Preliminary Programme

Recent historiography about the WHO has shown, among other things, the important role it has played in the modernisation of Public Health and in the establishment of standards to be applied to the fight against health problems around the world. However, in the Spanish case, there are some important aspects to be studied. One of them is the role played by the called “country programmes” of the WHO in Spain, an analysis of which has recently begun (Ballester Añón, Rosa, 2016; Porras, MI; Báguena, MJ; Ballester, R., Los Programas-país de la OMS con España para la lucha contra las enfermedades infecciosas (1951-1975). Poster. VII Congreso ALAP (Brasil- 2016); Porras, MI; Báguena, MJ; Ballester, R. La lucha contra las enfermedades víricas en España a través de los Programas-País de la OMS (1951-1986). Ponencia. VII Congreso ALAP (Brasil-2016); Porras, MI; Báguena, MJ; Ballester, R., El papel de los programas-país de la OMS en la investigación histórico-médica: la lucha contra las enfermedades infecciosas víricas en España (1951-1975). Poster. XX Simposio de la SEHM (Granada-2016).
The admission of Spain to the WHO in 1951, after its initial period of international isolation since the beginning of the Franco dictatorship, made it possible to benefit from different programmes of the WHO devoted to sanitary improvement. Among these were the so-called “country programmes”. We can identify 21 programmes of this type focused on Spain between 1951 and 1975. These cooperation projects consisted of material, technical support, and scientific training, combined with field visits of WHO experts to Spain to study health problems, to help to design appropriates actions to deal with them and, later, to verify the degree of implementation. One of these 21 country programmes was E25, focused on viral diseases, that contributed to helping the creation of epidemiological studies, as well as the establishment of the fight against these diseases. In doing so it made possible the development of the virology in Spain. However, the first WHO programme of assistance to Spain was Spain 0001 (E1), addressing zoonosis control – among others, rabies (E1.3).
Using this case study, our main aim is to analyse the impact of the E25 country programme [followed by E1901 (1971-1973) and VIR001 (from 1974 onwards)] in the development of virology in Spain; but we also need to consider the E1.3 programme related to rabies. Our paper is particularly focused on studying the role played by E25 in: 1) the development of scientific research about viral diseases (rabies, smallpox, influenza, poliomyelitis, rubella, measles and mumps) in Spain; 2) the improvement of scientific laboratories and other infrastructures for viral research and elaboration of vaccines against these diseases; 3) the training of scientists and health professionals in new techniques concerning the study of viruses, serological surveys, preparation, application and assessment of viral vaccines, and 4) the design and establishment of epidemiological studies and programmes to control viral diseases.
Our main sources are information from WHO historical archives (Geneva) and the Historical Archive of the National Health School and ISCIII (Madrid, Spain), various WHO publications (particularly the Bulletin and the Technical Reports prepared by the Expert Committees and Study Groups of this international body), the Reports of the General Directorate of Health, contemporary medical press, and a selection of the general press (ABC, La Vanguardia). (Show less)

The scientific studies on physical and psychological vulnerability of the early stages of life and the increased perception in the twentieth century of the social importance of taking care and safeguarding children’s lives (the “Century of Child” according to the Ellen Key´s book) led to the development of a series of political, social and health international responses (Rodriguez Ocaña, E. ed. Dossier: The health of children in Modern History. Dynamis 2003; 23). Within the framework of international reconstruction initiatives immediately after World War II, permanent services designed to protect the health of children were created, at national and transnational level; some within the UN specialized agencies (UNICEF, FAO, WHO) (Gillispie, J. International organizations and the problem of child health Dynamis 2003; 23:115-142).
Indeed, one of the star programs of the WHO, from its outset in 1948, was to establish health and social activities designed to meet emergency needs of children but this aim overlapped with parallel projects developed by UNICEF from its foundation in 1946. For this reason it was necessary to develop co-ordinated plans for investigating, training and setting up services of previous programs in order to ensure maximum effort towards assisting governments and ways in which they could be developed and coordinated.
In these first phases some friction continued to occur over the demarcation of competences but once overcome, collaboration was the rule. In 1949, a committee of experts on Maternal and Child Health was launched with the idea of establishing long-range plans and the maximum possible universality. The decentralization of the WHO into regions allowed for the considerable multiplication and diversification of the measures. Between 1959 and 1960, a hundred WHO/UNICEF projects were launched around the world. From 1950, both agencies together played a decisive role in the development of new scientific-technical challenges which had previously been scarcely addressed, if at all. Among these was prematurity, one of the most important causes of mortality in new-borns, especially among the poor (Expert Group of Prematurity. WHO Technical Report series 1950; 1950, n.27).
How was the worldwide problem of low-weight new-born addressed by those specialized agencies? Was there something particular about Spain? What actors –official and charitable foundations- were involved in the creation of Spanish prematurity centres?
This paper aims to get to the heart of the matter by examining the Spanish experience through documents from the WHO Historical Archive (published and unpublished, such as the reports of WHO/UNICEF consultors who visited Spain) and the National Library of Health Sciences (Instituto Carlos III in Madrid), the setup of Prematurity Units within health centres in the 1950s and early 1960s, and the role played by international agencies. The main objective is to describe the framing of this specific aspect of child health as an issue of Spanish health policy under Franco and to make a comparative analysis with other European countries in order to analyse similarities and differences and their historical meaning. (Show less)

It was during the inter-war period when the fight against poverty-related diseases was fully incorporated in the agenda of international health cooperation, with the creation of non-governmental organisations and scientific associations. In those years were indeed founded leagues or International partnerships to combat tuberculosis, venereal diseases, trachoma or leprosy, among other pathologies. Through the example of trachoma, this paper addresses the conceptual and methodological assumptions that guided the actions of these organizations, their relationships with international health agencies and governments, as well as their contribution to the eradication and control of those pathologies. The analysis of this historical experience can provide useful elements of reflection that help to address the current challenges of international health cooperation in the fight against neglected tropical diseases and the role of non-governmental organisations and new philanthropies. (Show less)

Tuberculosis is a disease closely tied to natural and social environment. Despite numerous global health initiatives after the World War II, it still poses a major health threat in developing countries, especially in Sub-Saharan Africa. One among many challenges has been the successful implementation of Western medical treatment in the conditions of the developing world. This paper examines the global and local dimensions of tuberculosis treatment and its decision making through one hitherto unstudied case, Somalia-Finland Tuberculosis Control project. The bilateral development aid project was implemented by the Finnish Anti-Tuberculosis Association (FATA) and the Finnish Ministry for Foreign Affairs. It became the leading TB initiative in Somalia during 1981–1990. In addition, the Project remains one of the most extensive health care aid projects that Finns have undertaken in developing countries.

The temporal focus of the paper will be on the first phase of the Project (1980–1983). At that time, FATA introduced the new treatment strategy for Somalia. However, the strategy based on short term treatment was not without controversy. Although the method became later the backbone of the WHO DOTS strategy, it did not follow the World Health Organization’s global tuberculosis policy for developing countries in the early 1980s. In addition, the FATA had no former experience of tuberculosis work in developing countries. The paper examines the formation of the treatment strategy by analyzing the dynamics of decision making. With the close reading and comparison of the correspondence, project plans, memos and meeting proceedings of the Finnish and Somali participants the paper identifies the role of the different actors. It analyzes how the field experiences and opinions of the Finnish and Somali participants and the global recommendations of WHO influenced the choices made in the Project. Recently, researchers have shown an increased historical interest in the implementation of global tuberculosis policies in developing countries. However, little historical attention has been devoted to the health care development aid projects of the late 20th century. Thus, the paper will shed light on encounter and contestation between local and global strategies of tuberculosis control in this context.

(Note: This paper is a part of the thesis project Exporting Expertise: Somalia- Finland Tuberculosis Control Support and Training Project, 1980-1990.) (Show less)

What is yet to be fully described in current historical literature is how colonial and post-colonial health development was indebted to medical missionaries and local African churches. Development was shaped by close personal relations between governments, international health organisations and medical missions. The mission field was not ‘secularised’ even when, from the 1920s onwards, it became increasingly bound up with technical solutions, international development organisations and state public health programmes. Christian ways of thinking, practicing and experiencing medicine changed, created, informed and made sense of these shifts. By describing the history of these processes in Ghana, they can be highlighted and analysed effectively across a long period of time. In Ghana (the Gold Coast before 1957) mission organisations and national churches did not dominate or control international and government health, but they were a critical part of a story which has been misinterpreted as a story of decline. Between 1919 and 1983, during a period of economic variation, cultural change and the emergence of an independent state, medical missions increased in size, scope and funding. They peaked in the 1950s when twenty-three mission hospitals were built in around ten years. Overall, analysing how different layers and trajectories in international health linked with Ghanaian healthcare will show that medical missions did not simply handover the torch to secular NGOs. In Ghana, 'spiritual' and 'secular' medicine were in dynamic relation across the twentieth-century.
I use the National Archives of the UK, the US and Ghana. As well as private collections of materials and interviews with people who were involved in the organisations which I study. In Britain, I use the archives of the Wellcome Trust, the British Library, the London School of Hygiene and Tropical Medicine, the Liverpool School of Tropical Medicine, the National Library of Scotland, the University of Oxford, the University of Birmingham. In the United States I have used the archives of the Medical Mission Sisters in Fox Chase, Philadelphia, those of the John Hopkins Medical School in Baltimore and the World Bank. Finally, I have used the archives of the World Health Organisation, the United Nations and the World Council of Churches in Geneva. (Show less)