quarantine measures
– ended in failure

• 10 Conferences between 1851 and 1902

– Unable to reach an agreement
The Early International Health Organizations

Pan American Sanitary Bureau- 1902

• World’s first international health agency

• To coordinate quarantine procedures in American States
• 1924- Pan American Sanitary Code signed
• 1947 –Pan American Sanitary Organization (PASO)
• 1949 –WHO Regional Office for the Americas
• 1958 –Pan American Health Organization (PAHO)
Office International D’Hygiene Publique- 1907

• Generally known as “Paris Office”

• To disseminate information on communicable

diseases and supervise international quarantine
measures

• First worldwide international health organization

• 1950 – Taken over by WHO

The Health Organization of the League of Nations -
1923

 League of Nations formed after the First World War (1914-18)

 Its Heath Organization – did creditable work

– Quarantine regulations
– Epidemiological information
– Epidemic disease problems
– Nutrition, housing, rural hygiene
– Training of public health workers
– Standardization of biological preparations
– Series of periodical epidemiological report
– Laid down lines for technical studies
 United Nations Relief and Rehabilitation
Administration (UNRRA)- 1943

 To organize recovery from effects of Second World War

 Outstanding work in
–Prevention of Typhus and other diseases
–Assistance to malaria control in Greece and Italy
–Campaign for eradication of malaria from Sardinia
Birth of WHO

– April 1945 - Conference held at San Fransisco to set

up UN- Brazil and China suggested establishment of
international health organization
– Constitution drawn up in 1946

– Came into formal existence on 7th April, 1948

– Culmination of efforts to establish a single worldwide

inter-governmental health agency
 OBJECTIVES OF INTERNATIONAL
HEALTH AGENCIES

• Control of epidemics and communicable

diseases affecting more than one country.

• International exchange of medical and dental

health information.

• International standardization of biological

preparations

• Combined research
• Help to under-developed countries.

• Advice to governments and health

authorities on health questions.

• International control of drugs of addiction.

• International help in disasters.

 TYPES OF INTERNATIONAL
HEALTH AGENCIES
2 kinds of agencies

Official Voluntary

Operated by federal, state Operated by groups of

or local governments. interested citizens. Obtain
Supported by public money from fund raising
taxation. appeals and other
voluntary private sources.
• Multilateral agencies
Funding comes from multiple governments and is
distributed to many different countries. All part of the
United Nations.

• Bilateral agencies
Governmental agencies in a single country which
provide aid to developing countries.

• Non-governmental organizations (NGOs)

Also known as private voluntary organizations (PVOs).
MULTILATERAL HEALTH
AGENCIES
 WORLD HEALTH
ORGANIZATION (WHO)
• Specialized, non-political, health agency of
the United Nations.

• Worldwide inter-governmental health agency

• Headquarters at Geneva
• Constitution drafted by the “Technical Preparatory
Committee” under the chairmanship of Rene Sand in
1946

• Approved by International Health Conference of 51

nations in New York in 1946

• Interim Commission set up

 Constitution came into force on 7th April, 1948

• 7th April- World Health Day

A World Health day theme is chosen each year
to focus attention on a specific aspect of public
health.
– 1994 – Oral health for a healthy life.

– 2006 – Working together for health

Objective

• “the attainment by all peoples of the highest

level of health”

• Current objective: Health for All by 2000 AD

attainment by all people of the world by the
year 2000 AD of a level of health that will
permit them to lead a socially and
economically productive life
• Two major policy developments have
influenced WHO in recent years:

– Alma Ata Conference in 1978 on primary health

care

– Global Strategy for Health for All by 2000

• Both WHO and UNICEF are striving towards

the goal of HFA by the year 2000 through
health system based on primary health care
Membership

• Open to all countries

• 1948 - 56 members

• Currently- 193 Member States

2 Associate Members
(Puerto Rico and Tokelau)

• Each member state contributes yearly to the

budget and is entitled to the services and aid
organization can provide.
Structure

• The World Health Assembly

• The Executive Board
• The Secretariat
The World Health Assembly

• “Health Parliament” of Nations

• Supreme governing body of WHO

• Meets annually, usually in Geneva in May.

• Composed of delegates representing Member States

 The World Health Assembly…

• Functions:
– determine the international health policy and
programmes

– review work of past year

– approve budget needed for following year

– elect Member States to designate a person to serve

for three years on the Executive Board

– Appoint Director-General on nomination of Executive

Board.
• Dr. Margaret Chan is the Director-General
of WHO, appointed by the World Health
Assembly on 9 November 2006.
Executive Board

• 34 members technically qualified in the field of

health. Designated by but do not represent their
governments.

• Members are elected for three-year terms.

• Meets at least twice a year, in January and May.

• Gives effect to the decisions and policies of the

Assembly.
The Secretariat

• Primary function:
To provide Member States with technical
and managerial support for their national
health development programmes.

• Headed by the Director-General

• Staffed by some 8,500 health and other

experts and support staff
Regions

• To meet the special health needs of

different areas- 6 regional organizations

• Regional office is headed by the Regional

Director

• Regional Committee composed of Member

States in the region
How is WHO funded?

• Has its own budget

• Members assessed on a scale based on

population and income/head- periodically
reviewed
United States pays- 32%
U.S.S.R- 12%
U.K.-7%
India-2%
• Besides its regular budget WHO receives
voluntary contributions.

• The total WHO budget planned for 2006-2007

is roughly $US 3.3 billion.

28%
Assessed
contributions from
Member States
 Work of WHO

• Classical or inherited work

Epidemic intelligence, quarantine, standardization of
biologicals

• Direct services to governments in the field

• Education and information

Training of doctors, nurses, sanitary engineers;
Studies, surveys; Courses, symposia, seminars
Fellowship programmes; Publications
 Work of WHO…

WHO’s first constitutional function :

To act as the directing and coordinating
authority on all international health work.

– to identify collectively priority health problems

throughout the world,

– to define collectively health policies and targets to

cope with them,

– to give effect to these policies and to attain targets.

Specific responsibilities
• Prevention and control of specific diseases
• Development of comprehensive health services
• Family health
• Environmental health
• Health Statistics
• Bio-Medical Research
• Health Literature and Information
• Cooperation with Other Organizations
WHO Publications

• Basic Documents and Resolutions and Decisions.

• The monthly Chronicle – account of current activities
• Bulletin – scientific articles
• Monographs and Technical Report Series
• Public Health Papers
• International Digest of Health Legislation
• Series of weekly, monthly and annual
Epidemiological Records
• World Health – a popular news sheet
 1979
1978 Eradication of
2004
International small pox Adoption of
conference on Global Strategy
primary health on Diet,
care
2003 Physical Activity
WHO and Health
Framework
1988 Convention on 2003
Tobacco Control
Global polio SARS identified
eradication Initiative and controlled
 WHO Oral Health Unit

1956

• No specific programme till 1956

• Programme entitled Dental Health (DNH)

inaugurated
• 1967….

– Epidemiologist: Dr. D. E. Barmes

– Oral Health Surveys: Basic Methods manual -1971
– Global Oral Data Bank (GODB) - 1969

– Application of the International Classification of

Diseases to Dentistry and Stomatology (ICD-DA )
completed as a companion to the ICD

– International Collaborative Study of Dental

Manpower Systems (ICS I) commenced

– Programme name changed to Oral Health (ORH)

1974….

• Dr. D. E. Barmes became Chief

• Further additions of the Oral Health Surveys (1977)

and ICD-DA manuals

• Pathfinder system for rapid and inexpensive data

collection was developed

• New data collection method for periodontal disease

indicators- CPITN index defined -1982.
1979 …
• Collaborative programmes established with NGO's
(FDI, IADR, IFDH)

• The ICS I - completed and ICS II - nearing completion

• Intercountry Centres for Oral Health were established

in Thailand, Syria, Nigeria and Belarus.

• Studies of different cost effective systems of oral

health care delivery and low cost materials and
equipment performed in Thailand, Indonesia and
Zimbabwe.
• 1979
First measurable goal for the year 2000
announced- 3 DMFT at 12 years of age

• 1981- Global goals proposed for year 2000

by WHO and FDI

• 7 April,1994
WHO introduced ART as part of the World
Health Day and celebrations of the Year of
Oral Health
1995

"WHO Oral Health Country/Area Profile Programme”

(CAPP)

• Objective : to present information on dental diseases

and oral health services for various countries/areas.

• Main server - located at WHO Collaborating Centre for

Education, Training and Research at the Faculty of
Odontology, Malmö, Sweden.

• A server for Periodontal conditions is located at Niigata

University, Japan
2003
• FDI, WHO and IADR presented new goals
for year 2020
 UNITED NATIONS INTERNATIONAL
CHILDREN’S EMERGENCY FUND
(UNICEF)
• Established by United Nations General
Assembly in 1946.

• To deal with rehabilitation of children in war

ravaged countries

• 1953 - “United Nation’s Children’s Fund”

• Headquarters: United Nations, New York

• Regional office of South Central Asian Region – New
Delhi

• 30 member Executive Board

• Works in collaboration with WHO and other

specialized agencies of UN

• MCH, nutrition, environmental sanitation

• WHOLE CHILD
Assistance to long term personal development and
development of countries in which they live – “country
health programming”
Content of services:
• Child health
• Child nutrition
• Family and child welfare
• Education – formal and non-formal
• GOBI
– G- Growth charts
– O- Oral rehydration
– B- Breast feeding
– I- Immunization
• Urban Basic Services (UBS)
• UNICEF has worked closely with the Government
and other partners in defluoridation programmes in
India.

• In the 1980s, UNICEF supported the Government's

Technology Mission.

• A number of demonstration projects have been

initiated in fluorosis-affected areas, with emphasis
on introducing household defluoridation.

• Has sponsored research and development on use of

activated alumina.
 UNITED NATIONS DEVELOPMENT
PROGRAMME (UNDP)
• Established in 1966

• Main source of funds for technical

assistance.

• Basic objective: Help poorer nations

develop their natural and human resources
more fully.
 THE FOOD AND AGRICULTURE
ORGANIZATION (FAO)
• Formed in 1945

• Headquarters in Rome.

• Main functions:
 Help nations raise living standards
 Improve nutrition of people of all countries
 Increase efficiency of farming, forestry and fishing
 Better conditions of people in rural areas.
 World Freedom from Hunger campaign to combat
malnutrition
 INTERNATIONAL LABOUR
ORGANIZATION (ILO)
• Formed in 1919- affiliate of the League of
Nations

• Headquarters in Geneva, Switzerland

• Main purpose: To improve the living and

working conditions of working population all
over the world.

• Close collaboration between ILO and WHO

in field of health and labour.
 THE WORLD BANK
• Specialized agency of the United
Nations

• Purpose: To help less developed

countries raise living standards of their
people.

• Gives loans for projects that will lead to

economic growth.
• Cooperative programmes between WHO
and World Bank
– Projects for water supply
– World Food Programme
– Population Control
– Onchocerciasis programmme in West Africa

• Disease Control Priorities in Developing

Countries - A World Bank Initiative
BILATERAL HEALTH AGENCIES
UNITED STATES AGENCY FOR
INTERNATIONAL DEVELOPMENT
(USAID)

• The US Government presently extends aid

to India through three agencies:

– USAID established in 1961

– The public law 480 (Food for Peace) programme

– The US Export-Import bank

• The US has been assisting India in:
– Malaria eradication
– Medical education
– Nursing education
– Health education
– Water supply and sanitation
– Control of communicable diseases
– Nutrition
– Family planning
 THE COLOMBO PLAN

• Established in 1950 at a meeting of

Commonwealth Foreign Ministers at Colombo.

• Main objective: Cooperative economic

development in South and South East Asia

• 20 countries within the region and

6 non-regional members - Australia, Canada,
Japan, New Zealand, UK and USA
 THE COLOMBO PLAN….

• Some support given to health promotion

• AIIMS, New Delhi- established with

financial assistance from New Zealand

• Canada- Cobalt Therapy Units in

medical institutions in India
Swedish International Development
Agency (SIDA)

– Assisting National TB Control Programme

since 1976

– Supporting partner to WHO for CAPP

Danish International Development
Agency (DANIDA)

6 major DANIDA-supported programmes in health

sector:

• Tamil Nadu Area Health Care Project (TNAHCP)

• Madhya Pradesh Basic Health Services Programme
(MPBHSP)
• Pulse Polio Immunisation Programme (PPI)
• DANIDA supported National Leprosy
Eradication Programme (DANLEP)

• Revised National Tuberculosis Control

Programme (RNTCP)

• DANIDA supported National Blindness

Control Program (DANPCB)
• Tanzania-Danida Dental Health Programme
(1981 to 1993)

169 Dental Therapists and 38 Assistant Dental

Officers trained in Ministry of Health institutions in
Tanzania during >10 years support from Danida

(Reference: Poulsen S, Fubusa F, Gemba PM, Lema PA,

Mosha HJ, Ntabaye MK. Distribution of dental therapists and
assistant dental officers trained under the Tanzania-Danida
Dental Health Programme 1981-1993. Odontostomatol Trop.
1999 Jun;22(86):19-22.)
NON GOVERNMENTAL
AGENCIES
THE ROCKFELLER FOUNDATION

– John Rockefeller -1913

– Active in public health and medical education
– Control of hookworm in Madras – 1920

– All India Institute of Hygiene and Public

Health at Kolkata

– Training, fellowships, travel grants, grants-in-

aid, development of medical college libraries
THE FORD FOUNDATION

• Active in development of rural health

services and family planning

• Work in India
– Orientation Training Centres
– Research and Action projects for environmental
sanitation
– Rural Health Services
– Establishment of NIHAE
– Family Planning Programme
Co-operative for Assistance Relief
Everywhere (CARE)

• Founded in North America in wake of

Second World War in 1945

• World’s largest, independent, non-profit

international relief and devlopment
organization

• Began operation in India in 1950

• Primary objective: Provide food for children

in India in 6-11 years
 INTERNATIONAL RED CROSS

• Non-political, non-official international

humanitarian organization

• Devoted to service of mankind in peace and war

• Founded by Henry Dunant, a Swiss

businessman
 International Red Cross…

• Work
– Humanitarian service to victims of war
– Service to armed forces, war veterans,
– Disaster service,
– First-aid and nursing
– Health education
– Maternity and child welfare services
Project HOPE
(Health Opportunities for People Everywhere)

• The largest NGO devoted to international

health in the United States

• Serving as a medical officer during World

War II, Dr. William B. Walsh, was moved
by the poor health conditions in South
Pacific

• Project HOPE founded In 1958.

 Project HOPE….

• SS HOPE, the first peacetime ship

• On voyages to Indonesia, Vietnam, Peru etc.

doctors, nurses, and technical staff provided
medical care and training to people in each
country visited.
 Project HOPE….

• 1999
Dental health program in Bali, Indonesian
island.

Over 15,000 elementary school children

received dental health care education. Also,
training of 60 Indonesian dentists in modern
day dental practices
 Oxfam International

• Worldwide, the most important NGO in long-

term international health

• An international confederation, comprised of

13 independent non-government
organizations dedicated to fighting poverty
and related injustice around the world.
 Doctors Without Borders/
Médecins Sans Frontières (MSF)

• Founded in 1971 as a nongovernmental organization

• Delivers emergency aid to people affected by armed

conflict, epidemics, natural or man-made disasters,
or exclusion from health care in more than 70
countries.

• Funds
– 80 % - general public
– 20% - international agencies
and governments
 FDI World Dental Federation

• Organization of national dental associations

• Founded in 1900 in Paris

• Early years- European organization- known as

Federation Dentaire Internationale (French)

• Global expansion- Name changed to World Dental

Federation

• Now represents over 150 national dental organizations

and 35 other international organizations- 700,000
dentists
• Headquartered in London for years. Now based at
Ferney-Voltaire, France

• Work- both scientific and political

• Its technical committees bring international experts

together to develop state-of-the art reports and
recommendations for further action

• Politically - helpful in development of dental care

services where the local profession has little
political clout.
Publishes
• International Dental Journal
• Developing Dentistry
• Community Dental Health
• European Journal of Prosthodontics
• Journal of the International Academy of
Periodontology
• Unilever and the FDI have created a unique
partnership -Live.Learn.Laugh - with the aim of
increasing oral health education and promotion in
countries around the world.

• The World Dental Development Fund supports oral

health projects worldwide with a strong focus on
education. The Fund was established in 1999 and
has since then given grants to 7 projects.
• Current Projects

– Improving oral health of handicapped children in Senegal

– Capacity building in Africa
– Integrating oral health in Primary Health Care in northern
Pakistan
– Smiling Schools of Namibia
– Oral health in rural India
– Oral health survey in Rwanda
– Oral Cancer Awareness for dentists in Latin America
– HIV/AIDS awareness training for dentists in Latin America
– Community oral health in Lomé, Togo
Oral health in rural India

• The project is based in town of Chitrakoot, a poor

rural area in India.

• In collaboration with a UK based NGO a dental clinic

was provided to an existing hospital belonging to the
project.

• The equipment provided allowed to expand the local

healthcare facilities, to offer dental treatment and
education in oral health to a community of about
150,000 people.
• Advocacy Activities

– Nairobi Conference on Oral Health in Africa

– Professionals and Tobacco Control

– Global Oral Health Planning Workshop

– Global Goals for Oral Health

– Sessions during Annual World Dental Congresses

– Rwanda Oral Health Policy

– Oral Health through Fluoride

 International Association for Dental
Research (IADR)

• Founded in December,1920

• Has about 10,000 members in about 100

countries- research workers in various
fields of dentistry
 IADR…..

• Aim:
– To advance research and increase knowledge for
the improvement of oral health worldwide.

– To support and represent the oral health

research community.

– To facilitate the communication and application of

research findings.
 IADR…..

Publications:

• Journal of Dental Research

– monthly publication,
– has the highest Scientific Impact Factor of any
dental journal in the world.
• Advances in Dental Research
 International Federation of Dental
Hygienists (IFDH)

• Formed on June 28, 1986 in Oslo, Norway.

• International, non-governmental, non-profit organization.

• Unites dental hygiene associations from around the

world in their common cause of promoting dental health.

• Publication: Supports International Journal of Dental

Hygiene
 VOLUNTARY HEALTH
AGENCIES IN INDIA

1. Voluntary Agencies Involved with

Maternal and Child Health
– Indian Council of Child Welfare.
– Family Planning Association of India.
– Kasturba Memorial Fund.
2. Voluntary Agencies Involved with the
Control of Specific Diseases or
Problems
– Tuberculosis Association of India.
– Hind Kusht Nivaran Sangh.
– The Indian Cancer Society.
– The Indian Blind Relief Society.
3. Professional Bodies involved with
Voluntary health work
– The Indian Dental Association
– The Indian Medical Association
– The Trained Nurses Association
4. Voluntary Agencies Involved with
General Health Care
– The Red Cross Society of India
– The All India Women’s Conference
– The Central Social Welfare Board
– The Voluntary Health Association of
India
 CONCLUSION

• Several agencies around the world working

towards the ultimate goal to achieve better
heath of the community.

• Primarily established for the control of

spread for communicable diseases, attention
has now begun to be given to non-
communicable diseases including oral
diseases.
• No single country can solve the growing list
of health challenges the world faces today.

• The continued international cooperation is

important to achieve the goal “Health for All”.
 REFERENCES
• Park K. Park’s textbook of preventive and social medicine. 18th
ed. Banarasidas Bhanot publishers.Jabalpur, India. 2005. p.
704-11.

• Peter S. Health agencies around the world. In: Peter S. Editor.

Essentials of preventive and community dentistry. 2nd ed. Arya
(medi) publishing house. New Delhi. 2003. p. 723-43.

• Chandra S, Chandra S. Indian Dental Association and

organizations of health and dental health. In: Chandra S,
Chandra S. Textbook of community dentistry. Jaypee Brothers,
New Delhi. 2000. p.442-459.
• Poulsen S, Fubusa F, Gemba PM, Lema PA, Mosha
HJ, Ntabaye MK. Distribution of dental therapists
and assistant dental officers trained under the
Tanzania-Danida Dental Health Programme 1981-
1993. Odontostomatol Trop. 1999 Jun;22(86):19-22.
• The Major International Health Organizations.
www.imva.org/Pages/orgbio.htm

• www.who.int

• www.who.int/oral_health/en/

• www.unicef.org/wes/fluoride.pdf

• http://www.ambnewdelhi.um.dk/en/menu/Danida/Health/

• http://www.oxfam.org/en/

• www.fdiworldental.org/