|Al-Ahram Weekly On-line
5 - 11 April 2001
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Dare to careWorld Health Organisation Regional Director for the Eastern Mediterranean Hussein A Geziary speaks to Hala Sakr on the changing nature of the WHO and its mission in the region
To what extent have the cultural, economic and political difficulties posed in the new millennium influenced the WHO in addressing health issues on a global scale?
photo: Youssry Aql
Change does not have to wait for a new century or a new millennium; the needs of communities change with time. What is important to WHO remains constant: to respond to those needs. WHO, has been evolving over the past years in order to be able to respond positively to such needs and changes. For example, when we found that management was one of the main problems plaguing health infrastructure, we started to organise relevant training courses.
As a technical agency, WHO is involved in a partnership with each country it operates in. This partnership extends across all levels of cooperation, from identifying problems, to data analysis, through to setting up a plan of action. We are not a donor agency. The least developed countries pay no more than $10,000 in the form of membership fees. In return, they usually get $5 million worth of services. The involvement of WHO also attracts other donors. We train people to do the work themselves and WHO adopts national programmes, which facilitates the partnership.
How did this trend evolve?
Back in 1948 [when the WHO was first established], WHO was still thinking more or less along the lines of what the colonial powers had been doing in the Third World: to spread exactly the same policies as those being adopted at home. The community was not considered. When Third World countries became independent, they started to think for themselves and we changed as well.
Less developed countries came to identify their own specific problems and priorities. For example, rural areas, where the majority of the population lives, were identified as requiring much more health care and assistance than urban areas. The curative approach remained dominant, and doctors were sent to rural areas to treat patients. [Now] preventive medicine has become the primary aim. A more comprehensive dialogue is possible between the different sectors involved in the medical process -- what we call the multi-sectorial approach to solving problems.
The most important aspect of our work is that the community feels it is in control of its own destiny. They should identify their own problems and suggest possible solutions, assisted by other organisations, including governmental organisations, UN organisations, NGOs, donor countries and others. But leadership is kept within the community.
In what way was this implemented in the Middle East?
One of WHO initiatives in this region is what we call the "basic developmental need." An organised community is asked to conduct a surveillance exercise to identify its problems and set priorities democratically. Every group nominates a representative in the governing body of the programme. Local employees also represent government organisations.
At the end of the day, the priorities people identify tend not to be medicine and doctors. Instead, they are water, roads, better nutrition, agricultural aid, good housing and sometimes even the health of their livestock over their own health.
How does the political setup of the region, heated as it is, affect the work of the WHO?
Political neutrality is the key word. Afghanistan has gone through difficult times over the past 25 years. Severe political changes have increased the number of refugees to more than half the population. WHO has managed to keep good relations with all the conflicting factions because it has never gotten involved in politics. We were accepted as an organisation that supports people, regardless of their affiliations. Cultural specificity must also be considered. Some organisations insist on bringing up gender issues. We have to respect the way of life that is acceptable to people.
The situation of health is getting better all the time. Polio cases have decreased and immunisation plans have been set up to eradicate this disease. WHO is supporting medical schools for both men and women, as well as female nursing schools. Safe water is a major problem. WHO contributes to the water projects that will gradually expand to cover the whole country, regardless of political affiliations. WHO is also helping out with the problem of land mines, and is involved in promoting awareness and training for treating [land mine] injuries.
What about Palestine?
The Palestinians have all sorts of problems. The UN refugee agency [UNRWA] provides decent health programmes in refugee camps, but people living under the Palestinian Authority are having a hard time. The difficulties are generally economic.
WHO is trying to mobilise and increase budget resources and bring in all kinds of support, but due to the blockade, no one can move resources into different areas, let alone move health workers and even ambulances. This is one place where political neutrality has failed. The Israelis won't accept it.
Egypt's public business sector is the largest producer of cigarettes in the Middle East, yet WHO is working with the Egyptian government on an anti-smoking programme. How is this paradox managed?
There is always short-term investment and long-term investment. Economic feasibility is significant. If you take out a loan with very high interest, you're very happy when you receive the money. But then you have to pay back much more than the value of your loan. The cigarette industry is the same thing. Cigarette companies have been able to expand and increase their profit, but this is the worst thing they can do. They are selling a poisonous, addictive material that is directly connected to a long list of diseases, including different cancers and cardiovascular disease.
The Ministry of Health pays the high medical expenses of treatment, so [for the government] this is not sound investment. The World Bank issued a book on the economic aspects of cigarettes and smoking. It clearly shows that cigarettes negatively affect the economy -- no gain in culture or industry -- just a waste of money and a sure way to bind future resources. Compensation will eventually have to be paid for the consequences of actions that should not have happened in the first place.
Does this hinder your programme?
It does. Recently, an attempt to increase tobacco prices was stopped in parliament. One of the most effective ways to combat smoking is to increase the price of cigarettes. More money is raised and fewer cigarettes are smoked. Children, the target of the tobacco industry, will not start to smoke until later, which will give them a chance to escape bad influences.
Why has the WHO chosen mental health as the theme for World Health Day this year?
Mental health is one of the few programmes that have been neglected for a long time. It is estimated that 25 per cent of all people seeking primary health care do not actually have any physical problems. It is their psychological condition, which can be managed through different forms of moral support. The slogan this year is: "Stop exclusion, dare to care."
Mental illness is like any other illness. Culturally and socially, however, mental patients are not accepted, even within their families -- although many cases are treatable. Only a few cases need to be placed in special institutions. Unfortunately, most institutions are in very bad condition and patients are treated very badly. We would like to see people getting support from their family, their friends and society in general.
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