To save the World Health Organization (WHO), move staff to regional and country offices; cut posts at the top not only bottom; reduce gig workers rationally; and create a merit- and equity-based HR strategy for all levels of the organization, urge critics 

The number of WHO’s top-ranked directors (D2), the highest level of staff before the Director General’s senior leadership team, has nearly doubled since Director-General Dr Tedros Adhanom Ghebreyesus took office, with 75 people holding D2 positions in July 2024 in comparison to only 39 in July 2017. 

The cost of WHO’s top-level echelon have grown even faster, with roughly $92 million spent on just 215 Directors, the DG and his 11 member senior team – and around $130 million if you consider P6 staff  who fill many of the same management functions, according to a detailed analysis of available data by Health Policy Watch. 

Most of new D2 positions are at WHO’s Geneva Headquarters, the costliest location of the global agency, where the number of senior directors increased from 29 in 2017 to 46 as of July 2024. 

The other region that saw a big increase in directors was Africa, with eight D2 posts in 2024, as compared to only one in 2017.  All other WHO regions saw an increase of 50-200% of D2 as compared to 31 July  2017, one month after Tedros took over. 

This is buried in a bi-annual WHO report on human resources that was presented at last month’s Executive Board.  Health Policy Watch reviewed the past 10 years of reports, published twice a year, to look at HR trends just prior to July 2017 when the DG assumed office, and since.   

Critical juncture for WHO 

This revelation come at a critical time in the organization’s financial future in light of the dramatic United States withdrawal from the organization, the organization’s top contributor which provided about 15% of WHO’s total income in 2022-23. 

Last Thursday, WHO staff were told that the organization faces a $175 million budget deficit in 2025, Health Policy Watch learned.  It is unclear if that number includes the 2025 dues of $130 million owed by the US. Equally unclear is if the Trump administration, which announced its intent to withdraw from the agency in January, will actually fulfill its legal obligations to pay its dues until the withdrawal is formalized in January 2026.   

Internally and externally, Dr Tedros has already announced a range of tough belt-tightening measures to compensate for expected 2025 budget shortfalls and to meet a 2026-27 budget of about $4.9 billion, or $2.45 billion a year. 

These have included a worldwide freeze on the recruitment of all new staff; dismissals of temporary staff and consultants; and the creation of three new WHO staff and administration committees to evaluate further new measures to be taken in terms of staff, resource mobilization and “organizational efficiencies and programme prioritization.”

Fixed term extensions curtailed

In an email sent by WHO division heads on Thursday, and seen by Health Policy Watch, WHO staff were informed that all personnel on temporary as well as fixed term contracts – which typically are renewed every two years – would only be extended “for a maximum of one year. Some contracts may be extended for six months only – if funding is not available and functions are planned to be deprioritized.”  

The one-year limitation on new or renewed fixed term contracts was confirmed in yet another memo from the Assistant Director of Business Operations, Raul Thomas, sent to all staff late Monday.

Meanwhile, earlier last week, an email was sent to all staff who would be 55 or older, as of June, early retirement with four months of salary if they opted to take the offer by 15 July.

The combined measures are stimulating more cries of distress from more WHO staff inside the organization. There are also mounting claims that measures disproportionately hit at mid- and lower-level staff who lack the tenured protection of the most veteran staff on “continuing contracts”.  Continuing contracts, which were discontinued in 2014, are expensive to cancel with staff entitled to up to 12 months net base salary – or an offer of a comparable post in another WHO office or region – where costs may, at least, be cheaper.

WHO sources told Health Policy Watch that a plan is also taking shape that would see a dramatic reduction in short-term consultants, whose numbers have ballooned since 2017.

As of July 2024, there were some 10,000 contracts for roughly 6,000 full time equivalent positions (FTEs) – although the latter number is an estimate in the absence of complete HR information on the actual number of FTEs represented by the nearly 5000 “Special Services Agreements” that regional and country offices issued in 2024.   

Other moves being considered are said to include shifting of key functions to less expensive and more relevant country locations and pooling administrative functions for greater efficiencies – moves that are likely to be welcomed by member states. 

These also could finally fulfil a longstanding WHO goal to ensure that roughly three-quarters of staff are based in regional or country offices. Since Tedros took office, the proportion of staff in headquarters have been declining but only very gradually – from 30.5% in July 2020 to 28.8% in July 2024, for instance.  

Elephant in the room

Amidst the cost-cutting moves, the elephant in the room is whether scrutiny will be extended to the most politically sensitive positions in senior management such as the bloated number of D2 posts. 

While voluntary retirement offers of staff aged 55+ might lead to some such reductions, it’s highly unlikely that directors in the most secure and highest-paying positions would grab offers to leave, based on only four months additional pay. 

But if more savings are not achieved in WHO’s most senior ranks, then the jobs of more entry-level WHO staff at P1-P3 are likely to be placed on the chopping block instead. This will curtail the entry of young  professionals, the organization’s “worker bees”, just when WHO may need them the most. 

That would be regrettable, critics say, as the salary of a single D2 at the highest grade can cover the costs of three to four P1 staff at entry level, or two to three P2 or P3s. And entry and mid-level professionals are also the future “lifeblood” of the organization.  

Half or more of P1-P3 staff are on short-term contracts of less than a year, which  are easiest to eliminate.  An increasing number of P-level staff in the Geneva headquarters are working on rolling contracts of only 60-days, which may include health insurance but no other benefits.

Additionally, gross salaries published by WHO comprise less than half the real costs to the organization, and net salaries about one-third, as per the 2024 published breakdown of payroll costs for P and D staff reflected in Table 21 of the 31.07.2024 HR update.

They do not include, for instance: post adjustment for Geneva (83% of net base salary in 2024 and 66.7% in 2025); education grant and boarding (up to $33,000 per child), dependents’ allowances, home leave and relocation grants, as well as WHO pension and insurance costs  – all of which are comparatively higher for WHO’s senior professionals who, as international recruits, have more entitlements.

Senior management overall increased by 9% since 2017 

The 2017-2024 comparisons shared with the EB in February shows that there has been a net 9% increase in the numbers of senior management (P6/D1 and above) positions since 31 July 2017 when Tedros assumed the reins of the organization.   

The biggest increase was in the most expensive D2 positions, which more than doubled. Other senior management numbers remained relatively stable with a slight decline in the total number of P6/D1 staff. 

Increases were seen across all regions except Africa and South-East Asia. In Africa, the reductions in P6/D1 staff numbers offset the 700% increase in more costly D2 positions. 

South-East Asia was the only region to see a net decline in total senior management positions by 23%.  Europe saw the biggest net increase of 30%, the Eastern Mediterranean and Western Pacific Regions, an increase of 21% each; and 10% in WHO’s Geneva headquarters. 

The WHO region of the Americas, or the Pan American Health Organization (PAHO) operates autonomously and thus is typically not included in WHO’s global HR reporting. 

D2 is the highest level of professional staff who are supposed to be hired through competitive, merit-based civil service competitions – although  politics, cronyism and geographic balance traditionally play a role in such appointments as well. 

WHO failed to respond when asked repeatedly by Health Policy Watch about the increase in D2 positions, and other aspects of staffing costs and priorities, prior to publication. At a Tuesday UN Geneva press conference, just after the article was published, WHO Spokeswoman Margaret Harris had this response: “we’ve been doing a lot of work on cost containment, on changing, as I mentioned, how we are funded, but what we do with our funds is critical, and particularly looking at where our programs have most impact, and our programs have most impact in the countries where we’re needed.

“What’s really been happening is a big transfer of funding and staffing and commitment at country level away from HQ, and that has been really the core of the transformation process, really the core of what Dr Tedros brought it to, who in his thinking when he became director general, it has been a slow process, and for sure, you know, the cold winds of economic rationalization are speeding that up.”

Senior leadership team also swelled between 2017-2021 – but since rolled back  

Above the D2s, there are currently 10 Assistant Director Generals and a Deputy Director General (Mike Ryan), comprising WHO’s Geneva-based “senior leadership team”. All are directly appointed by the DG.  

Five Regional Directors fill out the set of 17 staff in “Ungraded” (UG) positions. PAHO’s Regional Director is paid for by the PAHO budget, financed and managed separately by member states in the Americas region. 

Shortly after Tedros took office in July, 2017, the number of ADGs and others in  “ungraded” positions at headquarters also began to grow, peaking at 18 (not including the DG), in  December 2021. 

But those numbers shrunk again.  As of the July 2024, the headcount of the DG’s ungraded appointees was 11 – just one more than the 10  on the team of former DG Dr Margaret Chan prior to her retirement, as per the WHO HR report of December, 2016. 

Grade inflation?

Along with the increase in D2s, the parallel decline in P6/D1 staff in HQ and three regions – Africa, South-East Asia and the Eastern Mediterranean – since 2017 suggests a kind of “grade inflation” whereby serving D1s have, over time, received promotions to the higher-paying grade.  

Additionally, staff in P6 and D1 positions, who share the same pay scale, are sometimes combined within WHO’s HR tables – making it difficult to tease out nuances of staff movement in the upper grades.  

Typically, P6/D1s commonly serve as the heads of technical units or departments  – managing the day–to-day activities globally of WHO’s staff of 9,473 international and local professionals and administrative support, in 2024. That 2024 workforce also included more than 7,500 people on consultancies and other non-employment contracts – making for a global workforce of more than 17,000 in 2024.

Costs of most senior staff  to WHO: nearly $130 million 

In a period of belt-tightening, it is the costs to the organization of staff positions, by grade and region, that represents a critical bottom line in weighing budget choices and priorities.  Without their transparent assessment, decisions are more difficult to make, as well as to challenge. 

Those costs, stratified by grade and by region, are not publicly provided by WHO in its bi-annual HR reports to the EB or the WHA. WHO also failed to reply to repeated requests by Health Policy Watch to provide details on actual costs of staff at all grades and levels to the organization. 

However, reliable estimates can still be made, based on available published data.  We analyzed the data on gross and net base salaries for P1 to D2 staff, as published by WHO in its 2024 Staff Regulations and Staff Rules, against data on the proportion of net base salary to total Organizational costs, reported in the annual HR report. 

Those show that net base salary costs represented just 34-37% of the total organizational costs for all professional staff in 2024 – from  the lowest-level local and temporary hires to senior management. 

For senior staff, who generally are international recruits with large entitlements, the proportion of net base salary to other payroll costs would be even higher than the average since locally-hired P staff receive far fewer benefits, while  temporary staff on contracts of 60 days get almost none.  

In other words, the published salary levels for senior staff likely represent about 30%, of the total organizational cost of that position – once generous UN-mandated allowances for “post adjustment”; education, home leave, relocation and other entitlements exclusively available to international recruits are included.  

We tested this by comparing actual gross and net salary payments of existing or recently departed WHO P staff who receive entitlements, with the posted salary scales. The results also aligned roughly with a “30% rule”. 

Based on these assumptions, the average cost for each of the 54 D2s based at headquarters and the Africa Region was estimated at about $430,000. This calculation is based on a D2 at the mid-level Step VI of the salary scale with an average gross income of $171,895 and net base of $128,951. In other regions, costs for 21 D2s were estimated at a slightly lower average of  $420,000.

Together, the costs are estimated to approach exceed $33 million for D2 posts globally.   

Considering these assumptions, roughly $92 million can be attributed to just 215 of the organization’s most senior staff. If one includes P6 staff, who have more daily, hands-on management responsibilities, the costs of WHO’s 301 most senior staff rises to nearly $130 million.

Costs to WHO of salaries unpublished

It should be emphasized that these figures are an estimate as average real costs of staff salaries by grade, location and years of service, are not routinely published by WHO in its HR tables – only the aggregate of payroll costs for all professionals in comparison to net base salary. And these, as well, may not fully represent all organizational costs.

However, proportionally the cost to the organization for senior staff is likely to be larger than the average for several reasons. High-level professionals are more likely to be older with children in high school or university – and thus entitled to the maximum education allowances of roughly $33,500 per child annually for tuition and board through four years of university. Such recruits also may receive more in dependency allowances, health insurance, relocation grants, and home leave. 

Senior P and D staff also are more likely to have been internationally recruited  and entitled to the  “post adjustment allowances” for cost of living in expensive locations. In pricey Geneva, for instance, the post adjustment was 83.6% of the net base salary in 2024. 

In January 2025, that declined to 67.6% as part of a UN move to reduce overly generous location allowances.  Concurrently, salaries of all WHO professionals’, directors and senior leadership increased by 9.5% on a “no-gain, no-loss” basis.

Pay rates for senior leadership, as confirmed by the EB in February, were $293,003 gross and 218,602 net for the DG;  $235,064 gross and $170,642 net for the DDG; and to $213,655 gross and $170,642 for ADGs and RDs.  

WHO’s professional staff work tax- free in host and home countries, with the exception of US citizens or employees based in the the US. For WHO employees who are American citizens working at home or abroad, the organization foots the bill for that staff member’s salary-related tax payments to the US IRS so that they are not penalized in comparison to other international staff.  That adds further to costs.  

Some good reasons, but… 

There are some good reasons why WHO professionals enjoy a traditionally large basket of benefits.  

International staff typically uproot themselves and their families across countries, continents, and cultures, making relocation and “home” leave visits every two years essential to attract the highly qualified scientists, economists, doctors, nurses and other medical  professionals that WHO desperately needs. 

For children who cannot easily integrate into local school systems, culturally or language-wise, education grants provide them with an opportunity to attend a boarding school or a local international school. 

Most WHO staff do not accumulate points in their home countries’ pensions and social security systems while employed with the UN. And in an era of dual career families, many staff also  continue to maintain households in their home countries with all of the expense that involves.  WHO staff, including high-ranking staff, may be subject to considerable risks. Witness the DG’s Tedros and Deputy DG Mike Ryan’s recent trips to a range of epidemic hot spots, including to support Tanzania’s response to an outbreak of Marburg virus and Uganda’s Ebola response, not to mention conflict zones, such as Afghanistan and Yemen – where the DG was caught up in an Israeli air attack on Sanaa’s airport on 26 December. 

Finally, WHO staff salaries are not set by the organization. They fall in line with salaries across the wider UN civil service system. But when all is said and done, the sum total of Geneva’s high “post adjustment”; education and other benefits, on top of a tax free salary as well as certain customs benefits, offers the most senior staff at WHO headquarters a very generous net income in comparison to comparable jobs elsewhere. 

“When I moved back to the United States, I had to take a big salary cut,” one former WHO director told Health Policy Watch, speaking on the basis of anonymity. “It raises questions when senior WHO team members earn more than US Senators or the ministers of health in their home countries.”      

The consultancy conundrum 

At the opposite end of the scale from the highest-paid directors and managers, contracts for short-term WHO consultants more than doubled between 2016 and 2023.  These “consultants” are one of three “non-staff” categories under which contracts are issued. All in tall, the growth in short-term, non-employment contracts and consultancies dwarfs significant increases in high- and lower-ranking staff alike. 

Just prior to the COVID-19 pandemic, the number of consultants was already increasing, although it only totaled 1,169 people, and 303 Full-time Equivalents (FTEs) in the year 2018. 

By December 2022, as offices remained closed and remote work blossomed, that had grown to 2,324 consultancy contracts and 874 FTEs.  The number of contracts continued to grow, post-pandemic. In 2023, HQ issued 2,438 consultancy contracts for 1,025 FTEs. Globally, it was a record  6,311 contracts for 2,398 FTEs.

Although the DG’s report to the EB in February 2024 cites a decline consultancy contracts in comparison with July 2023, there is growth, not decline, if you count FTEs issued by end 2023. In just the first seven months of 2024, the number of consultants  globally amounted to 3,353 FTEs – nearly 1,000 more than 2,398 FTEs registered in the entire previous year.

But consultancies are only part of WHO’s evolving gig economy. There are also Special Services Agreements for nationals or residents of the host countries where WHO regional offices are located.  These too, have increased by 56% from 3584 in 2016 to 5,606 in 2023, and to 4,811 in just the first seven months of 2024. A striking exception is Europe, whose strict work laws likely make such contracts impractical. 

Finally there are product-related contracts, Agreements for Performance of Work (APW) that are typically outsourced to companies for graphic design, printing and web-related services. It is the only non-staff category to have remained relatively stable since 2017 – with contracts worth 517 FTEs in 2024, as compared to 480 FTEs seven years earlier. 

This can partly be explained by a decline in the use of APWs at HQ to comply with strict Swiss employment rules excluding individuals who were not legally self-employed. The result: gig workers who didn’t have the right paperwork became “consultants” instead.   

If indeed most SSAs are indeed full-time positions – something undefined by the WHO reporting –  then there were an estimated 7,579 FTEs in non-staff positions as of July 2024, as compared to 3,798 as of July 2017.

Pragmatic and justified – sometimes

In many cases, short-term non-staff contracts are pragmatic and justified. They are an avenue for flexible, cost-effective hires for short-term projects and events in a world of unpredictable health crises. The DG’s HR update presented at the EB in February  hints at this with its references to “adapting to evolving needs.”  

Moreover, outsourcing expertise for localized health challenges can be vital to meet a series of  health emergencies that have wracked regions such as Africa  without bloating permanent payrolls.  

But the consultancy boom also raises questions in today’s current crisis. 

As WHO freezes hiring for rank-and-file staff positions in an effort to peel back costs, there’s a heightened risk that the organization will be forced to fall back even more on cheap and short-term consultants who are available locally or can work remotely. 

Long term, consultants replacing regular staff will drain the organization of skills, experience and institutional knowledge and act as a bandaid rather than a sustainable model for funding woes. 

In addition, the managerial and administrative costs of managing 6,311 contracts for just 1,253 FTE consultants, to take one category of work, are huge. That works out to nearly five contracts a year per full time position. 

Finally, how geographically balanced are consultancies filled at headquarters,  where young Europeans with Swiss or EU visas can easily fill positions, but Africans, Asians and Americans cannot compete at all? 

As UN Secretary General Antonio Guterres stated in an open letter to member states on 7 February: while “hiring restrictions are inevitable because personnel costs constitute the largest part of the budget. Unfortunately, hiring restrictions undermine gender and geographic representation goals and weaken the effectiveness of our operations.”

Gig economy and expanding staff

But for now, the trend is clear: WHO has been leaning hard into the gig economy over the past few years – even as total staff increased by 17%, from 8,029 in July 2017 to 9,473 as of July 2024.  When non-staff contracts are included, the total workforce increased by a whopping 46% from around since 2017 – from roughly 11,800 to  17,220 staff and non-staff in 2024.

Naturally, increased staff has also meant increased costs – rising faster at the Geneva Headquarters where post adjustment and certain other allowances are comparatively higher.  As of 2024, costs at WHO’s Geneva office for professionals and senior managers, including post adjustments and other benefits, had increased by roughly 50% in comparison to 2017. 

Costs continued to grow between 2023-24, even when average staff and contract numbers flattened out because the most expensive layers of professional staff had increased faster than other categories and P staff also receive in-grade advances every year or two, increasing their costs, particularly in the higher ranks.

At the February EB, China asked why, if “the number of individual staff has remained relatively stable and that the number of non-staff personnel, consultants and special service agreements has been significantly reduced, staff costs have risen from 36% to 47% over the past year.” 

In fact, between 2023 and 2024, the total P, D and senior staff, the most expensive pay categories by far, increased by about 4% from 3,787 people in 2023 to 3,923. In contrast, staff at all levels – national, administration and professional – increased by only about 2.2% from 9,261 to 9,473 staff. 

Low and mid-rank professional staff are most vulnerable 

Along with reducing new, younger staff hires, the risk is that the austerity measures will boomerang on existing professional staff in the P1-3 grades, the organization’s “worker bees”, through hiring freezes and contract expiration. 

The default option will be to leave most of the highest-paid and highest-ranking staff in place as they are the most difficult to trim, both politically and legally,  while shedding rank and file at the bottom of the pyramid.

Only about half of professional staff in the low-mid (P1-3) have “long-term” contracts of a year or more that would protect them from immediate dismissal. An increasing number of professional staff in Geneva’s headquarters have been engaged on rolling contracts of 60 days or less, which may include health insurance, but no vacation days or other benefits.  

In comparison, over 90% of D1-2s have long term contracts – including many on continuing contracts that are not term-limited at all.  Termination of such contracts is a complex process, involving either payouts or relocation to other jobs of equivalent status. 

The comparison also highlights the historic paucity of staff in the P1-2 ranks – inexpensive, entry level positions that young, talented professionals from around the world would be keen to fill.  

In 2024, there were only 18 P1 staff in the entire organization and only 287 P2s, or less than 8% of the entire workforce.   Even in 2017, such positions were often filled by APWs or other short-term contractors who were easier to hire, didn’t require work visas, and didn’t receive benefits either. 

How to prioritizing without knowing the real costs?

In a time of belt-tightening, the inevitable question arises: who may be released and who may be retained? 

The WHO letter to all staff aged 55 and older, offering them early retirement with four months of pay was hailed as an effort to pare back in its more senior ranks.

The problem is that such offers target people by age, rather than by their real cost to the organization – not to mention productivity or lack thereof. 

Those in the highest paying ranks of the organization with the fewest qualifications and motivation would also be the least likely to bite at early retirement offers because the WHO salary and benefits are simply too good compared to what they could earn elsewhere. 

Along with freezing staff recruitment, reducing contract renewals to 1 year, and offering early retirement, in his email to staff on Monday, WHO’s Thomas said non-staff costs such as procurement and travel were being rolled back.

“Our response is built around three key pillars: resource mobilization and continued engagement, cost containment and efficiencies, and prioritisation,” he said in the message seen by Health Policy Watch, stressing that “prioritization”  is the operative word to “ensure that every resource is direted toward the most pressing priorities, while preserving WHO’s ability to make an lasting impact.”

The rub is this. Without more transparent disclosure of data, and discussion about the real cost of staff positions at different ranks and locales – including the number of consultants and their pay; and the optimal balance of high-ranking and rank-and-file staff – the big risk is that austerity will only make the organization more top-heavy and more inefficient. 

Unless hard data on staff costs, not only positions, is shared transparently, member states, donors and staff will be unable to rationally assess and respond to any of the cost containment moves that WHO makes – against strategic priorities, budget goals and ceilings. 

Turning crisis into opportunity: recalibrating the pyramid 

Suggestions coming from staff focus on looking at the highest-level ranks of the organization first rather than last – and taking the much-vaunted “transformation” initiated by Tedros in 2017, a step further, with measures such as:  

• Eliminate D2 positions altogether – reverting all Directors positions to D1s;
• ⁠Reduce directors at headquarters, the most costly locations. (there are 46 D2s there now) and ship them off to the regions or country offices – some might choose to resign instead;. 
• Create an even slimmer headquarters that was envisioned by Tedros or his predecessors with a HQ to Regional office to Country office professional staff ratios of 15:15:70 – as compared to the nearly 30% proportion that Geneva’s headquarters has currently, including both professional staff and consultants. 

 ⁠“The problem is that there is no clear HR strategy,” one senior staff member told us.  “Even with the transformation, it’s not very clear what was done. Member states are asking.” 

Another WHO scientist told Health Policy Watch:  “If the organization is serious about cost reduction we should invert our pyramid to have a lean and mean HQ and strengthen our country presence – which is the mantra for an organization that’s looking for country impact.

“Even when some programmes or tasks need to be maintained near headquarters, they can be  moved to Budapest, Copenhagen, Istanbul etc.

“This was also supposed to be the focus of the Director General’s transformation initiative, and could leave him with a lasting legacy.”

________________________

Acknowledgments and disclaimers: Former and existing WHO staff, who requested anonymity, made significant contributions to the data analysis and review.  From 2004 until 2018, Elaine Ruth Fletcher served as a P-3 and P-4 staff member at WHO, managing a budget of over $400,000 in the final years of her career there – as well as a team of short-term consultants.  

Updated Tuesday 11 March to include details of the latest email from WHO to staff and response from WHO spokeswoman Margaret Harris.

Image Credits: WHO/L.Mackenzie, WHO Human Resources Update, Workforce data, 31 July 2024., U.S. Mission Geneva/ Eric Bridiers, WHO HR Update, 31 July 2024, Appendix 1. WHO Staff Regulations and Staff Rules, January 2024, WHO , Source: Table 3B HR update 31 July 2024, WHO HR and EB records, 2023-2024, Amendments to staff regulations and staff rules, EB 156, Item 27.6, You Tube/Reuters, WHO Workforce Data 2016-2024, 2017 and 2024 WHO HR Data , WHO HR Update, Workforce Data, as of 31 July 2024.