Governance structure of the World Health Organization
A structure describes the inner connection and organisation of a system. In extension it may mean the framework governing interconnected components. An analysis of an organisation’s strocmre will help us better understand its mechanism. Behaviourism holds that the structure can influence and even determine the outcome of an organisation (Hammond, 1986, pp. 379—420). A brief analysis of WHO’s structure is thus in order to better understand its governance agenda.
Structure of the World Health Organization
The principal bodies of WHO are the World Health Assembly, the Executive Board and the Secretariat. Although they share the same goals in global health governance, they have different decision-making functions and follow different sets of procedures.
18.104.22.168 The World Health Assembly
As mandated by the Constitution of the World Health Organization, the World Health Assembly is the highest governing or the highest policymaking body of WHO. With respect to its role in the adoption of global health regulations and recommendations, WHO is also often referred to as a legislative organ. Article 13 of the Constitution stipulates that the World Health Assembly shall meet in regular annual sessions. If necessary, special sessions shall be convened at the request of the Board of WHO or upon a majority vote of the members. The Board, afterconsultation with the secretary-general of the United Nations, shall determine the date of each annual and special session. The World Health Assembly shall at each annual session select the comrtry or region where the next annual session is to be held, with the Board srrbsequently fixing the specific location. The Board shall determine the place where a special session shall be held. Regarding the frequencies of the Health Assembly, in 1950, the Norwegian and Swedish delegations submitted a report to the Health Assembly recommending that the Assembly meet from once a year to every two years to be economical with resources and tune. They also held that one year was not sufficient for a careful formulation of a new agenda to be srrbmitted to the next Assembly. However, their recommendation was not adopted. Since then, the time provision has remained unchanged, though the length of each assembly has been shortened. In 1996, the length of each meeting was stipulated not to exceed six days.
The World Health Assembly is made up of delegates from member states:
Each Member shall be represented by no more than three delegates, one of whom shall be designated by the Member as chief delegate. These delegates should be chosen from among persons most qualified by their technical competence in the field of public health, preferably representing the national health administration of the Member.
(Constitution of the World Health Organization, p. 5)
Delegates, as spokespersons for member states, can express the views of their governments. Delegates of the Executive Board, the United Nations, other specialised agencies, intergovernmental organisations that have special relations with WHO and observers from non-member countries as well as NGOs can participate in the World Health Assembly without voting rights. Article 18 of the Constitution of WHO stipulates the functions of the World Health Assembly, which include, among others, the right to review and approve of reports of the director-general and the budget as well as the right to participate in the discussion for other important issues.
22.214.171.124 Executive Board
The Execirtive Board is the executive organ of the World Health Assembly. The Board is composed of 34 technical experts in the field of health, each designated by a member state and approved by the World Health Assembly. Members are elected for a three-year term; one-third of the membership is replaced every year. The five permanent members of the UN Security Council are naturally members of the Executive Board, each of them is rotated out for a year once every three years. Article 28 lays out specific provisions on the functions of the Executive Board (Constitution of the World Health Organization, p. 8), whose main duty is to implement all the policies and work of WHO in cooperation with the World Health Assembly. On one hand, the Board's role includes preparing the agenda for the World Health Assembly meetings; advising the assembly on questions and matters assigned to WHO by conventions, agreements and regulations and submitting to the assembly for consideration and approval a general programme of work covering a specific period. On the other hand, the Board also assumes the role of an execirtive body of the World Health Assembly. In other words, it enforces decisions and policies of the World Health Assembly and performs any other functions entrusted to it by the assembly. Tire World Health Assembly is thus closely related to the Executive Board.
The Secretariat is the third organ to implement the work of WHO under the Constitution of the World Health Organization. Its origin traces back to the transitional committee before WHO formally came into being. The Secretariat is led by a director general and six regional directors and consists of technical as well as administrative staff. Since the World Health Assembly and the Executive Board convene respectively once and twice per year, they are unfit to implement all the work of WHO in the brief duration when they meet. It is therefore
WHO and global health governance 65 necessary to establish a permanent body to handle the day-to-day affairs of WHO, a role assumed by the Secretariat. It has six regional offices (see Table 2.1). Its regional arrangement has proved to be the most controversial issue with respect to WHO's organisational structure, especially regarding the issue of whether the Pan-American Health Organization should be merged into WHO. WHO finally solved the controversy by adopting the principle of “progressive and ultimate merger”: The Constitution of WHO stipulates that the regional committees shall be designated as “an integral part of the Organization” in accordance with the Constitution of the World Health Organization. In other words, WHO shall have supreme authority worldwide in the governance of future intergovernmental international public health issues. After painstaking negotiations, the Pan-American Health Organization finally agreed in 1949 to become WHO’s regional office in the Western Hemisphere,7 making WHO the most authoritative global intergovernmental organisation in the field of public health.