The World Health Assembly (WHA) is the annual meeting of the ministers of health of all United Nations (UN) Member States, which is the governing body of the World Health Organization (WHO). The WHA is the largest meeting of the year for WHO. The group has met yearly since the founding of the UN in 1948. The goal of the meeting is to review, plan, and approve the future agenda for WHO. Each UN Member State has one vote, usually cast by their minister of health.
Many Non-Governmental Organizations (NGOs) and organizations in official relations with WHO attend the WHA to monitor reports and voting, and to make statements during the proceedings to support particular issues. There are multiple side-events, at which allied organizations meet to report on progress and plan collaborative efforts. The significance of the WHA to neurosurgeons increased markedly in 2015. One month after publication of the Lancet Commission Report on Global Surgery (Meara JG, Leather AJM, Hagander L, et al: Global Surgery 2030:evidence and solutions for achieving health, welfare and economic development. The Lancet, Vol. 386, No. 9993, p569-624), the WHA unanimously passed Resolution 68.15 on strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage. This resolution, for the first time, underscored the importance of surgical care and anesthesia and spelled out the specific mandates for Member States and for the WHO Secretariat. It is estimated that 5 billion people do not have access to safe, timely and affordable surgical care and anesthesia when needed, and 16.9 million lives were lost in 2010 due to untreated surgical conditions. Neurosurgeon Walter Johnson has been hired by WHO as the full-time, Geneva-based Lead for the Emergency and Essential Surgical Care (EESC) Programme. (www.who.int/surgery/). Activities of this office include: promotion of national surgical policies, improving surgical education and training, building capacity of surgical delivery systems, establishing protocols and monitoring to improve quality and safely, research using surgical analysis tools, resource-stratified treatment algorithms, developing WHO Collaborative Centers for Surgery and Anesthesia worldwide, and advocacy for surgeons and surgical patients.
The recent adoption of WHA Resolution 68.15 for strengthening emergency and essential surgical care and anesthesia marks a new era in global surgery and international cooperation in surgical care. National Surgical, Obstetric and Anesthesia Plans (NSOAPs) are being written into their National Health Strategic Plans by multiple UN Member States that will address health workforce issues, surgical education and training, budgeting, and other resource allocation, governance and management, and building strong surgical delivery systems. Neurosurgical clinicians, educators and policy-makers will find opportunities to work collaboratively with other partners and global health specialties, both through the WHO and its WFNS liaison, as well as through other new NGOs that are developing in response to this new opportunity.
Since the 1970s, the World Federation of Neurosurgical Societies has been in official relations with the WHO EESC. Other non-state actors in official relations with WHO EESC include: International College of Surgeons (ICS), International Federation of Surgical Colleges (IFSC), Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) and World Federation of Societies of Anaesthesiologists (WFSA). Official relations are accomplished via a tri-annual renewal process, which requires disclosure of financial information to prevent conflicts of interest. One benefit of membership is the opportunity for WFNS to register observers, who may attend the WHA and any useful side-events and contribute relevant statements. Neurosurgeons involved in the WFNS have, when able, volunteered their time and resources to attend the WHA and report to the WFNS Administrative Council. Advantages of this association have included neurosurgical input on International Statistical Classification of Diseases and Related Health Problems ICD-10 and ICD-11 and technical expertise on various projects within the WHO EESC.
This year, the WFNS sent the following representatives: Najia El Abaddi, Kee Park, Gail Rosseau, Aberrahmane Sidi Said and Yong-Kwang Tu. Other neurosurgical participants, under the sponsorship of ICS, included Drs Aij-Lie Kwan and Izabela Chudzicka. The group attended the daily assembly and official WHO side-event sessions, such as those sponsored by Dr. Johnson’s EESC Programme. The WFNS representatives also met with other members of the global surgery community, including the G4 Alliance, Consortium of Universities for Global Health (CUGH) and public health leaders in multiple medical disciplines from all around the world.
This meeting included election for a new Director-General (DG), for the first time by private ballot. The delegates selected Dr. Tedros Adhanom Ghebreyesus, the first DG from Africa. Dr. Tedros is from Ethiopia, where he served as his nation’s Minister of Health from 2005-2012 and Minister of Foreign Affairs from 2012-2016. He holds a Ph.D. in Community Health and is considered an expert in malaria and healthcare manpower. He began his 5-year term July 1. During his tenure as health minister, surgical services were a top priority in Ethiopia, the results of which are evident today. He has made both verbal and written commitments to continue to make surgical care on a global scale a priority during his term as DG.
A formal report on the two-year progress towards implementing WHA 68.15 was presented. Also, a Decision Point was passed which will require the WHO Secretariat to continue reporting every two years on progress in implementing WHA resolution 68.15, from now until 2030. This serves to keep the spotlight on surgical care within the WHA agenda for the next 13 years.
The strong neurosurgical presence at the 70th WHA firmly positioned neurosurgeons to be a key future partner in scaling up of emergency and essential surgical care and anesthesia in the developing world, where traumatic brain injuries and stroke continue to be major public health problems. The voice of organized neurosurgery will resonate in spreading advocacy campaigns, designing policies that affect surgical care delivery, and setting the global health agenda so that neurosurgical patients everywhere will get the best care possible.
Gail Rosseau MD
Assistant Secretary, World Federation of Neurosurgical Societies