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Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities

• Tsegahun Manyazewal   ORCID: orcid.org/0000-0002-8360-7574 1  

Archives of Public Health volume  75 , Article number:  50 ( 2017 ) Cite this article

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Acknowledging the health system strengthening agenda, the World Health Organization (WHO) has formulated a health systems framework that describes health systems in terms of six building blocks. This study aimed to determine the current status of the six WHO health system building blocks in public healthcare facilities in Ethiopia.

A quantitative, cross-sectional study was conducted in five public hospitals in central Ethiopia which were in a post-reform period. A self-administered, structured questionnaire which covered the WHO’s six health system building blocks was used to collect data on healthcare professionals who consented. Data was analyzed using IBM SPSS version 20.

The overall performance of the public hospitals was 60% when weighed against the WHO building blocks which, in this procedure, needed a minimum of 80% score. For each building block, performance scores were: information 53%, health workforce 55%, medical products and technologies 58%, leadership and governance 61%, healthcare financing 62%, and service delivery 69%. There existed a significant difference in performance among the hospitals ( p  < .001).

The study proved that the WHO’s health system building blocks are useful for assessing the process of strengthening health systems in Ethiopia. The six blocks allow identifying different improvement opportunities in each one of the hospitals. There was no contradiction between the indicators of the WHO building blocks and the health sustainable development goal (SDG) objectives. However, such SDG objectives should not be a substitute for strategies to strengthen health systems.

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The 2016 transition in global health from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs) is a remarkable move for resource-limited countries that have been struggling to improve the quality of healthcare at the ground [ 1 , 2 , 3 , 4 ]. The various MDG targets for health were instrumental in shaping healthcare outcomes; with a significant number of resource-limited countries able to meet the targets [ 5 , 6 ]. Similarly, it is worthy that these countries have given increased attention to the current SDGs for health. However, fulfillment of global health targets, unaided by the overall health system strengthening efforts which is mainly a national issue [ 7 ], does not guarantee improvement of the overall health system [ 8 , 9 , 10 ].

Acknowledging the health system strengthening agenda, the World Health Organization (WHO) has formulated a health systems framework that describes health systems in terms of six building blocks which include service delivery, health workforce, information, medical products, vaccines and technologies, financing, and leadership/governance (Fig. 1 ) [ 11 ]. Good service deliveries are those which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources. A well-performing health workforce is one that works in responsive ways, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances. A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status. A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, with scientifically sound and cost-effective use. A good health financing system raises adequate funds for health, in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. Leadership and governance involve ensuring the existence of policy frameworks combined with effective oversight, coalition building, regulation, attention to system design and accountability. Strengthening health system means improving these six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes which require technical and political knowledge and action [ 11 ]. The WHO has supported its health system framework with a monitoring and evaluation framework to monitor program management of health system investments, assess health system performance and evaluate the results of health reform investments [ 12 ].

The WHO Health Systems Framework [ 11 ]

Studies indicate the WHO health system framework is instrumental in strengthening the overall health system and uses as catalyst for achieving global health targets such as the SDGs. Unlike other health system strengthening strategies which are disease-specific [ 13 ] or narrow [ 14 , 15 , 16 ], the WHO’s health system framework intends to improve the overall health in a responsive, financially fair and most efficient way [ 11 ]. Evidences revealed that the framework helps to assess in-country healthcare performances [ 17 ], interactions between health reforms and country health systems [ 18 ], implications of health sector reforms [ 19 ], and the status of health facilities [ 20 ] and specific health problems [ 21 ].

The various global health development goals and commitments have been the alarm bells to the government of Ethiopia. With significant contributions from global partners, the government of Ethiopia tailored to meet many of the global health indicators. For instance, the country has successfully achieved six of the eight MDGs, including MDG Goal 4 and other targets for HIV/AIDs, malaria, tuberculosis and other diseases, while MDG 5 (improve maternal health) is an area the country was off-track [ 22 ]. However, meeting such global targets alone could not justify improved and sustainable health system and the readiness responding effectively to unanticipated health threats.

Since 2008, the Ethiopian government is implementing healthcare reform aimed at strengthening the overall health system [ 23 ]. A system of tracking clients’ opinions and complaints about services has been put in place to enable the Ethiopian government to take appropriate and immediate actions. Based on the principle of BPR [ 24 ], the FMoH has conducted “as is” analysis to document pertinent issues, understand the pros and cons of the existing healthcare delivery system in the country and figure out the different dynamics that should be considered in the redesign of the new reform. With these, “to be” business processes were designed, public health sector standards formulated, and standard operating procedures and implementation tools developed [ 25 ]. The reform has been progressively implemented through a series of training sessions for managers and technicians at all levels followed by changes in staff deployment, specific job assignments and the recruitment of new staff. Stretched objectives were synthesized and sub processes that form the core process identified. Public hospital services were structured into three major case teams namely; Emergency, Outpatient, and Inpatient, where Outpatient and Inpatient case teams were further classified into eight and nine case teams, respectively [ 26 ]. However, despite implementing the healthcare in public healthcare facilities, little is known about the current status of the public hospitals in terms of the WHO’s health system building blocks.

Building on the lessons learned in the MDGs and considering the current socioeconomic landscape, the Government of Ethiopia is developing and implementing its Health Sector Transformation Plan (HSTP) – a five-year (2015–2020) national health sector strategic plan and the first phase in the ‘Envisioning Ethiopia’s Path towards Universal Health Coverage through Strengthening Primary Healthcare’ [ 22 ]. In the HSTP, four pillars of excellence are believed to help the sector attain its mission and vision: health service delivery, quality improvement and assurance, leadership and governance, and health system capacity. The four pillars are linked with the WHO’s six health system building blocks.

The status of the WHO’s six building blocks at public health facilities would configure the health system and its outcomes in national as well as global needs. Public hospitals, with their possibilities for improved healthcare services, training, research and innovations, are potential to favorably influence the broader array of the healthcare system. Thus, periodic evaluation of the overall healthcare system is required to identify gaps and provide appropriate interventions. Such constructive insights would consolidate global health development goals and routine healthcare needs for possible improvements of the overall health system. Keeping this up-front, this study intends to determine the current status of the WHO’s six health system building blocks in public hospitals in central Ethiopia.

A quantitative, cross-sectional study was carried out to analyze the status of the Six WHO health system building blocks in public hospitals in central Ethiopia, thus Addis Ababa. Addis Ababa was selected among the 11 administrative divisions of Ethiopia considering its presence as the largest and city capital of Ethiopia. The Addis Ababa Health Bureau has been implementing the healthcare reform in public healthcare sector that it owned. The bureau administers six public hospitals which deliver advanced preventive and curative health services, from which all that have been implementing the BPR healthcare reform since its inception in 2009 ( n  = 5) were purposively selected to maximize the scope of the study thereby ensure external validity. Hence, the five public hospitals were purposively sourced as they were in a post-reform phase.

The study was conducted between January and June 2015. The target group was all healthcare professionals in the public hospitals ( n  = 1681) which included medical doctors, nurses, laboratory professionals, pharmacists, dentists, health officers, and sanitarians. Of these, all who started working in the hospitals at least a year ahead of initiation of the reform ( n  = 476, 28%) were purposively drawn to select respondents who knew the performance of the hospitals before implementation of the reform and better analyze the changes that occurred because of the reform.

A self-administered, structured questionnaire targeting healthcare professionals was developed in a 5-level scale and used for data collection. To elicit a quality questionnaire, secondary data and related studies conduct elsewhere were reviewed and the questionnaire pretested. The questionnaire was structured to cover the six WHO health system building blocks and specific indicators were adapted from the target in the BPR healthcare reform document for improvements in healthcare facilities:

Leadership/governance : new organizational practices and policies, the best use of resources, appropriate use of staff working hour, satisfaction of patients and providers, capacity to assemble and manage resources;

Healthcare financing : efficient and effective healthcare financing system, linkage of financial mobilization with evidence-based plan, effective budget consumption, the required financial resources to ensure sustainability, and reduced wastage and enhanced cost-effective interventions;

Health workforce : qualified staff, job satisfaction, motivation, conducive structure, appropriate and timely feedback;

Medical products/technologies : adequate drugs, medical supplies, medical apparatuses and equipment, up-to-date technologies for patient diagnosis, new organizational practices and policies, networking with the external environment;

Information : monitoring and evaluation, up-to-date and appropriate guidelines and protocols, appropriate internet access, easy and time-efficient reporting system;

Service delivery : patient satisfaction, on-time services, improved treatment and respect to patients, patient indiscrimination, mode of communications suitable to patients.

Data analysis was performed through calculation of descriptive statistical procedures on IBM SPSS version 20. Each of the five responses had a numerical value (1–5), in which the highest two scoring answers (4 and 5) were taken as positive outcomes while the rest three responses were considered as negative outcomes. With this, a positive outcome for each of the WHO six building blocks had a value of 4, which is equivalent to a mean percentage score [ 27 ] of 80% or above. As the questions were grouped under the six building blocks, a scale score was computed as the mean of the scale item scores, while the median score was employed to measure central tendency among individual questions.

The study was granted ethical clearance certificate from the Higher Degrees Committee of the Department of Health Studies, University of South Africa and the Research and Technology Transfer Core-process of the Addis Ababa City Administration Health Bureau. Informed consent form was developed for each respondent to read and sign before moving on to fill-in the questionnaires.

Socio-demographic profile

A total of 406 healthcare professionals participated in the study, among which 282 (69.5%) were women. The majority of participants (195, 48%) were in the age ranging from 30 to 39, while very few (26, 6.4%) were in the age ranging from 50 to 59. The largest proportion of participants (304, 74.9%) was nurses, followed by medical doctors (35, 8.6%), medical laboratory professionals (24, 5.9%), pharmacist (16, 3.9%), X-ray technicians (11, 2.7%) and sanitarians (2, 0.5%). Academically, the largest proportion of participants (342, 84.2%) had bachelor’s degree, followed by Diploma (37, 9.1%), medical doctorate with specialization (18, 4.4%), MSc/MA or MPH (7, 1.7%), and certificate 2 (0.5%). A large number of participants (202, 49.8%) worked as a healthcare professional for 10 to 19 years.

Table 1 summarizes the status of the WHO six building blocks in the study hospitals.

Leadership/governance building block

Data was collected about elements of governance/leadership from public healthcare perspectives. Given the increasing diffusion of new organizational practices and policies across the study hospitals, the impact of this practice had little benefit (60%) when weighed against the perceived value (≥ 80%). Resource management had challenges in that the best use of resource (65%) and the capacity to assemble and manage resources (61%) in the hospitals were not adequate, signifying that leadership skills were loosen on this matter. Regarding staff working hour, the result was smaller (58%) and even lesser than all the rest scores in leadership/governance section, implying a higher misuse of working hours in the hospitals. Healthcare professionals in the hospitals perceive an overall 61% satisfaction of employees and patients regarding how the hospitals are currently operating. In this leadership/governance category, a relatively highest score (65%) was in the use of resources, while the least score (58%) was in the use of staff working hours. In general, the average score of leadership/governance in this study was 61%, which was lower than the 80% score perceived in the WHO’s health system framework.

Healthcare financing

For this building block, five questions were posed to realize the healthcare financing capacity of the hospitals. The author learned from the healthcare professionals that there is a loosen linkage between financial mobilization and evidence-based planning. The performance of the hospitals toward reducing wastage of resources while enhancing cost-effective interventions was deprived and the overall budget consumption was ineffective, which were potential for financial recessions. There had been a relatively better achievement (65%) towards gaining financial resources essential for sustainability of healthcare services. The average score of leadership/governance was 62%, which was yet lower than the perceived 80% score.

Health workforce

This section witnessed multifactorial public health workforce challenges which need contextual changes in line with the WHO health workforce needs. The study captures major claims on availability of staff restrooms (47%). There exist job dissatisfaction and demotivation of the public health workforce, with potential impacts on the overall health system. The average score for health workforce was 55%, which was much lower than the 80% score perceived for the WHO’s health system framework for health workforce.

Medical products/technologies

The impetus for medical technologies and practices had gaps when scaled against the intended WHO requirements. The hospitals are not well-resourced with enough drugs, medical supplies, medical apparatus and equipment. As well, there was a need for networking the hospitals with the external environment for a possible exchange of medical technologies. The average score of medical technologies was 58%, which was much lower than the 80% score intended in the WHO’s health system framework for medical products/technologies.

Information

The study set out to the existing information system in terms of the WHO building block and found that information is limited in opportunity and scope. Healthcare professionals in the hospitals recognized that access to internet is limited (38%) to hospital staff. The hospitals’ duties were poorly supported by up-to-date and appropriate guidelines and protocols. Monitoring and evaluation system of the hospitals was viewed as a fairly practice when compared with other responses in this section. The average score for information was 53%, which was much lower than the intended 80% score.

Service delivery

Service delivery had some fairly gains. The healthcare professionals (80%) highlighted that there are no patient discriminations, though this finding needs to be confirmed with patients. On-time access to services and availability of services in a mode of communication suitable to patients both scored 69%. The average score for service delivery was 69%, which was yet lower than the perceived 80% and above score. While this 69% score for service delivery was the highest among the six WHO health system building blocks.

Overall performance

In line with the WHO health system building blocks, the overall health system performance of public hospitals in central Ethiopia was 60%. Looking at each building block, results were lesser for information (53%), health workforce (55%), medical products/technologies (58%), leadership/governance (61%), healthcare financing (62%) and service delivery (69%). There was a significant difference in healthcare performance between at least two hospitals (χ 2  = 571.902, p  < .001).

This study aimed to find out the current status of the six WHO health system building blocks in public healthcare facilities in Ethiopia. The findings revealed that the overall performance of public hospitals which were in a post-reform phase was lesser when weighed against the WHO’s six health system building blocks. The public hospitals scored less for each WHO building block, which includes information, health workforce, medical products/technologies, leadership/governance, healthcare financing, and service delivery.

Over the past decade, the WHO and other organizations in the field have given much attention to the issue of health systems strengthening [ 7 , 14 , 28 , 29 , 30 ] and the government of Ethiopia has been in the loop reaffirming its commitments and consolidating the gains [ 10 , 13 , 31 , 32 , 33 ]. This study deepens understanding of how healthcare facilities can develop a platform to assess and monitor their performances for on-going improvements in the context of the WHO’s six health system building blocks. The approach facilitates results measurement through generating data for measuring outputs for a better and sustained improvement. The main data source of the study was from healthcare professionals which are the ultimate resources of health systems and markedly responsible for monitoring the healthcare climate [ 34 ]. Studies exhibited that healthcare professionals are key sources of information to track and monitor health system progresses [ 35 , 36 ], and there have been unwanted variations in healthcare practices that cannot be explained by patients [ 37 ].

The study witnessed that there were major issues which may affect the status of the six WHO building blocks in public hospitals. The hospitals’ governances did not pursue staff loyalty to effectively use their time to maximize the hospitals’ capacity and sustainability. This needs keener interest of the hospitals’ administrations to probe on the governance constraints and take possible interventions to attain the intended WHO governance/leadership needs among others.

Healthcare financing was another concern in the current status of the WHO building blocks. The healthcare financing capacity, in relation to healthcare goods and services, indicates that mandatory steps still remain. The hospitals were not effective enough in linking financial mobilization with evidence-based plans. Besides, the hospitals were unable to reduce wastages and enhance cost-effective interventions. These indicate that the healthcare financing gaps identified in this study need to restructure. The policy options that the FMoH proposed to address challenges in healthcare financing are health insurance and social health insurance [ 38 ]. These two options could be considered as possible options for improvement in healthcare financing. However, additional specific strategies which target public hospitals need to be formulated to address finance related gaps identified in the study. As households in rural part of Ethiopia are included in public health insurance schemes [ 39 ], the Ethiopian government could shift existing budgets for strengthening health system at public hospitals. The cost which was estimated for implementing the HSTP in the year 2015/16–2019/20 is $177,723,169, where the highest share goes to human resource and infrastructure [ 22 ]. From this budget, public hospitals need to secure a significant share to enhance their capacity and be equipped with innovative technologies.

Regarding health workforce, only a fraction of the WHO building block for workforce was achieved. Lack of job satisfaction, motivation, convenient infrastructure, timely performance feedback, and qualified staff were major gaps identified in the public hospitals. This finding is in support of previous studies conducted in Ethiopia at different times and with different target populations [ 40 , 41 , 42 , 43 ]. A previous report of the FMoH also witnessed scarcity and inappropriate usage of medical products and technologies in public hospitals [ 22 ]. There were scarcities of drugs, medical supplies, medical apparatus, and equipment in the hospitals. There was less effort taken towards initiating new practices for effective and advanced usage of technologies. Hence, evocative strategies with huge investments in health workforces’ education and training, management, retention, incentives, motivation, and job satisfaction are required to meet the intended human resource need.

Similarly, information communication and exchange methods, which are active catalysts in the broad-based health development, were stagnated, thus need improvements. The hospitals have been highly affected by lack of sufficient internet access in the hospitals, which could hinder staff from updating their knowledge and translating to their patients. In the same sense, there have been many guidelines that the FMoH and its partner organizations developed and shared for bench-level use. However, the guidelines and other standard operating procedures were not fairly in place as quick references. Such constraints need practicable health information strategies coupled with monitoring system. Overall, there is a need for further progress in all the six WHO health system building blocks. The use of the six WHO health system building blocks was proved to be instrumental for assessing and following-up of the overall healthcare system.

This study is with some limitations. Evidences only from healthcare professionals might be subjected to their experiences and expectations. Hence, expanding the sources of the study data set to capture more inclusive information that could be obtained from patients or the existing hospital data was necessary. On the other side, the relatively low proportion of physicians among those who answered the interview may hide the actual view of clinicians in the analysis. Or else, the study’s approach proved that the use of the six WHO building blocks to numerically assess and monitor public healthcare sectors is possible. Healthcare facilities can employ this approach to assess and follow-up their own strengths and weaknesses with minimum costs. With this, it is possible to strengthen health system at various levels, and simultaneously integrate global health commitments for sustainability and ownership.

The study proved that the WHO’s six health system building blocks are useful for assessing the process of strengthening health systems in Ethiopia. The six blocks allow identifying different improvement opportunities in each one of the hospitals. There is no contradiction between the indicators of the WHO health systems building blocks and the health sustainable development goal (SDG) objectives. However, such SDG objectives should not be a substitute for strategies to strengthen health systems.

Abbreviations

Federal Democratic Republic of Ethiopia Ministry of Health

Health Sector Transformation Plan

Millennium Development Goal

Sustainable Development Goal

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Acknowledgments

The author would like to thank Prof. MC Matlakala, Prof. MJ Oosthuizen, and Dr. Shewangizaw Getahun for their expert guidance.

This research project has been supported by the University of South Africa.

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TM conceived, designed and implemented the study. TM analysed and interpreted data, wrote the first draft, critically revised it for important intellectual content and approved the final version of the manuscript for publication.

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The study was granted an ethical clearance certificate from the Higher Degrees Committee of the Department of Health Studies, University of South Africa, and the Research and Technology Transfer Core-process of the Addis Ababa City Administration Health Bureau.

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Manyazewal, T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Arch Public Health 75 , 50 (2017). https://doi.org/10.1186/s13690-017-0221-9

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World Health Organisation (WHO) - UPSC Notes

The World Health Organisation (WHO) is a specialized agency of the United Nations that looks into matters of public health. Established on April 7th, 1948, its headquarters is located in Geneva, Switzerland. WHO is an important topic for the IAS exam , as it is keeping in news concerning the Covid-19 outbreak. On 9th July, 2020, WHO created an Independent Panel for Pandemic Preparedness and Response (IPPR) to evaluate the world’s response to the COVID-19 pandemic.

World Health Organisation (WHO)

Recent Update:

To evaluate the world’s response to Coronavirus pandemic, Independent Panel for Pandemic Preparedness and Response (IPPR) has been created by the World Health Organisation. The main points related to it are:

• New Zealand former President Helen Clark and Liberia former President Ellen Johnson Sirleaf are co-chairs of  the IPPR, as announced by the WHO Director-General Tedros Adhanom Ghebreyesus
• The IPPR comes on the heels of the Landmark Resolution related to Covid-19 that was adopted in the 73rd World Health Assembly in May 2020.
• On 7 July 2020, President Trump formally notified the UN of his intent to withdraw the United States from the WHO. However, in January 2021, President Joe Biden announced plans to rejoin, and signed an executive order to that effect after his inauguration.
• In February 2021, the WHO team visited China in order to investigate the origins of the COVID-19 virus that allegedly had its origin in the Wuhan Virology Institute. The team will publish its findings in mid-march.
• WHO chief Tedros Adhanom Ghebreyesus on February 26, 2021 had lauded Prime Minister Narendra Modi’s commitment for supporting vaccine equity and sharing COVID-19 vaccines with over 60 countries across the world, hoping that other nations will follow his example.

Facts about WHO for UPSC

At the 1945 United Nations Conference on International Organization (also known as the San Francisco Conference), Szeming Sze, a delegate from the Republic of China (modern-day Taiwan), proposed the creation of an international health organization under the auspices of the new United Nations . Alger Hiss, the Secretary-General of the conference, recommended using a declaration to establish such an organization. 

As a result of these proceedings, the World Health Organisation came to be established in 1948. It became the first specialized agency of the United Nations to which every member subscribed.

• The WHO is headed by its Director-General and is headquartered in Geneva. Currently, the WHO has 194 member countries. 
• Full membership of the WHO is only guaranteed with the ratifying of the treaty known as the Constitution of the World Health Organisation.  To know more about Important Headquarters of International Organisations , visit the linked article.
• The member states of the WHO appoint delegates to the World Health Assembly, which is the supreme decision-making body. The World Health Assembly is attended by delegations from all Member States and determines the policies of the Organisation.
• On May 19, 2020, India was elected by the 73rd World Health Assembly to the Executive Board of the World Health Organisation for three years. Union Health Minister Harsh Vardhan took charge as the chairman of the WHO Executive Board on May 22. He succeeds Dr. Hiroki Nakatani of Japan.
• The WHO celebrates World Health Day annually on its formation day (7 April). The theme for 2020 was “Y ear of the Nurse and Midwife”.

WHO UPSC Notes:- Download PDF Here

What is the Overall Focus of the WHO?

The WHO Constitution states that the organization’s objective “is the attainment by all people of the highest possible level of health”.

The WHO fulfills this objective through the following functions:

• By playing a role as the directing and coordinating authority on international health work.
• Maintaining and establishing collaboration with the UN and any other appropriate bodies.
• Assisting governments, upon request, in strengthening their health services.
• Giving appropriate technical assistance and in case of emergencies, required aid upon the request or acceptance of governments.

What is the Health Policy of the WHO?

The WHO addresses government health policy with the following two aims:     

• To address the social and economic determinants of health through policies and programs “that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches”.
• To promote a healthier environment, intensify primary prevention, and influence public policies in all sectors to address the root causes of environmental threats to health”.

Contribution of WHO

The WHO has been instrumental in eradicating the suffering of millions all over the world through its assistance to various governments. Some of the important milestones include:

• Eradication of smallpox in 1980.
• The organization is close to eradicating Polio, a disease that affects mainly infants and young children. Due to eradication programs by the WHO, polio cases have come down by 99% since 1988. As of 2019, only three nations are suffering from polio – Nigeria, Afghanistan, and Pakistan.
• In 2008, the WHO initiated the observance of the ‘World Malaria Day’. This day is observed annually on April 25. Read more about this day in This Day in History dated April 25 .
• It focuses on infectious diseases like HIV, influenza, malaria, tuberculosis , and Ebola; and also other non-communicable diseases such as heart disease and cancer.
• It also takes efforts in the direction of maternity and infant healthcare, old-age care, and hygienic food and water for all.

Contributions of the WHO in India

India is a member of the WHO and the organization has its offices in various parts of the country. The WHO Country Office (WCO) is headquartered in New Delhi.

The WHO Country Cooperation Strategy (CCS) – India has been jointly developed by the Ministry of Health and Family Welfare of the GOI and the WCO. 

• Its chief aim is to contribute to improving health and equity in the country. 

The National Strategic Plan for Elimination of Malaria (2017-2022) was launched by the Union Minister for Health and Family Welfare. 

• Its chief aim is to eliminate Malaria by 2027. 
• The National Strategic Plan has formulated year wise elimination targets in various parts of the country. 
• It is formulated with the support of the World Health Organization’s Global Technical Strategy for Malaria (2016-2030).

What are the current challenges of WHO?

As an international organization, WHO has its fair share of challenges. Some of them are as follows:

• The WHO is largely dependent on funds from donors – usually from economically well-developed countries and organizations such as Melinda Gates Foundation – rather than a secured channel of funding.
• As a result, most of the WHO’s funding for crucial programs remain on the back burner as some of these programs also clash with the interests of the donors. 
• The effectiveness of the organization has come under question especially due to its disastrous handling of the Ebola outbreak in West Africa and the very recent coronavirus outbreak in 2019-20.
• Consequently, the WHO’s role as a leader in global health has been supplanted by other intergovernmental bodies such as the World Bank, and increasingly by big foundations.
• Initial concerns included the observation that while the WHO relies upon data provided and filtered by member states, China has had a “historical aversion to transparency and sensitivity to international criticism”. US President Donald Trump has been the most vocal of all the critics of the organization. This has led to the US’s withdrawal from the WHO.

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70% of workers are at risk of climate-related health hazards, says the ILO

Excess heat causes 18,970 work-related deaths annually, according to the ILO. Image:  Unsplash/Daniel Moqvist

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Stay up to date:, health and healthcare.

• The global workforce is facing a serious health crisis due to the negative impacts of climate change.
• The climate crisis could expose 2.4 billion workers to health hazards like cancer, cardiovascular illness, kidney dysfunction and physical injury, says a new ILO report.
• The World Economic Forum’s Quantifying the Impact of Climate Change on Human Health report forecasts how the climate crisis will impact the global health landscape over the next 20 years.

Around 2.4 billion workers globally are likely to be exposed to health hazards like cancer, cardiovascular illness, kidney dysfunction and physical injury as a result of climate change, according to the International Labour Organization (ILO).

The report, called Ensuring Safety and Health at Work in a Changing Climate, says excessive heat affects 70% of the global workforce of 3.4 billion people, causing 18,970 work-related deaths and around 23 million workplace injuries annually .

As a share of the growing global population, the proportion of people exposed to extreme work-related heat has increased from 65.5% in 2000, to 70.9% currently .

Have you read?

Which health areas are impacted by climate change and where is more guidance needed, these 3 climate disasters will have the biggest impact on human health by 2050, the climate crisis disproportionately hits the poor. how can we protect them.

Pregnant women working in heat extremes face twice the risk of miscarriages and stillbirths, and face an increased risk of bearing babies with low birth weight, a 2024 study published in the National Library of Medicine shows .

A deadly crisis

Exposure to extreme heat and other impacts of the intensifying climate crisis form what the report calls a “cocktail of hazards'' resulting in premature death or potentially serious health consequences.

These include:

• 1.6 billion workers exposed to UV radiation, causing more than 18,960 work-related deaths from skin cancer annually.
• 1.6 billion workers breathing polluted workplace air, resulting in up to 860,000 work-related deaths of outdoor workers each year.
• More than 870 million agricultural workers in contact with dangerous pesticides, causing more than 300,000 deaths annually from pesticide poisoning.
• 15,000 work-related deaths each year due to parasitic and vector-borne diseases, such as malaria.

Keeping workers well. It is the united aim of a global community influencing how companies will keep employees safe. What is the role of COVID-19 testing? What is the value of contact tracing? How do organizations ensure health at work for all employees?

Members from a diverse range of industries – from healthcare to food, utilities, software and more – and from over 25 countries and 250 companies representing more than 1 million employees are involved in the COVID-19 Workplace Commons: Keeping Workers Well initiative. Launched in July 2020, the project is a partnership between the World Economic Forum and Arizona State University with support from The Rockefeller Foundation.

The COVID-19 Workplace Commons: Keeping Workers Well initiative leverages the Forum’s platforms, networks and global convening ability to collect, refine and share strategies and approaches for returning to the workplace safely as part of broader COVID-19 recovery strategies.

Companies can apply to share their learnings and participate in the initiative as a partner, by joining the Forum’s Platform for Shaping the Future of Health and Healthcare.

Learn more about the impact .

A global health challenge

Looking ahead, the World Economic Forum’s Quantifying the Impact of Climate Change on Human Health report forecasts how the climate crisis will impact the global health landscape over the next 20 years.

Growing threats like new pathogens, pollution and extreme weather events could amplify today’s health challenges, while exacerbating inequalities that adversely impact vulnerable communities.

The intensifying climate crisis looks set to place immense strain on global healthcare systems, causing 14.5 million deaths and $12.5 trillion in economic losses by 2050, the report says.

Breaking that down, as extreme weather-related events increase in frequency and intensity, floods are expected to claim 8.5 million lives worldwide, with the Asia Pacific region suffering the highest death toll due to heavily populated at-risk coastal communities and the prospect of higher levels or rainfall.

Droughts are expected to claim approximately 3.2 million lives worldwide, with the long-term effects of disease and related deaths a major driver.

The report also predicts: an estimated 1.6 million deaths from heat waves, with people aged 65 and over hardest hit by prolonged temperature extremes; half a million deaths from extreme tropical storms; and an additional 300,000 loss of life from wildfire spread.

Healthy workforces

So, what can be done to mitigate the impact of the climate crisis on workplace global health?

The obvious answer is to stop burning fossil fuels. Global emissions must reduce by at least 28-42% by 2030 , compared to current scenarios, to keep the planet on-track for 1.5C or 2C above pre-industrial temperatures, says the UN Environment Programme.

While there is still time to rein in global emissions, there is no quick fix.

Part of the challenge lies in raising awareness of the health hazards people face, motivating stakeholders to act by adopting workplace best practices and encouraging greater investment and policy measures to protect peoples’ health.

To that end, the Forum’s Healthy Workforces network brings together stakeholders from the worlds of business, government, organizations and civil society, to prioritize physical and mental health in the workplace .

By sharing insights, stakeholders can adopt and implement evidence-based best practices to promote employee wellbeing and realize a more productive, resilient and healthy global workforce.

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License and Republishing

World Economic Forum articles may be republished in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Public License, and in accordance with our Terms of Use.

The views expressed in this article are those of the author alone and not the World Economic Forum.

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