Introduction
"Nothing on earth is more international than disease", said Paul Russel. 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 examples of the spread of pestilences – particularly of plague and cholera, along trade routes. In order to protect against the spread of disease from one country to another, many attempts were made in the past by individual rulers particularly of and States to place barriers against infection by detection and isolation of incoming travellers. In the 14th century, a procedure known as "quarantine" was introduced in Europe to protect against the importation of plague. Ships, crews, travellers and cargoes, suspected of harbouring infection, were detained for a 40-day period. The underlying idea was that the passage of time would give dormant disease to manifest itself or die out. Quarantine soon became an established practice in many countries, and different countries adopted different quarantine procedures. This was the origin of international health work.
Quarantine failed in its objective because of the lack of scientific knowledge regarding the causation and mode of spread of disease. Opposition to quarantine came from several quarters because the 40-day detention 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. International conferences were held and organizations set up for discussion, agreement and cooperation on matters of international health. A brief account of these endeavours and of the early health organizations which preceded the World Health Organization is given below.
First International Sanitary Conference (1851)
The origin of international health cooperation dates back to 1851, when an international sanitary conference - the first of its kind - was convened in Paris. The Conference was attended mainly by European countries Austria, France, Great Britain, Greece, Portugal, Russia, Spain and four Sovereign States (Sardinia, the two Sicilies, the Papal States, Tuscany) that were later to form a united Italy. Turkey also participated in this Conference. The objective of this Conference was very limited i.e., to introduce some order and uniformity into quarantine measures which varied from country to country. The conference lasted six months with no lasting results. Some members opposed quarantine, and some took an intermediate position. Despite the many difficulties involved, an international sanitary code was prepared, comprising 137 articles dealing with cholera, plague and yellow fever. But, the sanitary code never came into force as it was ratified by only three countries – France, Portugal and Sardinia of which Portugal and Sardinia withdrew in 1865. Thus the conference was generally regarded as having ended in failure. The 1851 conference was followed in rapid succession by further no less than 10 conferences between 1851 and 1902, but they were equally unable to reach an agreement on quarantine measures.
Pan American Sanitary Bureau (1902)
The next important milestone in international health work was the establishment of Pan American Sanitary Bureau (PASB) in 1902 in the Americas. It was primarily intended to coordinate quarantine procedures in the American States. In 1924 an important document was signed by the American Republic namely "The Pan American Sanitary Code" which is still in force between the States. In 1947, the Bureau was reorganized and the organization was called the Pan American Sanitary Organization (PASO). In 1949, an agreement was reached whereby the PASO would serve as the WHO Regional Office for the Americas. In 1958, the name was changed to Pan American Health Organization (PAHO). Over the years, PAHO has grown from a small information centre to a major health agency with its headquarters in Washington, D.C. The Pan American Sanitary Bureau was the World's first international health agency.
Office International D'Hygiene Publique (1907)
At the 1903 International Sanitary Conference, a step of fundamental importance was taken, that is, to establish a permanent International Health Bureau. This decision was probably influenced by the fact that the American republics had already established a similar bureau, the Pan American Sanitary Bureau in 1902. Accordingly in 1907, the "Office International d'Hygiene Publique" (OIHP), generally known as the "Paris Office" was created to disseminate information on communicable diseases and to supervise international quarantine measures. At its inception, the OIHP was predominantly European, but later on a considerable degree of cooperation grew up between OIHP and PASB. Sixty other countries, including British India, joined the OIHP, giving the Office an international character.
Although the OIHP had no field staff to undertake investigation of epidemics it did remarkable work in disseminating knowledge of communicable diseases and their control, and also information on a variety of health problems of worldwide interest. The OIHP continued to exist until 1950, by which time its responsibilities had been taken over by the WHO.
The Health Organization of the League of Nations (1923)
After the first World War (1914-18), the League of Nations was established to build a better world. It included a "Health Organization' to "take steps in matters of international concern for the prevention and control of disease". Although the League of Nations was a failure on the political side, its Health Organization, which was established in 1923, did creditable work. Not confining itself to quarantine regulations and epidemiological information or even larger problems of epidemic diseases, the Health Organization of the League branched out into such matters as nutrition, housing and rural hygiene, the training of public health workers and the standardization of certain biological preparations. The League analysed epidemiological information received, and started the series of periodical epidemiological reports now issued by the WHO. It also established the Far Eastern Bureau at Singapore. It laid down lines for technical studies (including the use of expert committees) which are substantially followed by the WHO. The WHO owes much to the work done and methods devised by the Health Organization of the League. It may be mentioned that efforts to amalgamate the OIHP, PASB and the Health Organization of the League of Nations proved a failure, and all the three organizations were co-existing during the years between the two World Wars. In 1939, the League of Nations was dissolved but its Health Organization in Geneva continued to deal as best it could with requests for information and the publication of the Weekly Epidemiological Records was never suspended.
The United Nations Relief and Rehabilitation Administration (1943)
The United Nations Relief and Rehabilitation Administration (UNRRA) was set up in 1943 with the general purpose of organizing recovery from the effects of the Second World War. The UNRRA had a health division to care for the health of the millions of displaced persons, to restore and help services and to revive the machinery for international interchange of information on epidemic diseases.
UNRRA did outstanding work of preventing the spread of typhus and other diseases, so that they never reached serious epidemic levels anywhere. Similarly, UNRRA'S assistance to malaria control in such countries as Greece and Italy, where war had disrupted peace-time anti-malaria services, was on an immense scale. The world renowned campaign for the eradication of malaria from Sardinia was begun as a joint effort of UNRRA, the Rockefeller Foundation and the Italian Government. At the end of 1946, UNRRA terminated its official existence and its health activities and financial assets were taken over by the Interim Commission on the WHO.
Birth of the WHO
The WHO has its origin in April 1945, during the conference held at San Francisco to set up the United Nations. The representatives of Brazil and China proposed that an international health organization should be established and that a conference to frame its constitution should be convened. The constitution was drawn up at an international health conference in New York in 1946. The same conference set up an "Interim Commission" to prepare the ground for the new organization and to carry out urgent tasks until the WHO constitution had been accepted by the required number of UN Member States. The ratifications were secured by 7th April 1948, the formal existence of the WHO as a specialised agency began on that date. The formation of WHO represents the culmination of efforts to establish a single worldwide intergovernmental health agency.
World Health Organization (WHO)
The World Health Organization is a 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 Rene Sand, and was approved in the same year by an International Health Conference of 51 nations in New York. The constitution came into force on 7th April, 1948 which is celebrated every year as "World Health Day". A World Health day theme is chosen each year to focus attention on a specific aspect of public health.
Objective
The objective of the WHO is "the attainment by all peoples of the highest level of health" which is set out in the preamble of the Constitution. The current objective of WHO is the 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:
• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic and social condition.
• The health of all people is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and States.
• The achievement of any State in the promotion and protection of health is of value to all.
• 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.
• Informed opinion and active cooperation on the part of the public are of the utmost importance in the improvement of the health of the people.
• Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
The WHO is unique among the UN Specialized Agencies in that it has its own constitution, own governing bodies, own membership and own budget. It is part of, but not subordinate to, the United Nations.
Membership
Membership in WHO is open to all countries. While most countries are members of both the UN and of WHO, there are some 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 relations may be admitted as associate members. Associate members participate without vote in the deliberations of the WHO. Each member state contributes yearly to the budget and each is entitled to the services and aid the organization can provide. In 1948, the WHO had 56 Members. WHO now has 194 member states and two associate members.
Work of WHO
WHO's first Constitutional function is to act as the directing and coordinating authority on all international health work. This function permits WHO's Member States to identify collectively priority health problems throughout the world, to define collectively health policies and targets to cope with them, to devise collectively strategies, principles and programmes to give effect to these policies and to attain the targets.
1. Prevention and Control of Specific Diseases
Almost all communicable diseases are or have been at sometime the subject of WHO activities. The global eradication of smallpox is an outstanding example of international health cooperation. With the same energy and commitment with which WHO eradicated smallpox, it is now directing the global battle against poliomyelitis.
An important activity of WHO is epidemiological surveillance of communicable diseases. The WHO collects and disseminates epidemiological information on diseases subject to International Health Regulations and occasionally other communicable diseases of international importance through an Automatic Telex Reply Service (ATRS) and the "Weekly Epidemiological Record" (WER). The latter contains more complete details and brief reviews of communicable diseases of international importance. 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.
The WHO has also paid attention in its programme of work to non-communicable disease problems such as cancer, cardiovascular diseases, genetic disorders, diabetes, blindness, mental disorders, drug addiction and dental diseases. The activities of WHO have also branched out into the fields of vector biology and control, immunology, quality control of drugs and biological products, drug evaluation and monitoring and health laboratory technology as these activities are relevant to the control of both communicable and non-communicable diseases. Immunization against common diseases of childhood (Expanded Programme on Immunization) is now a priority programme of the WHO.
2. Development of Comprehensive Health Services
WHO's most important single function is to promote and support national health policy development and the development of comprehensive national health programmes. This broad field of endeavour encompasses a 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 managerial capabilities (including monitoring and evaluation) and health services research. Appropriate Technology for Health (ATH) is another new programme launched by the WHO to encourage self-sufficiency in solving health problems. The new programme is part of WHO's efforts to build up primary health care.
3. Family Health
Family health is one of the major programme 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.
4. Environmental Health
Promotion of environmental health has always been an important activity of WHO. WHO advises governments on national programmes for the provision of basic sanitary services. The activities are directed to protection of the quality of air, water and food; health conditions of work, radiation protection and early identification of new hazards originating from new technological developments. A number of programmes have been developed such as the 'WHO Environmental Health Criteria Programme' and 'WHO Environmental Health Monitoring Programme' towards improving environmental health.
5. Health Statistics
From its earliest days in 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. Readers interested in current data may obtain it from the Chief Statistician, Dissemination of Statistical Information, WHO, Geneva. In order that statistics from different countries may be comparable, WHO publishes 'International Classification of Diseases which is updated every 10th year. The Tenth Revision of ICD came into effect from 1st January 1993. Assistance is also given to countries in the improvement of their medical records, and in the planning and operating national health information systems.
6. Biomedical Research
The WHO does not itself do research, but stimulates and coordinates research work. It has established a worldwide network of WHO collaborating centres, 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.diseases (malaria, schistosomiasis, trypanosomiasis, filariasis, leishmaniasis and leprosy) are the target of the WHO Special Programme for Research and Training in Tropical Diseases to develop new tools, strengthen research institutions and training workers in the countries affected.
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 centres of and Retrieval System (MEDLARS) of the US. National of the Medical Literature Analysis Library of Medicine MEDLARS is fully computerised Indexing system covering the whole of medicine on an international basis. The WHO has also a public information service both at headquarters and each of the six regional offices
COOPERATION WITH OTHER ORGANIZATIONS
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.
Structure
The WHO consists of three principal organs: the World Health Assembly, the Executive Board and the Secretariat.
(a) THE 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 Assembly is composed of delegates representing Member States, each of which has one vote. The main functions of the Health Assembly are: (i) to determine international health policy and programmes (ii) to review the work of the past year (iii) to approve the budget needed for the following year and (iv) to elect Member States to designate a person to serve for three years on the Executive Board, and to replace the retiring members. The Health Assembly also appoints the Director General on the nomination of the Executive Board. It is now the practice to organize on the occasion of each Health Assembly, "technical discussions" on some subjects of world interest.
(b) 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 (1976) increased the membership from 30 to 31, providing that no fewer than three are to be elected from each of the WHO regions (11). The board now has 34 members. The members of the Board are to be "technically qualified in the field of health"; they are designated by, but do not represent their governments. One-third of the membership is renewed every year. The Executive Board meets at least twice a year, generally in January and shortly after the meeting of the World Health Assembly in May. 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.
(c) 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 programmes. While in 1948, WHO staff counted 250 persons, the Organization in 1985 counted 4475 international public servants. The secretariat, by 2010, is staffed by about 8000 health and other experts and support staff. At WHO headquarters in Geneva, there are 5bAssistant 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, 1985, the WHO Secretariat comprised of the following divisions.
1. Division of epidemiological surveillance and health situation and trend assessment.
2. Division of communicable diseases.
3. Division of vector biology and control.
4. Division of environmental health.
5. Division of public information and education for health.
6. Division of mental health.
7. Division of diagnostic, therapeutic and rehabilitative technology.
8. Division of strengthening of health services.
9. Division of family health.
10. Division of non-communicable diseases,
11. Division of health manpower development.
12. Division of information systems support.
13. Division of personnel and general services.
14. Division of budget and finance.
Regions
In order to meet the special health needs of different areas, WHO has established six regional organizations. (Table 1).
TABLE 1 WHO Regional Organizations
Region
1. South East Asia
2. Africa
3. The Americas
4. Europe
5. Eastern Mediterranean
6. Western Pacific
The regional organizations are an integral part of the WHO and have under the constitution an important part in implementing the policies and programmes of the WHO. The regional office is headed by the Regional Director, who is assisted by technical and administrative officers, and members of the secretariat. There is a regional committee composed of representatives of the Member States in the region. 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.
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, New Delhi. The Region has now 11 members (Table 2).
The WHO activities in South East Asia Region cover a wide range of subjects such as malaria eradication, tuberculosis control, control of other communicable diseases, health laboratory services and production of vaccines, health statistics, public health administration and rural health services, maternal and child health, nursing, environmental health and water supply, health education, nutrition, mental health, dental health, medical rehabilitation, quality control of drugs and medical education.
OTHER UNITED NATIONS AGENCIE UNICEF
UNICEF (United Nations International Children's Emergency Fund) is one of the specialized agencies of the United Nations. 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 Kathmandu, Nepal; the region is known as the South Central Asian Region which covers Afghanistan, Sri Lanka, India, the Maldives, Pakistan, Bhutan, Bangladesh and Nepal. UNICEF is governed by a thirty six nation Executive Board as in 2010. The headquarters of the UNICEF is at United Nations, New York.
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 urgent problems such as malaria, tuberculosis and venereal diseases. Later, its assistance to countries covered such fields as maternal and child health, nutrition, environmental sanitation (especially the provision of water supplies to rural communities), health centres and health education and programmes which would directly or indirectly, benefit child health.
More recently, the tendency has been for UNICEF to turn away from campaigns for the eradication of specific diseases unless they are of direct benefit to mothers and children. Greater attention is being given to the concept of the "whole child" meaning that assistance should hence forward be geared not only to health and nutrition, as before, which are of immediate benefit to children, but also to their long-term personnel development and to the development of the countries in which they live. 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.
Content of services (12)
(a) Child health: UNICEF has provided substantial aid for the production of vaccines and sera in many countries. UNICEF has supported India's BCG vaccination programme from its inception. It has also assisted in the erection of a penicillin plant, near Pune; donated a DDT plant; two plants for the manufacture of triple vaccine and iodized salt. UNICEF has also assisted environmental sanitation programmes 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. Currently, UNICEF is focusing attention on providing primary health care to mothers and children. Emphasis is placed on immunization; infant and young child care; family planning aspects of family health; safe water and adequate sanitation. The services contemplated are intended to be so organized that the local community can participate in planning personnel and material support. The services will be delivered economically at the village level through resident volunteers or part time primary health workers selected for the purpose with the agreement of the local community.
(b) Child nutrition: UNICEF gives high priority to improving child nutrition. Its aid for child nutrition, which first took the form of supplementing child feeding began to expand in mid-1950s with the development of low-cost protein-rich food mixtures. In collaboration with FAO, UNICEF also began aiding "applied nutrition" programmes 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. The UNICEF has supplied equipment for modern dairy plants in various parts of India, viz. Maharashtra, Gujarat, Karnataka, Uttar Pradesh, West Bengal, Andhra Pradesh. Specific aid is also given for intervention against nutritional deficiency diseases, viz. provision of large doses of vitamin A in areas where xerophthalmia is prevalent; enrichment of salt with iodine in areas of endemic goitre; provision of iron and folate supplements to combat anaemias and enrichment of foods. More recently, FAO, UNICEF and WHO have been encouraging the development of national food and nutrition policies that make provision for child nutrition.
(c) 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 centres, 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 programmes.
(d) Education-formal and non-formal: 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.
The 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;
• 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,
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) women in selected cities and towns. The overall objective is to improve the degree and quality of survival and especially for children and development of the children of urban low-income families.
In short, UNICEF activities cover programmes assisting in child survival, protection and development; interventions like immunization, improved infant feeding practices; child growth monitoring, homebased diarrhoea management, drinking water, environmental sanitation, birth spacing, education of girls and income-generating activities for women.
As full partners in primary health care, UNICEF and WHO have been developing joint strategies in support of its implementation at country level.
UNDP
The United Nations Development Programme (UNDP) was established in 1966. It is the main source of funds for technical assistance. The member countries - rich and poor of the United Nations meet annually and pledge contributions to the UNDP.
The basic objective of the UNDP is to help poorer nations develop their human and natural resources more fully. The UNDP projects cover virtually every economic and social sector agriculture, industry, education and science, health, social welfare, etc.
UN Fund for Population Activities
The United Nations Fund for Population Activities (UNFPA) has been providing assistance to India since 1974. In addition to funding national level schemes, Area Projects for intensive development of health and family welfare infrastructure and improvement in the availability of services in the rural areas have been under implementation in eleven districts of Bihar and 4 districts of Rajasthan.
The UNFPA inputs are designed to develop national capability for the manufacture of contraceptives, to develop population education programmes, to undertake organized sector projects, to strengthen programme management as well as to improve output of grass-root level health workers and introduction of innovative approaches to family planning and MCH care (16).
FAO
The Food and Agriculture Organization (FAO) was formed in 1945 with headquarters in Rome. It was the first United Nations Organization specialized agency created to look after several areas of world cooperation. 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. FAO's prime concern is the increased production of food to keep pace with the ever-growing world population. The most important aspect of FAO's work is towards ensuring that the food is consumed by the people who need it, in sufficient quantities and in right proportions, to develop and maintain a better state of nutrition throughout the world (13). In this context, the 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 FAO is also collaborating with other international agencies in the Applied Nutrition Programmes. The joint WHO/FAO expert committees have provided the basis for many cooperative activities nutritional surveys, training courses, seminars and the coordination of research programmes on brucellosis and other zoonoses (4).
ILO
Soon that the First World War, it was recognized that problems of industry, like disease, know no frontiers. In 1919, the International Labour Organization (I.L.O.) 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 (1) to contribute to the establishment of lasting peace by promoting social justice (2) to improve, through international action, labour conditions, and living standards and (3) to promote economic and social stability. The International Labour Code is a collection of international minimum standards related to health, welfare, living and working conditions of workers all over the world. The ILO also provides assistance to organizations interested in the betterment of living and employment standards. There is a close collaboration between ILO and WHO in the field of health and labour. The headquarters of ILO is in Geneva, Switzerland.
WORLD BANK
World Bank is a specialized agency of the United Nations. It was established with the purpose of helping less developed countries raise their living standards. The powers of the Bank are vested in a Board of Governors. The Bank gives loans for projects that will lead to economic growth (e.g., India's Population Projects). The projects are usually concerned with electric power, roads, railways, agriculture, water supply, education, family planning, etc. Health and environmental components have been added to many projects. Cooperative programmes exist between WHO and the Bank, e.g., projects for water supply, World Food Programme, Population Control, and the control of onchocerciasis programme in West Africa (14).
HEALTH WORK OF BILATERAL AGENCIES 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) Programme; and (3) The US Export-Import Bank. The 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.
The US has been assisting in a number of projects designed to improve the health of India's people. These are: (1) malaria eradication; (2) medical education; (3) nursing education; (4) health education; (5) water supply and sanitation; (6) control of communicable diseases; (7) nutrition; and (8) family planning (15). The recent trend in assistance from the USA is increasingly in the support of agricultural and family planning programmes, with some reduction in aid in the general public health field (5)
THE COLOMBO PLAN
At a meeting of the commonwealth Foreign Ministers at Colombo in January 1950, a programme was drawn up for cooperative economic development in South and South East Asia. Membership comprises 20 developing countries within and 6 Japan, New Zealand, UK and USA. The bulk of Colombo Plan assistance goes into industrial and agricultural development, but some support has also been given to health promotion, mostly through fellowships. The All India Institute of Medical Sciences at New Delhi was established with financial assistance from New Zealand. The Plan provides for visits to countries by experts who can offer advice on local problems and train the local people. The contribution of Canada in supplying Cobalt Therapy Units to medical institutions in India was an important item of aid under the Colombo plan (5). Colombo plan seeks to improve living standards of the people of the area by coordinating reviewing developmental plans and development assistance.
SIDA
The Swedish International Development Agency is assisting the National Tuberculosis Control Programme since 1979. The SIDA assistance is usually spent on procurement of supplies like X-ray unit, microscopes and anti-tuberculosis drugs.
DANIDA
The Government of Denmark is providing assistance for the development of services under National Blindness Control Programme since 1978.
NON-GOVERNMENTAL AND OTHER AGENCIES
Rockefeller Foundation
The Rockefeller Foundation is a philanthropic organization chartered in 1913 and endowed by Mr. John D. Rockefeller. Its purpose is to promote the well-being of mankind throughout the world. In its early years, 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 (13).
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. Since then, the Foundation has been associated with several medical and public health programmes in India. 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. The Foundation's programme included the training of competent teachers and research workers; training abroad of candidates from India through fellowships and travel grants; the sponsoring of visits of a large number of medical specialists from the USA; providing grants-in-aid to selected institutions: development of medical college libraries; population studies; assistance to research projects and institutions (e.g., National Institute of Virology at Pune and more recently the setting up of a field demonstration area (Ballabhgarh) in connection with a department of preventive and social medicine, as well as to the All India Institute of Medical Sciences. At present the Foundation is directing its support to the improvement of agriculture, family planning and rural training centres as well as to medical education (5).
Ford Foundation
Whereas the Rockefeller Foundation earlier concentrated most of its assistance on universities and post-graduate institutions, on professional education and on research, the Ford Foundation has been active in the development of rural health services and family planning (5). The Ford Foundation has helped India in the following projects:
(1) Orientation training centres: The orientation training centres at Singur, Poonamalle and Najafgarh were set up with help from the Ford Foundation. The centres provide training courses in public health for medical and paramedical personnel from all over India.
(2) Research-cum-action projects: These projects were aimed at solving some of the basic problems in environmental sanitation, e.g., designing and construction of hand-flushed acceptable sanitary latrines in rural areas.
(3) 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.
(4) Establishment of NIHAE: In the last few years, the Ford Foundation has supported the establishment of the National Institute of Health Administration and Education at Delhi. The Institute provides a senior staff-college type training for health administrators.
(5) Calcutta water supply and drainage scheme: The Foundation has helped in the preparation of a master plan for water supply, sewerage and drainage for the city of Calcutta in collaboration with other international agencies.
(6) Family planning programme: The Foundation is supporting research in reproductive biology and in the family planning fellowship programmes.
CARE
CARE (Cooperative 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. CARE provides emergency aid and long term development assistance.
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. From mid 1980s, CARE-India focused its food support in the ICDS programme and in development of programmes in the areas of health and income supplementation. It is helping in the following projects: Integrated Nutrition and Health Project; Better Health and Nutrition Project; Anaemia Control Project; Improving Women's Health Project; Improved Health Care for Adolescent Girl's Project; Child Survival Project; Improving Women's Reproductive Health and Family Spacing Project; Konkan Integrated Development Project etc.
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.
International Red Cross
The Red Cross is a non-political non-official international humanitarian organization devoted to the service of mankind in peace and war. It was founded by Henry Dunant, a young Swiss businessman, who when travelling through North Italy in 1859 happened to be on the scene of one of the most savage battles of history, the battle of Solferino. Appalled by the neglect of thousands of the wounded and dying soldiers, Dunant recruited volunteers from nearby villages to help relieve their suffering. Later, in his 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". He proposed further that these societies should have a protective emblem and trained workers and their services to the wounded should be protected by international treaty.
Dunant's plea met with success. 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. It has since grown into a mighty mission with branches all over the world symbolising the spirit of compassion and universal brotherhood. In 1919, the League of the Red Cross Society was created with headquarters in Geneva to coordinate the work of the national societies, which now number more than 90.
Role of Red Cross
In the beginning, the role of the Red Cross, as conceived by Dunant, was largely confined to humanitarian service on behalf of the victims of war. Soon thereafter, it was realised that natural disasters too bring in their wake great human suffering and that on such occasions there is equally great need for help among nations "as good neighbours". Later on the work of the Red Cross was extended to other programmes 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.
Indian Red Cross
The Red Cross Society of India was established by an Act of the Indian Legislature in 1920 with the three objectives of the improvement of health, prevention of disease and mitigation of suffering. In peacetime, the Society provides military hospitals with such amenities as newspapers, periodicals, musical instruments and other comfort goods. The Red Cross Home at Bangalore for disabled ex-servicemen is one of the pioneer institutions of its kind in Asia. Disaster services comprise distribution of milk, medicines, Vitamin tablets, codliver oil and hundred other items to the famine stricken people and to those who have been hit by the floods. In the development of maternity and child welfare services, the Society has done pioneering work and has functioned as an auxiliary of the country's health services.
The JUNIOR RED CROSS is one of the most active sections of the Society. It gives an opportunity to lakhs of boys and girls all over India to be associated with activities like the village uplift, first aid, antiepidemic work and building up of an international fraternity of youth, thus promoting international friendliness, understanding and cooperation.
There are numerous other non-governmental organizations (NGO's). Some of these are: Oxfam, Save-the-Children Fund, International Planned Parenthood Federation, The Population Council, Voluntary Health Association of India, All India Women's Conference, India Medical Association, Trained Nurses Association of India, International Agency for the Prevention of Blindness, World Federation of the Deaf, International Leprosy Association, World Federation of Medical Education, International Union against Cancer, and so on. Non-governmental Organizations constitute a valuable resource in promoting health care.