The Role of WHO as International Organisation in Relation to Globalisation

Introduction The essay addresses the role World Health Organisation (WHO) in relation to globalisation. It aims to assess the role of WHO in improving global public health, particularly in Indonesia. It focuses on the policy and programme of reducing child mortality rate in Indonesia as the example of how an international organisation act globally. The essay is structured into four sections. The first section is introduction which contains aim and the structure of the essay. The second section is theory. It defines the concept of globalisation and proposes universalisation as the definition of globalisation. The second section also gives a brief description about WHO. The third section assesses the role of WHO as an international organisation in relation to globalisation. It focusses on the effort of WHO in improving public health in Indonesia particularly in reducing child mortality rate. The section also analyses the adoption of Millennium Development Goals (MDGs) by Indonesian Government and its relationship with the role of WHO. The last section is conclusion. The essay concludes that WHO as international organisations has a crucial role to improve health quality in developing countries. However, the performance of WHO in a country still depends on the supports of its partners, especially the government. The Theory of Globalisation and WHO Globalisation Globalisation is a concept that tries to portrait the integration and interconnectedness of people in the world (Jones, 2006, p112-113). Many experts agree that globalisation is processes that picture the transformation of social connection activities beyond states and regions (Jones, 2006, p112-113). Holton (2011, p185) said that globalisation is a range of ‘cross-border phenomena’ relationship of significant issues. He gave examples on how recent social activities are located on forms of communication, ‘inter-dependence’ and ‘inter-connection’ rather than lie on states, regions, localities or national affiliation (Holton, 2011, p185). In here, Holton argued that globalisation cannot be translated into a single master system. His argument is based on two reasons. First, globalisation is a set of inter-locking, tough sometimes conflicting, trends. Secondly, recent development shows that the systemic element cannot be found. In addition, there is a dispute in measuring the power of the global capitalist economy. From demography view, globalisation is linked to geographical borders (O’ Brien, 1992, in Hartungi, 2006, p729). In here, globalisation covers international and multinational activities. International activities happen between different countries while the multinational involves many countries. Recent research shows that globalisation brings many improvements in all aspect, from financial, economy, technology and sociology. On the other hand, it contributes to the climate change that one of the impacts is a biophysical vulnerability (O’ Brien and Leichenko, 2000, p224). The climate change also causes social vulnerability because the degradation of land can decrease the quality and the quantity of food in certain areas affected. As the effect, it can affect the public health. In a broad conceptualisation, globalisation is “the extension of social relations over the globe” (Mann, 2001, in El-Ojeili and Hayden, 2006, p13). It refers to the improvement of human social organisations in connecting distant communities and expanding their influence across the world. There are four concepts that can be used to understand the conceptualisation. First, “stretched social relations”. It is circumstances where events or processes in a location affect other parts of the world. Secondly, “intensification of flows”. It is proven by the escalation of interaction in all aspects. Thirdly, ‘increasing interpenetration’. In here, the interpenetration of social and economic practices is increasing as the result of social relation improvement. It also opens opportunities for different and distant cultures to interact. Finally, ‘global infrastructure’. It is institutional arrangements that are bases for the network to operate (Cochrane and Pain, 2000, in El-Ojeili and Hayden, 2006, p13). Universalisation Globalisation can be defined as universalisation (Scholte, 2008, p1473). It Illustrates a process of spreading universal values, concepts and knowledge to all people. In here, globalisation is assumed to use or implement a uniformity in a diverse world. For example, the attempt of economists to uniform prices for goods or services (Bradford and Lawrence, 2004, in Scholte, 2008, p1473). On the one hand, universalisation means ‘globalisation as homogenisation’. It aims to create uniformity in several aspects. On the other hand, it can improve innovation and promote cultural diversity (Scholte, 2008, p1473). From the statement, living in a uniformity situation would attract creativity or innovation from the society. Universalisation aims to links people around the world and treat them to the same extent (Scholte, 2008, p1496). One concept that is spread through universalisation is the importance of the recognition of human rights (Waters, 1996, p597). An example of the recognition is The Universal Declaration of Human Right in 1948. It shows that universalisation intents to spread ideas, particularly the recognition of human rights. On the other hand, Scholte argued that the achievement of universalisation is various. It is related to some factors, such as territorial position (Scholte, 2008, p1496). Compared to western European countries, southern Asian countries get less impact of universalisation or globalisation. The distortion in globalisation also happens among regions or locals in a country. For instance, remote regions experience fewer impacts of globalisation rather than coastal regions. World Health Organisation (WHO) WHO is an international organisation under United Nations (UN) that aims to build a better and healthier environment for everyone. WHO began on 7 April 1948. It was a result of a discussion amongst diplomats that formed United Nations (WHO, 2017a, n.p.). It was continued by the first World Health Assembly that formally approved the constitution (Brown, et al., 2006, p64). WHO has three major constituent parts. First, the World Health Assembly. It is the general policy-making body. It arranges a meeting annually. Secondly, an Executive Board of Health Specialist. The executive board is elected by the Assembly for a three-year term. Lastly, WHO has a Secretariat that organised and run the organisation. The Secretariat has regional offices and officers throughout the world (Jones, 2006, p234). Related to the funding, the main financial contributors are member governments. The contribution based on the relative ability of the members to pay (Jones, 2006, p234). The aim of WHO is furthering international cooperation in improving health condition (Jones, 2006, p234). It works together with governments to raise the quality and the health level of people (WHO, 2017a, n.p.). In here, health means “a state of complete, physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO in Jones, 2006, p234). To achieve the aim, WHO also works with other partners that also have a concern in health matters. WHO and the partners strive to eradicate several health problems. They combat infectious diseases such as HIV and influenza, or ‘non-communicable diseases’ such as cancer and heart disease. They work to reduce infant, baby and mother mortality rates. They also concern to ensure the quality of air, water and food for people. Related to health services, WHO and the partners try to improve the quality of medicines and vaccines and its distribution to the recipients (WHO, 2017a, n.p.). Within the UN system, WHO has authorities to give direction and build coordination in improving global health (WHO, 2017a, n.p.). In here, WHO has several responsibilities. First, ‘providing leadership’. It aims to solve critical cases in health matters and partnership cases where joint action is needed. Secondly, WHO plan the ‘research agenda’. It organises health research and the dissemination of valuable and recent knowledge of the research. Thirdly, WHO sets ‘norms and standards’. It aims to uniform and direct the implementation of health services. Fourthly, WHO translates policy options that adopt ‘ethical and evidence-based’ approaches. WHO also provide ‘technical support’. It gives guidance for the implementation of WHO programmes. It is important for dealing with unexpected events or programme sustainability. Lastly, WHO performs ‘monitoring’. It records and studies data about health condition and health trends (WHO, 2017a, n.p.). The Role of WHO in Relation to Globalisation Brown, et al., (2006, p62) said: “WHO is an intergovernmental agency that exercises international functions with the goal of improving global health”. Some points can be drawn from the statement. First, as an intergovernmental agency, WHO is an organisation of countries that have a concern in health matter. Secondly, it has an international function. The organisation can exercise its function across the boundaries of the countries. Finally, WHO aims to improve global health. In general, ‘global health’ prioritises health services provision of all people above the country bureaucracy (Brown, et al., 2006, p62). It is an upgrading from the previous term, ‘international health’, that refers to the attempt of countries in combating the spreading of diseases (Brown, et al., 2006, p62). Related to the attempts of WHO in performing global action, there are several initiative programmes that involves international partners. In the mid-1950s, WHO launched “global malaria eradication programme” (Brown, et al., 2006, p62). It then was followed by campaigns of WHO in countries which were endemic of the disease. WHO also supports research that have a relation with global health (Brown, et al., 2006, p69). From the research, WHO can identify threats to global health. WHO, therefore, can warn its members to take preventive actions to tackle the threats (Kickbush, 2003, p384). WHO can also direct its member to adopt new knowledge related to health problems. The attempt to spreading health knowledge can be initiated from a small scale. It can also use a mediating institution to ease the goals. For instance, in early 1980, WHO European Regional Office build a community network that involved local authorities, universities, schools, hospitals, and professionals (Kickbusch, 2003, p385). The network aimed to spread new health policy through several collaborators. It can be done by arranging meetings, publications, discussion and dissemination. By using this mechanism, the information can spread more effective than if did only by one organisation. Then, the new concept of health promotion can be adopted by other regional offices. As a result, it can improve global health. In here, WHO develops health targets from organisational to international scope. WHO in Indonesia As an international organisation that deals with health matters, WHO has a crucial role in spreading new concepts and knowledge to its members. One of WHO’s tasks is providing ‘technical support’ (WHO, 2017a, n.p.). In here WHO gives advice and directions to its members in dealing with health matters. In Indonesia, WHO gives ‘technical support’ in several areas or functions (WHO, 2008, p20). First, ‘technical support for collaborative interventions’. It focusses on public health priorities. Secondly, it gives ‘policy support for health system development’. It analyses health data and proposes ideas and concepts related to the health system. Thirdly, ‘Support for donor-assisted initiatives to improve health’. WHO facilitates and assists the donors in making the funds give significant impacts. Fourthly, ‘Advocacy and technical support for emerging priorities in health’. It supports health initiatives based on estimation on the future. Next, ‘Technical support for emergency preparedness and response’. In here, WHO mitigates the relationship between emergencies and health impacts. Lastly, WHO gives ‘other forms of technical support’. It covers the evaluation of the programme, needs identification, technical meeting and training (WHO, 2008, p20). WHO has a country office in Indonesia. Having a representative office can benefit both WHO and Indonesian Government (WHO, 2008, p21). First, both WHO and the Ministry of Health can arrange frequent meetings more often. They can share ideas or opinion and find the best solution to tackle health problems in the country. Secondly, to reach wider scope, WHO places staffs at provincial and district levels. The presence of WHO in those levels can either ease the technical support provision or detect local health problems faster. Thirdly, related to the implementation of health system in Indonesia, WHO providing experts and technical advisors (WHO, 2008, p21). In here, WHO can give advice and assist the implementation of a sufficient health system in Indonesia, based on WHO experiences. From the explanation, WHO aims to improve the quality of health provision especially in developing countries. The effort of WHO in spreading knowledge, therefore, shows the role of WHO in globalisation, particularly the improvement of global health. The attempt of WHO in improving health in Indonesia faces several obstacles (WHO, 2008, p21). First, WHO has limited fund to implement the programmes. It causes WHO must give priority to the more urgent programmes. One solution that can solve the problem is by exercising partnership with other stakeholders (WHO, 2017b, n.p.). In here, WHO can work together with other partners or donors to solve funding problems. Secondly, as an international organisation, WHO has many technical programmes that are globally or regionally organised. The implementation of global or regional policies might be insufficient with the local priorities and needs (WHO, 2008, p22). In Indonesia, WHO involves many local partners and hire local staffs. WHO also arranges regular meetings with the government. By involving local personnel and doing regular meetings, WHO might give a leeway to the country office to change or modify a health programme policy. Thirdly, the prospect of collaboration with other partners is limited because WHO staff and fund are linked or seen as under specific units or programmes of the government. Finally, WHO needs more experienced and loyal staff to support technical, administrative, and financial matters. They are needed to maintain the sustainability of WHO programmes. As the concern for health matters, WHO support the declaration of the United Nations Millennium Development Goals (MDGs). It contains eight goals that the member states have agreed to achieve by the year 2015. WHO argued that all goals in MDGs are interdependent and related with health matter (WHO, 2017c, n.p.). For example, better education can give knowledge to the people to get better health. On the other hand, better health can ease children to get a better education. One of the goals of MDGs is to reduce child mortality. One of the concerns of child mortality is infant mortality. Related to MDGs, Indonesian government has formed a regulation about infant health. The regulation is a decree that is issued in 2014 by the Minister of Health (MoH). Compared to the launching of MDGs, the enactment of the decree takes 14 years after the launching or a year before the programme ends.       Table 1. Infant Mortality Rate in Indonesia 1990 – 2012 Number Year Infant Mortality Rate (per 1,000 live birth) 1 1990 71 2 1994 66 3 1997 52 4 2000 47 5 2002 43 6 2007 39 7 2010 26 8 2012 34 Source: Statistic Indonesia, 2017, n.p In 2012, infant mortality rate reached 34 per 1,000 live birth (Statistic Indonesia, 2017, n.p.) It was far from target set, 23 per 1,000 live birth. To tackle the problem, Ministry of Health Republic of Indonesia launched several programmes (MoH, 2010, n.p). First, birth planning and complication prevention programme. Secondly, the government intensifies the use of Child Immunisation Card. Lastly, the government distributes Health Operational Grant to all community health posts in Indonesia. The programmes are designed to improve the quality of health, especially reducing infant and mother mortality rate. The programmes are aligned with the programmes from WHO. In here, WHO has promoted the importance of reducing child mortality to Indonesian government. WHO, therefore, has a crucial role in globalisation, particularly improving global public health. MDGs ended in 2015. To sustain the programme, UN launches the Sustainable Development Goals (SDGs). Related with SDGs, WHO have a critical role in the implementation of the programme. They can promote and assist SDGs in the country members (WHO, 2015, n.p.). As the country that signed SDGs, Indonesia must work hard to achieve the targets. As Indonesia did not achieve targets in MDGs (MoH, 2016, p1), the Minister of Health expected active participation from all stakeholders. In here, WHO as the global agency that deals with the health agendas, is expected to assist the country to achieve the targets. The effort of WHO to achieve targets in SDGs needs active participation from other stakeholders. In here, WHO also can collaborate with other organisations. For instance, WHO, Unicef, Worldbank and United Nations forms the ‘Inter-agency Group for Child Mortality Estimation’ (UN-IGME). It aims to provide an accurate estimation of child mortality and monitors the achievement of child survival goals in the country members (You, et al., 2011, p2). The estimation is very useful to produce better global planning, health strategies and implementation of the policies. On the one hand, the collaboration can adjust the progress on child health. They can provide more accurate data based on their experience and network (Groupa, 2006, p229). They can also share funds because it involves World Bank as the donor. On the other hand, related to bureaucracy matter, it can delay the progress of the programme. For example, World Bank as the donor could set a straight direction related to the use of fund (Brown, et al., 2006, p68), it can make other organisations spend much time to comply. Also, the timing of the collaboration might be different with WHO’s programmes. It might require WHO to re-arrange the programme that has been already set. Conclusion The existence of World Health Organisation (WHO) as an international organisation in a country is very important. It can help the country to encourage their effort in improving public health and diminish the health quality gap between developed and less developed countries. They can perform actions in transferring and spreading knowledge and innovation to improve health qualities on its members. WHO can maximise the effort in improving global public health by performing a collaboration with other partners. The collaboration can be used to execute some agendas simultaneously.  Although the focus of the collaboration might be different with WHO’s, the aims of the collaboration will be useful in improving global public health. It is because WHO can touch aspects such as education to maximise its role in improving global health. The effort of WHO in improving global public health cannot be made only by transferring knowledge from developed countries to developing countries. WHO must consider the situations in a country before runs an international programme. In doing its function to give ‘technical support’, WHO must realise that a country has its characteristics that might require special treatment or policy. 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