Instructions: Each student shall find and post in the designated Assignment Fold
ID: 246622 • Letter: I
Question
Instructions:
Each student shall find and post in the designated Assignment Folder two proper APA Style references for two (2) “External Authoritative Sources” (as defined below), discussing the content in Chapter 4. A link which leads to the full article referenced is required immediately following each reference.
“External Authoritative Sources” for purposes of this course shall mean: books, peer reviewed journal articles, education and government sites as well as non-partisan national or international organizations (such as WHO, UNICEF, UNAIDS etc) provided, the foregoing source/material selected has in text citations and references to support statements made therein. Under no circumstances are newspapers including the Wall Street Journal, blogs (regardless of source), editorials, panel discussions and dot com sites to be used. The foregoing are not considered authoritative for this course.
CHAPTER 4
Role of International Organizations in Health Systems
Allen Johnson, Matthew W. Walker, and Maxwell Droznin
? Introduction
Although national health systems have an important role in providing health services, they are not the only entities that are tasked with improving and ensuring the health of individuals and populations. There is a spectrum of organizations that directly and indirectly contributes to global health that include foundations, development banks, nongovernmental organizations, bilateral agencies, and intergovernmental organizations. Myriad organizations and agencies that are independent from governments or larger health systems work to provide conditions conducive for good health. Additionally, partnerships among nation-states have been ever present in global health through collaborative efforts to prevent conflict, famine, and disease. The focus of this chapter is on organizations beyond national health systems that broadly fall into one of two categories: intergovernmental organizations and nongovernmental organizations.
? Intergovernmental Organizations
Intergovernmental organizations (IGOs, also referred to as international governmental organizations) are organizations composed primarily of sovereign states, referred to as member states. IGOs are established by treaty among member states, and the treaty acts as a charter for creating the group. Although formally established by treaty, IGOs are distinct agencies and differ from organizations of sovereign states unified by treaties like the North American Free Trade Agreement (NAFTA). IGOs are also distinguished from informal groupings or coalitions of states, such as the Group of Eight (G8). IGOs vary in function, membership, membership criteria, goals, and scope, which are often outlined in the treaty or charter that established the organization. IGOs are developed to carry out mutual interests with unified aims to resolve conflict and improve international relations, promote international cooperation on matters such as environmental protection, promote human rights and social development (education, health), render humanitarian aid, and foster economic development. Some are more general in scope, whereas others may have specific missions. The largest IGO is the United Nations (UN).
The United Nations System
After World War I, the League of Nations was created in 1920 as the first IGO with the purpose of achieving world peace.1 At its height, the League was composed of 58 member states.2However, the start of World War II made it apparent that the League of Nations had failed at its primary goal. In 1941, Franklin Roosevelt and Winston Churchill signed a “Declaration by United Nations” as a pact to fully cooperate in the war against the Axis powers. In addition, the declaration outlined the necessity to defend life, liberty, religious freedom, and human rights.3 Later, 47 additional states, including the Soviet Union and China, signed the pact.4,5 In 1945, a delegation of representatives from 50 governments met in San Francisco for the United Nations Conference on International Organization. It was the culmination of a process that started in 1944 to create a new IGO that would formally replace the now defunct League of Nations. On October 24, 1945, the United Nations Charter was ratified and the UN was officially established.6
The UN is composed of 193 member states and is divided into 6 main branches: General Assembly, Security Council, Economic and Social Council, International Court of Justice, Secretariat, and Trusteeship Council. Each branch has its own unique role and function within the UN to help achieve the mission of world peace, friendly relations among nations, and international cooperation on economic, social, environmental and humanitarian issues.7,8 In addition to the 6 main branches, the UN system includes 11 funds and programs, 15 specialized agencies, and many other affiliated groups.9 To ensure effective communication among its members, Arabic, Chinese, English, French, Russian, and Spanish are official languages of the UN with documents presented in all 6 languages.10 The UN headquarters is located in New York City. Although it is situated in the United States, the land occupied by the UN headquarters is under the sole administration of the UN and not the U.S. government. The UN has 3 additional headquarters, located in Geneva, Switzerland; Vienna, Austria; and Nairobi, Kenya. Each site is considered international territory and is exempt from the jurisdiction of local law.11
The General Assembly is the main representative arm of the UN. The General Assembly oversees the UN budget, receives reports from various UN system organizations, and makes policies and recommendations for resolutions. The General Assembly also has the power to appoint or dismiss nation-states from various roles within the UN, including Security Council roles and UN membership. Member states are equally represented in the General Assembly, with all 193 given one vote per state. An appointed president of the General Assembly, the secretary-general, presides over its annual meetings. Resolutions pass with a simple majority vote among those present and voting. However, if the membership deems an issue to be critical, then the issue must pass with a two-thirds majority. Such issues are usually matters of budget, appointments, dismissals, peace, and security.7 The General Assembly may also be called to meet outside of its regularly scheduled meetings for emergency special sessions. Such sessions may be convened either at the request of the Security Council or at the request of a majority of the member states. If the Security Council is at an impasse on resolution, they may hold an emergency special sessions to deal with a breach of peace. In such an event, the General Assembly has the power, with a two-thirds majority vote, to recommend use of armed forces.12 Special sessions may also be called to confront a range of humanitarian issues, such as the one called in 2001 to discuss the HIV/AIDS pandemic.13
According to the UN Charter, the role of the Security Council is to maintain international peace and security. Additionally, the Council has the power to add new members to the UN as well as to alter the UN Charter. All UN member states must comply with resolutions of the Security Council charged with establishing peacekeeping operations, sanctions, and authorizing military action. The 15-member council is composed of 10 appointed, nonpermanent member states and 5 permanent members.7 The 5 permanent members include the United States, United Kingdom, France, Russia (replacing the Soviet Union in 1991), and China.14 All Security Council decisions must pass with a 9-member assenting vote. However, a negative vote by one of the 5 permanent members on any resolution is an effective veto.15
The Economic and Social Council has the primary role of UN economic, social, and environmental policy review and implementation. Composed of 54 member states, 14 specialized agencies of the UN system, and over 3,200 partner nongovernmental organizations, the Council coordinates the effort of agreed-upon development goals. The Economic and Social Council is elected by the General Assembly for 3-year terms.7,16
The International Court of Justice is the judicial branch of the UN. Its primary responsibilities are to settle disputes among member states in accordance with international law and to give legal counsel on questions referred by other UN departments and specialized agencies.7 The Court is composed of 15 judges elected to 9-year terms by the General Assembly and Security Council.17All 193 members of the UN must comply with the court’s decisions, and its orders are enforced by the Security Council.18 Situated in The Hague (the seat of the Dutch government), the Netherlands, the Court is the only primary organization of the UN not headquartered in New York City.7
The UN Secretariat is composed of the secretary-general as well as 44,000 civil servants. Its primary purpose is to carry out the mandates of the other 5 main branches, including day-to-day operations, peacekeeping operations, research and communication with nonstate participants. The secretary-general is the head of the Secretariat and is appointed to a renewable 5-year term by the General Assembly after a recommendation from the Security Council.7,19
Working together with the UN main body, its funds, programs, and specialized agencies are integral to the achievement of the UN mission.
Funds and Programs
Throughout its history, the UN General Assembly has established a number of programs and funds to address particular humanitarian and development concerns. Each of the funds and programs is headed by an Executive Director and is governed by an Executive Board. These bodies report to the General Assembly through the Executive Board. Following are a few notable funds and programs.
United Nations Children’s Emergency Fund In 1946, the General Assembly created the United Nations Children’s Emergency Fund (UNICEF) to provide food and health care for children of countries that were ravaged by World War II. Since then the goal of the organization has expanded to the development of sustainable community-based systems that provide for the well-being of all children. UNICEF currently operates in 190 countries and relies on member state contributions as well as private donations. For its efforts and achievements, UNICEF was awarded the Nobel Peace Prize in 1965.20
United Nations Development Programme Founded in 1965, the United Nations Development Programme (UNDP) serves as the global development network of the UN. Funded entirely by member states, the UNDP works to help 170 countries reach their development goals. The focus of the UNDP is broad and includes the reduction of poverty, inequality, and HIV/AIDS, as well as the creation of sustainable environmental, energy, and crisis prevention projects. To measure their progress, the UNDP releases an annual Human Development Report.21
United Nations High Commissioner for Refugees Founded in 1950, the United Nations High Commissioner for Refugees (UNHCR) is a UN agency focusing on the protection and well-being of refugees. It strives to make sure that all peoples have the ability to seek safe asylum in another country when necessary. It also works to protect the ability of refugees to voluntarily integrate into the society of the host country, relocate to another country, or return home. For its efforts, the UNHCR was awarded the Nobel Peace Prize in 1954 and again in 1981.22
World Food Programme Considered the largest humanitarian organization focused on hunger in the world, the goal of the World Food Programme (WFP) is to ensure every person has sustained access to food necessary for a healthy life. Founded in 1961, the WFP works in 75 countries and provides food assistance to an estimated 80 million people each year. In addition to food aid, the WFP works on community-level projects that help reduce the risk of food shortage and malnutrition. It is funded by a combination of member-state support and private donations.23
Specialized Agencies
Specialized agencies are autonomous organizations working with the UN and each other through the coordination of the United Nations Economic and Social Council. Specialized agencies may or may not have been originally created by the UN, but they are incorporated into the UN system. Although they are part of the UN system, specialized agencies typically have their own member states separate from UN member states. Following are a few notable specialized agencies.
International Monetary Fund The International Monetary Fund (IMF) is composed of 189 member states working to foster global monetary cooperation, secure financial stability, facilitate international trade, promote high employment and sustainable economic growth, and reduce poverty around the world. The IMF promotes international cooperation, trade, exchange-rate stability and sustainable economic growth. The IMF collects money from member states to create a monetary reserve. Countries may borrow from the IMF reserve to stabilize their economy or invest in development projects. Additionally, the IMF may assist in the management of international payment difficulties and financial crises.9,24,25
World Bank The World Bank’s primary goals are to reduce poverty by providing grants, low-interest loans, and interest-free credit to developing countries and to promote foreign investment and international trade. Founded in 1944, two of the main branches, the International Bank for Reconstruction and Development and the International Development Association, now have 188 and 173 member states, respectively. To become a member of the World Bank, a country must first join the IMF. Although not a UN agency, the World Bank coordinates with the UN on a number of economic development projects.9,26
World Health Organization Founded in 1948, the World Health Organization (WHO) is a specialized agency of the UN focused on global public health.27 Its overall mission is “the attainment of all people to the highest level of health.”28 Through research, health policymaking, education initiatives, and disease monitoring and intervention, the WHO seeks to stop the spread of communicable diseases and lessen the burden of chronic disease. Currently involved in the fight against HIV/AIDS, malaria, and tuberculosis, the WHO is also a major partner in the Global Polio Eradication Initiative. Its World Health Report publication highlights health concerns relating to each of its member states.27
A Look at Other Intergovernmental Organizations
Although the UN is the largest IGO with great influence and participation around the world, it is by no means the only one. The following section summarizes a few of the world’s largest and most influential non-UN IGOs.
African Union
Formed in 2002, the African Union is composed of 54 member states (every country on the African continent except for Morocco). It aims to foster international cooperation, peace, and economic and social development among African peoples. The African Union functions with its own Secretariat; Assembly; Economic, Social, and Cultural Council; Peace and Security Council; and peacekeeping force. Its highest decision-making body, the Assembly of the African Union, is composed of the heads of state of all 54 of its member states.29
International Criminal Court
Founded in 2002 as part of the Rome Statute and located in The Hague, the International Criminal Court (ICC) is an international tribunal whose purpose is prosecuting individuals for international war crimes, crimes against humanity, and genocide. The ICC initiates prosecution, following investigations and requests by individual states or by the UN Security Council. The ICC may also take up an investigation when a country’s national courts are unwilling to prosecute an individual. Currently, 124 countries are members of the ICC.30
Organisation for Economic Co-operation and Development
Originating in 1948 as the Organisation for European Economic Co-operation to help administer the Marshal Plan, it was reformed in 1961 as the Organisation for Economic Co-operation and Development (OECD). The mission of the OECD is to implement policies that improve the economic and social well-being of people around the world. Most of the 34 states that comprise the OECD have high-income economies and a high Human Development Index score. Through government collaboration and analysis of successful strategies and underlying global issues, the OECD provides a forum for implementing quality of life improvement for every country.31
World Trade Organization
The World Trade Organization (WTO) was founded in 1995 and currently is composed of 162 member states with the explicit purpose of regulating international trade. The WTO oversees the implementation of trade deals and serves as a forum for its member states to settle trade disputes. It provides assurance among consumers and producers that international markets will remain open to them. The philosophy of the WTO is that by removing trade barriers, it also removes barriers among peoples and nations. Although not formally a UN specialized agency, the WTO has cooperative agreements with the UN.32
? Nongovernmental Organizations
The term nongovernmental organization (NGO) remains vaguely defined. In general, NGOs are broadly defined as “legal entities created by private individuals, private organizations, publicly traded organizations, or in some combination where governmental influence, supervision and management are removed, or at least greatly minimized, from the NGO’s strategic and operational mission.”33 The term came into currency in 1945 because of the need for the UN to differentiate in its charter between participation rights for intergovernmental specialized agencies and for international private organizations. At the UN, virtually all types of private bodies can be recognized as NGOs. They only have to be not-for-profit, noncriminal, independent from government control, and not seeking to challenge governments either as a political party or by a narrow focus on human rights.34 The definition generally used by the U.S. Peace Corps to define an NGO is “a specific type of organization that is not part of government and that possesses the following four characteristics:
Works with people to help them improve their social and economic situations and prospects
Was formed voluntarily
Is independent, controlled by those who have formed it or by management boards representing the organization’s stakeholders
Is not-for-profit; although NGOs engage in revenue-generating activities, the proceeds are used in pursuit of the organization’s aims.”35
NGOs serve in a wide and varied spectrum of advocacy and operations around the globe. From locally based groups meeting in private homes to global giants with budgets in the hundreds of millions of U.S. dollars, NGOs make significant contributions to global health based on their unique missions. NGOs engage in a wide array of activities involving political advocacy, the environment, health care, women and children’s rights, economic development, and many other issues. By definition, NGOs are independent from government influence, and therefore they are often in a unique position to address issues that governments do not. Operating in milieu, lacking constraints by bureaucratic or political considerations, NGOs are often able to provide leadership and resources for producing and advocating public policy when government agencies are unable or unwilling to do so. The efficiency of NGOs is, in part, attributed to their grassroots approach. According to the UN, the strength of NGOs lies in their “proximity to their members or clients, the flexibility and the high degree of people’s involvement and participation in their activities, which leads to strong commitments, appropriateness of solutions and high acceptance of decisions implemented.”36
NGOs are not formally part of the UN system; rather, some NGOs work closely with the UN in consultative capacities. Having participated in the work of the UN from its inception, NGOs first took a role in formal UN deliberations through the Economic and Social Council in 1946. Initially, 41 NGOs were granted consultative status by the Council, and by 1992, more than 700 NGOs had attained that level of credibility. The number has been steadily increasing ever since, and today, 2,921 NGOs hold consultative status with the UN.37
There are over 1.5 million NGOs operating in the United States alone.38 The amount of resources controlled and distributed by these organizations vary greatly and can be quite extensive. For instance, one of the largest in terms of budget and scope, World Vision, had annual expenses for 2015 of over US $993 million,39 as much as 20 times the gross domestic product (GDP) of some of the smaller countries around the world.40 Based on firm financial growth, the largest NGOs continue to expand in both funding and mission.
Classifying NGOs
Nationally and internationally, the broad range of NGOs has become so expansive that the establishment of a single classification system is exceedingly difficult. The World Bank classifies NGOs into two categories: operational and advocacy.41 According to the WHO definition, the primary purpose of an operational NGO is the design and implementation of development-related projects, as opposed to advocacy NGOs which assert a primary purpose to defend or to promote a specific cause. NGOs can be further classified as either relief oriented or development oriented by the development status of the countries in which they work, by the nature of their work, and whether they are faith based or secular or any combination thereof. Due to extensive variation among NGOs, a list of acronyms has been developed to aid in the classification of such organizations. Some examples of these include the following:
FONGO—Funder-Organized NGO
RINGO—Religious International NGO
PVO—Private Voluntary Organization
CBO—Community-Based Organization
CSO—Civil Society Organization
BONGO—Business-Organized NGO
TANGO—Technical Assistance NGO
A Look at Some of the Largest International NGOs
The following section summarized the NGO “global giants,” who have hundreds, even thousands, of employees and budgets in the hundreds of millions of dollars. This list, although certainly not exhaustive, represents some of the largest and most established NGOs working in the world today.
Acumen
Acumen is a nonprofit global venture fund that uses entrepreneurial approaches to address the problems of poverty. Headquartered in New York City, with regional offices in India, Pakistan, Kenya, and Ghana, it aims to help build financially sustainable organizations that deliver affordable goods and services to improve the lives of the poor. Acumen raises charitable donations that allow it to make long-term debt or equity investments in early-stage companies providing reliable and affordable access to agricultural inputs and markets, quality education, clean energy, healthcare services, formal housing, and safe drinking water to low-income customers. Founded in 2001, Acumen has approved US $88 million in investments and has invested in 82 enterprises, creating over 60,000 jobs.42
Amnesty International
Amnesty International (commonly known as Amnesty) was founded in 1961 in London. It was originally established to facilitate the release of political prisoners. Amnesty has since grown into an organization aimed at upholding the whole spectrum of human rights, including abolishing the death penalty, protecting sexual and reproductive rights, combatting discrimination, and defending refugee and migrant rights. It draws attention to human rights abuses, and it campaigns for compliance with international laws and standards. The organization was awarded the Nobel Peace Prize in 1977. Amnesty currently has over 7 million members and supporters worldwide.43
BRAC
BRAC (formally Bangladesh Rural Advancement Committee) is an international development organization based in Bangladesh. Established in 1972 as a small-scale relief and rehabilitation project to help returning war refugees, today BRAC is the largest NGO in the world in terms of number of employees. BRAC employs over 100,000 people, roughly 70% of whom are women. The organization’s activities involve economic development, education, public health, and gender equality. BRAC’s Economic Development Programme includes the use of microcredit. It provides collateral-free loans to mostly poor, landless, rural women, enabling them to generate income and improve their standards of living. Reaching nearly 4 million borrowers, BRAC has provided loans to those who, due to extreme poverty, have been otherwise unable to secure other financial sources. BRAC’s microcredit program has funded over US $1.9 billion in loans with 95% of its borrowers being women. According to BRAC, the repayment rate is over 98%.44,45
CARE International
Founded in 1945 to provide relief to World War II survivors, CARE is committed to promoting social change and ending global poverty. CARE currently works in 95 countries around the world. A leading humanitarian organization fighting global poverty, CARE’s philosophy is that women are essential in regard to helping families and communities escape poverty. Women are at the heart of CARE’s community-based efforts to improve basic education, prevent the spread of HIV, increase access to clean water and sanitation, expand economic opportunity, and protect natural resources. CARE also provides emergency aid to survivors of war and natural disasters.46
Human Rights Watch
The largest human rights organization based in the United States, Human Rights Watch conducts fact-finding investigations into human rights abuses around the world. Founded in 1978 as Helsinki Watch to monitor human rights in the former Soviet Union, Human Rights Watch publishes numerous books and reports every year, generating extensive coverage in local and international media. Human Rights Watch also meets with government officials to urge changes in policy and practice. In extreme circumstances, Human Rights Watch presses for the withdrawal of military and economic support from governments that egregiously violate the rights of their people.47
International Committee of the Red Cross
The International Committee of the Red Cross (ICRC) is based in Geneva and is a three-time Nobel Prize Laureate. The ICRC is mandated to protect victims of international and internal armed conflicts. Such victims include prisoners, refugees, civilians, and other noncombatants. The ICRC is part of the International Red Cross and Red Crescent Movement, which—along with the ICRC—includes the International Federation of Red Cross and Red Crescent Societies consisting of 190 national societies. The ICRC is the oldest and most honored organization within the Movement and one of the most widely recognized humanitarian organizations in the world. Today, the ICRC is based in around 80 countries and has a total of more than 12,000 staff.48
Médecins Sans Frontières (Doctors Without Borders)
Médecins Sans Frontières (MSF) is an independent humanitarian medical aid agency that is committed to two objectives: providing medical aid wherever needed, regardless of race, religion, politics, or gender, and raising awareness of the plight of the people they help. Founded in 1971, MSF has 20 country offices and provides emergency medical aid in more than 60 countries. MSF teams are composed of doctors, nurses, and other professionals, medical and nonmedical, working alongside locally hired staff. In 2014, MSF teams working in 63 countries around the world provided around 8.3 million outpatient consultations, admitted more than 511,800 patients for inpatient care, and helped deliver more than 194,000 babies.49
Oxfam International
The name Oxfam comes from the British group Oxford Committee for Famine Relief, founded in 1942 during World War II. Oxfam International is a confederation of 18 independent NGOs working with thousands of partner organizations in more than 90 countries with the common goal of ending global poverty and related injustice. Oxfam works with communities, allies, and partner organizations undertaking long-term development, emergency work, research, and advocacy. Oxfam focuses on a broad range of issues, including trade, conflict, debt and aid, and education.50
Partners in Health
Partners in Health (PIH) was founded in 1987 in Boston, Massachusetts, United States, to deliver health care to the poorest areas of Haiti. Today, PIH has programs in nine countries on four continents. With a mission to provide a preferential option for the poor in health care, PIH works globally to bring the benefits of modern science to those most in need through service delivery, training, research, and advocacy.51
Save the Children International
Save the Children International promotes children’s rights, provides relief, and helps support children in developing countries. Headquartered in the United Kingdom, it aims to improve the lives of children through better education, health care, and economic opportunities, as well as to provide emergency aid in natural disasters, war, and other conflicts. The organization includes 29 national organizations who are members of Save the Children International, providing a global network of organizations supporting local partners in over 120 countries around the world.52
World Vision International
World Vision International is a Christian humanitarian organization that is dedicated to working with children, families, and communities worldwide to reach their full potential by tackling the causes of poverty and injustice. World Vision began caring for orphans and other children in need first in South Korea in 1950, and then it expanded throughout Asia. Today, World Vision International works in nearly 100 countries around the world and has expanded its mission to include community development and advocacy for the poor. World Vision International’s child sponsorship program has been popular in attracting donors who send funds each month to provide support for sponsored children and projects.53
NGO Diversity by Country
NGOs have become increasingly influential in world affairs. They often impact the social, economic, and political activities of communities and countries as a whole. In numerous countries, NGOs have led the way in democratization, combatting diseases and illnesses, promoting and enforcing human rights, and increasing standards of living. It is difficult to estimate the comprehensive value of NGOs over the past 60 years (since the establishment of the UN Charter); however, it is clear that NGOs will continue to play an important role into the future considering the varied nature of their work. TABLE 4-1 lists examples of NGOs actively working in countries discussed in this book. A diverse sample of NGOs was chosen to present an overview of the broad range of work they perform on a global scale.
Explanation / Answer
WHO.(1948-1967).Twenty years in South East Asia.New Delhi,India:Regional office of South East Asia. WHO.(1977).WHO Chronicle.