Newly-elected African Regional Director, Dr Mohamed Yakub Janabi.

Dr Mohamed Yakub Janabi, of Tanzania, was elected as the new African Region nominee for Regional Director, in a special meeting of the WHO African Regional Committee on Sunday – replacing fellow Tanzanian, RD-elect Dr Faustine Ndugulile, who died suddenly in November, 2024.

The WHO Executive Board will be asked to approve Janabi’s nomination at their meeting immediately after the World Health Assembly, clearing the way for his formal appointment by WHO Director General Dr Tedros Adhanom Ghebreyesus.

Janabi beat out three other candidates in secret voting by the committee, which followed a series of presentations and interviews of the four candidates at Sunday’s meeting. They included candidates proposed by ​​​​Côte d’Ivoire, Togo, and Guinea.

A senior health advisor to Tanzania’s late president and its present head of state, Samia Hassan, Janabi is a cardiologist by training and the former executive director of Tanzania’s largest hospital.

Born in 1962, his career spans over three decades of work in clinical and policy settings, from the early days of the HIV epidemic to his role today as presidential advisor, he noted, in his presentation before the African Regional Committee.

Hardships caused by out-of-pocket expenses

Janabi said his first priority as Regional Director would be achieving Universal Health Coverage for the African Region, reducing catastrophic health expenses that cause financial hardship.

“During the course of my duties, I have witnessed, first hand, patients being denied access to health care due to financial constraints, families parting ways with their position, their very means of living just to pay hospital bills,” he told the Regional Committee.

“Yet, despite making these heartbreaking sacrifices, many still find themselves trapped in debt and still in poor health conditions. For me, this is a harrowing experience out of pocket, costs have pushed countless families into the depths of poverty, thereby recycling poverty.”

He also noted his  involvement in HIV vaccine trials in Tanzania and Mozambique in the early 2000s, and later, public health advocacy that convinced Tanzania’s then-president to get a public HIV test, “encouraging 5 million Tanzanians to get tested that year.”

In 2021, he supported Tanzania’s new president, Samia Hassan, in devising a new, COVID-19 vaccination strategy, “which played a key role in countering misinformation and boosting vaccine uptake,” he noted. Hassan took over following the death in March 2021 of then-President John Magufuli, a COVID vaccine skeptic, who ultimately succumbed to the virus himself, according to some reports.

Janabi also is the founder of the Jakaya Kikwete Heart Institute in 2014, which he claimed achieved a “95% reduction in overseas heart disease referrals” within five years of its founding.

Building health systems on primary health care

Other priorities he cited would include supporting larger fixed contributions to WHO from member states “for more predictable, flexible and sustainable investment” along with stepped up domestic financing for health systems – through blended financing, private-public partnerships and solidarity levies.”

Building emergency preparedness, including through cross border collaborations, as well as advancing maternal and child health, along with nutrition, are other high priority items he said, noting that 70% of maternal deaths and 56% of deaths of children under the age of 5 still occur on the continent.

Janabi also pledged to tackle infectious diseases as well as non-communicable diseases through a “One Health” approach that  “acknowledges the interconnectedness of humans, animals and the environment” – as well as tackling antimicrobial resistance, through better surveillance systems, as well as strengthening local production of diagnostic, therapeutics and vaccines “by leveraging the pandemic agreement” – the new accord expected to be approved at this year’s WHA.

He added that primary health care and Community Health Worker networks need more investment as the backbone of health systems – noting that in high-income countries nurse practitioners carry out many functions that doctors used to perform.

“You have to build on your community health workers, because these are the people who have the trust. They are the people who are communicating with your general population every day,” he said, adding, “There’s other thing, which unfortunately is not very prominent in Africa. They are called nurse practitioners… So if they get training on basic things like immunization, maternal and child health, education, these efforts will improve access.”

Janabi, once confirmed by WHO’s Executive Board and formally appointed by the DG, will step into the shoes of the late RD-elect, Nduguilile, who died on November 27, 2024, at the age of 55, while receiving medical treatment in India.

Ndugulile, a former Tanzanian Deputy Health Minister and member of parliament had been elected as the WHO Africa Regional Director in August of 2024 and was scheduled to begin his term in February 2025. His death led to a special session of the WHO Regional Committee for Africa in January 2025 to decide on a new election process. Dr Matshidiso Moeti had been the WHO Africa Director for two terms before Ndugulile’s election.

This week’s budget discussions take place just ahead of the WHO’s World Health Assembly, convening next week at Geneva’s Palais des Nations 19-27 May.

WHO’s budget for 2026-27 could reduce the agency’s global footprint by about 20% from a total of 9,463 staff as of December 2024, to 7,525  – with the biggest cuts in entry-to mid-level professional staff who are ranked as P1 to P3. 

Some 30% of staff P 1-3 in 400 positions would be terminated, according to initial estimates of staff allocations by grade, contained in a confidential white paper presented this week to the WHO’s Planning, Budget and Administration Committee (PBAC) of the WHO Executive Board, and seen by Health Policy Watch.

The PBAC meeting came ahead of next week’s World Health Assembly (19-27 May), when member states will consider a draft resolution approving a base budget of $4.2 billion and a total budget of about $6.2 billion, including voluntary donations for polio eradication and emergency appeals.  

Only six D2 directors would leave the agency—just a 9% reduction in the agency’s most senior directors—according to an “indicative summary staffing table” in the white paper presented to PBAC, covering the $4.2 billion base segment of WHO’s 2026–27 budget. The estimates, like all published WHO HR data, do not include staff in the Regional Office of the Americas (Pan American Health Organization/PAHO), which has a separate budget—except for the head of PAHO’s Regional Office, who is paid by headquarters.

The number of senior directors nearly doubled between July 2017 and July 2024 as WHO Director General Dr Tedros Adhanom Ghebreyesus expanded numbers of both staff and senior management, while promoting many existing directors from D1 to D2 grades, during a period of rapid WHO expansion.   

If the white paper projections were indeed implemented, there would be only a net global reduction of just 32 directors at D1 to D2 levels, according to a comparison of current and planned 2026-27 staffing levels by Health Policy Watch.   

HP-Watch assessment of projected WHO staffing for the 2026-27 budget, presented this week to PBAC, as compared with December 2024.

The number of staff in senior leadership positions, so called “ungraded” (UG1-UG2), would, meanwhile, decline from 16 to 13. That would include the heads of WHO’s six regional office as well as a deputy director general in a seven-member leadership team at WHO’s Geneva headquarters.

That contrasts with the latest organigram presented to WHO member states, which noted a leadership team of only six alongside the director general himself. In that array, there was no deputy director general earmarked at all, a position estimated to cost more than $500,000 a year. No deputy director general was named, as well, in the recent announcement by Tedros’ of his new senior leadership team.

New WHO organizational plan, announced 22 April, reduces 10 divisions at headquarters to just four.

The global staffing plan, seen by Health Policy Watch, also seems to anticipate a net reduction of D1 and D2 directors that is far less than had been promised for headquarters alone.  

In his presentation Wednesday to the PBAC, Tedros told member states that the number of departments at headquarters would be reduced by more than half from 76 to 34. That should, in principle, lead to 42 fewer directors in headquarters. 

“Decisions about which directors will lead which departments will be made following the World Health Assembly. That, I know, will also be tough, given the downsizing from 76 to 34 departments,” Tedros said in his message to PBAC members, which was published by WHO.

At the same time, 90% or more of directors have long term contracts that protect them from sudden layoffs, complicating such reductions. According to UN rules, those who see their programmes at headquarters slashed or eliminated would have to be offered positions elsewhere in the global system – or alternatively a year’s salary – with all of those associated costs. 

All short term professional and administrative staff eliminated 

In contrast, short-term professional and administrative staff would be eliminated almost entirely from the organization’s ranks in the new staff planning, as they have almost no protection from layoffs whatsoever. 

But cost forecasts also contained in the white paper suggest a continued heavy reliance on WHO consultants over the coming two years. 

HPW rendering of projected WHO budget costs, by category, 2026-27, as per a White Paper presented at WHO’s PBAC meeting this week.

The paper estimates the cost of “contractual services” – meaning consultants – at some $1.19 billion – or around 52% of total staff costs of $2.26 billion for the same period. And that does not include contractual services for general operating expenses, such as building maintenance, or equipment, vehicles and furniture. 

The budget total adds up to $4.267 billion, equal to the base budget that WHO member states will be asked to approve for the coming biennium at the upcoming WHA, in a draft resolution published on WHO’s WHA website.  On top of the base budget are WHO’s polio eradication effort, Special Programmes, and Health Emergency appeals, which depend heavily on voluntary contributions and add another $2 billion, for a total of $6.206 billion, not including PAHO, included in the draft  2026-27 Programme budget resolution that will go before member states.  Currently, however, some $1.7 billion of even the base budget remains unfunded. 

From July 2017 to the end of 2024, the number of WHO consultants in all categories increased from 3,798 to nearly 7,600, according to a Health Policy Watch analysis of the data in March. 

Sources: Based on WHO HR reports for 2017 and 31 July 2024. Covers all three categories of consultants: Agreement for Performance of Work (APW); Consultancies; and Special Services Agreements (SSAs).

WHO’s end-year 2024 HR data, however, reflected a reduction in “non-staff” positions as compared to the previous year. As of end 2024, there were some 7582 “non-staff affiliates” in all categories, up just three positions from July, but down by nearly 15% from the all-time WHO peak of 8818 non-staff affiliates in 2023.

Asked to comment on the White Paper and its consequences, a WHO spokesperson said:

“The HPW article is misleading. The paper it refers to is a modelling exercise done primarily for budget modelling purposes. It is also missing some elements—e.g., country data from Europe. Under no circumstances should this be viewed or considered to pre-empt the actual managerial decisions which are about to take place in the coming months. Those decisions will be made based on prioritization, looking at synergies and eliminating duplications. The only layer where decisions were made is at the Assistant Director-General level so far. We haven’t gone through any other functional review. It would be more appropriate to wait for these decisions—we will report everything properly—and analyse them then. To draw any conclusions from this at this point is not meaningful or helpful.”

Indeed, along with the routine exclusion of PAHO, the data “does not include country level positions for the regional office for Europe,” the White Paper states.

The White Paper also states that the staffing and expenditure breakdown are “solely for indicative purposes. Staffing figures will evolve once operational planning has been concluded. The actual implementation of the workplan plans will be subject to the availability of funding.”

However, the fact remains that with large proportions of higher-level staff on long-term contracts that make lay-offs difficult, large reductions of staff in the organization’s lower ranks are much easier legally and financially.

WHA will review latest updates on the budget crisis

Next week’s World Health Assembly will review a summary report from the closed-door PBAC session, along with the latest updates from the WHO’s leadership on the budget crisis, triggered by the withdrawal of the United States, WHO’s largest donor, from the global health agency in January.

The member state group will also discuss the ongoing “prioritization” exercise aimed at determining which WHO programmes and activities are deemed less essential and should therefore be discontinued in light of the pending budget and staff reductions.

Strikingly, the PBAC White Paper—as well as other documents presented to PBAC on WHO’s financial outlook—only discloses total staff costs to the organization in the aggregate, rather than providing any assessment of costs by staff grade, type of contract, and geographic location.

Knowledge of the real costs of staff at different levels would enable nuanced member state assessment of the tough financial tradeoffs faced, analysts say—for instance, between offering early retirement versus relocation to senior directors and high-ranking professionals; options for retaining more staff in mid- or lower-level ranks; and costs of consultants versus staff for certain types of tasks.

So, amidst the extensive documentation prepared for PBAC and the upcoming WHA, the lack of detailed cost disclosure remains a glaring omission.

  • Updated on 17.05.25 to include WHO’s response and the exclusion of PAHO from the budget and staffing estimates in the exercise. 

Image Credits: WHO/Pierre Albo , WHO HR Update 31.12.2024 & PBAC White Paper , WHO, White Paper, PBAC.

A child with HIV takes a paediatric dose of antiretroviral medication. Many paediatric HIV trials were conducted in South Africa over the past 20 years.

Essential research on tuberculosis and HIV cancelled. Clinical trial participants in limbo. Young researchers’ careers halted  – and billions of dollars invested and expertise developed over 30 years potentially down the drain.

These are some of the impacts on South Africa of the decision by the National Institutes of Health (NIH) barely a week ago to prohibit United States scientists from working with foreign researchers via “subawards”, leading to the immediate and mass cancellation of such grants with South African institutions.

At least 39 TB and HIV clinical research sites in South Africa are under threat due to NIH funding cuts, jeopardising at least 27 HIV trials and 20 TB trials, according to an analysis by the Treatment Action Group (TAG) and Médecins Sans Frontières (MSF) drawn mostly from the NIH’s Division of AIDS (DAIDS) presented at a media briefing on Thursday.

Impact of NIH cuts on TB and HIV research in South Africa

TB trials at risk include testing potential vaccines and new drugs; shorter, safer regimens, and the best treatment for TB meningitis. 

The HIV trials at risk include cure-related treatments involving broadly neutralising antibodies (bNAbs); vaccines designed to prime the body to make bNAbs; the impact of hormone treatment on women with HIV and treatment options for pre-exposure prophylaxis to prevent HIV.

Many of these trials are global, with South Africans making up 30-50% of global trial participants and 50-90% of trials on interventions for children and pregnant women, said Lindsay McKenna, TAG’s TB project co-director.

She estimates that the average investment in each trial participant is $12,000 – potentially all wasted if the trials are discontinued, and some have been going for several years already.

For some 30 years, South African clinical studies have provided global guidance on issues including prevention of mother-to-child HIV infection, when to start children on antiretroviral treatment, how to simultaneously treat TB and HIV, as well as the safety of HIV and TB treatments. Meanwhile, operational research, such task-shifting from HIV doctors to nurses, has led to more efficiency and cost-cutting.

“NIH funding is not aid. It’s competitive funding that researchers here competed for that went through stringent NIH processes and committees,” stresses Marcus Low, an epidemiologist and editor.

The NIH cuts come on top of the cancellation of grants from the US Agency for International Development (USAID) and US Centers for Disease Control (CDC) – primarily for HIV and TB programmes.

Impact on institutions

“South African academic and research institutes could lose about 30% of their annual income and may be forced to lay off hundreds of staff as a result of US funding cuts,” the analysis notes.

It warns of “the potential collapse of TB and HIV research and development capacity” in the country, with global impact in light of “ the substantial contributions of South African research centres to advancements in TB and HIV prevention, treatment, and care worldwide.”

(From Top L-R) Lindsay McKenna, Ian Sanne, Tom Ellman, (Bottom L-R) Marcus Low, Ntobeko Ntusi and Linda-Gail Bekker
(Top L-R) Lindsay McKenna, Ian Sanne, Tom Ellman, (Bottom L-R) Marcus Low, Ntobeko Ntusi and Linda-Gail Bekker

Professor Ntobeko Ntusi, head of the South African Medical Research Council (SAMRC), told the media briefing that the country had been disproportionately affected both because of its high burden of HIV and TB and the excellence of its scientific community – making it a preferred site for research.

“Universities are now beginning retrenchments at scale,” said Ntusi, adding that affected scientists also provide postgraduate training.

“Hundreds of master’s, doctoral and post-doctoral fellows, whose stipends and research costs are dependent on these grants, find themselves in a position of inordinate precarity,” said Ntusi.

‘Ethical nightmare’

Prof Ian Sanne, co-principal investigator of the Wits HIV Research Group Clinical Trials Unit, describes navigating the US funding cuts as a “major regulatory and ethics nightmare”.

NIH investment in South African HIV and TB research “amounts to almost $2 billion over 20 years”, according to Sanne. His institution alone, Wits University in Johannesburg, stands to lose $150 million to $180 million in NIH funding.

As co-chair of Wits University’s ethics committee, Sanne has had to work with units on contingency plans for both staff and trial participants – despite US funds being terminated with immediate effect with nothing left over to wind down processes.

“In one of the studies in KwaZulu-Natal, the sponsor, USAID, stopped funding overnight and the microbicide rings that were under research with the participants were terminated without their knowledge,” said Sanne, leading to “a real ethical problem”.

Microbicide rings impregnated with ARVs are inserted vaginally to prevent HIV and studies often involve women at high risk of HIV infection.

Sanne’s unit lost US funding with immediate effect on 21 March – but it then had to embark on retrenchment procedures in terms of South African law, draining the reserves of the unit.

Expertise and infrastructure lost

Prof Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the University of Cape Town, says her centre will lose $6.9 million out of $10 million in NIH funds.

Earlier in the year, the centre lost a HIV vaccine grant worth $45 million over five years from USAID that would have seen five trials in eight southern African countries “contributing to the global quest to find an effective HIV vaccine”, she added.

The centre employs 400 people and will have to retrench “one-third to half our workforce”, said Bekker, whose groundbreaking research on a twice-yearly injection to prevent HIV infection earned her a standing ovation at the International AIDS Conference in Munch last year.

Professor Linda-Gail Bekker presenting the results of the PURPOSE 1 trial at the Munich AIDS conference, which found a twice-a-year injectable ARV prevented all women in the trial from contracting HIV.

“We have an incredible critical mass of very experienced and very well-established research organisations in the country, and the infrastructure that has been built over the last 30 years has established an extraordinary clinical trial infrastructure,” said Bekker.

South Africa was able to use this expertise and infrastructure during the COVID-19 pandemic to “pivot to test at great speed, new COVID-related vaccines”.

“Throughout the years, we have contributed to creating new knowledge that is often [Investigational New Drug] related studies… that feeds into important guidance, such as the WHO guidance.”

Impact on other African countries

Dr Tom Ellman, director of MSF’s Southern Africa Medical Unit, said that MSF has applied the “pragmatic” HIV and TB research generated in South Africa in resource-poor settings throughout the continent.

Recently back from the Democratic Republic of Congo (DRC), Ellman said it was able to draw on the “self-managed, fixed-combination antiretroviral treatment regimen” developed in South Africa for people living with HIV in the conflict zone in South Kivu.

MSF’s large HIV programme in Kinshasa relies on dolutegravir – “a basic, simple, effective drug enabled by South African research”, said Ellman, who listed several other drugs that had been trialled in South Africa before hitting the global market.

“The best science leads to impact in the most difficult settings. There’s no question that South African science has transformed access to HIV, TB and other disease responses across Africa and across the world.”

Ellman said the funds cut is “particularly awful”  as “we are closer than ever to finding ways out of the HIV, TB and malaria pandemics”.

Appeal for support

TAG, MSF and the SAMRC have appealed for “alternative funds to sustain TB and HIV research in South Africa”.

Ntusi says numerous donors and governments have offered support and solidarity – but most wish to remain anonymous at present.

The researchers all agreed that the most urgent need is to provide immediate support to clinical research sites to ensure continuity of care and follow-up for study participants. 

“South African trial participants must be supported to complete treatments safely and, in cases of treatment failure, be offered appropriate alternatives, and research sites must be supported to complete data collection and analysis,” said TAG and MSF.

Image Credits: Paul Kamau/ DNDi, IAS.

A billboard in South Africa in support of a tax on sugary drinks as part of a campaign in 2017.

Significant portions of health care budgets across Africa have vanished. Countries across the continent are grappling with the unprecedented scale and speed of recent reductions in development assistance for health.

In 2021, external financing supported more than a third of health expenditures in half of the countries in sub-Saharan Africa. While multilateral and bilateral development assistance for health, which have historically supported about 30% of health care spending, were expected to decline by 2050, the region was not prepared for a staggering drop from $80 billion in 2021 to $24 billion in 2025. 

The question is this: How will governments address these unplanned deficits, fulfill essential health care needs, and meet new demands created by demographic transitions, climate change, and the non-communicable disease (NCD) epidemic?

Solution in plain sight

There is a solution hiding in plain sight. Taxing harmful commodities to increase government revenue and reduce societal costs is a tool that has been around for centuries, dating back to the 17th century when sin taxes were imposed in England on tobacco.

More recently, the Task Force on Fiscal Policy for Health estimates that raising the price of tobacco, sugary beverages, and alcohol by 50% worldwide through excise taxes could prevent 50 million premature deaths over 50 years. Over five years, this solution would produce an additional $3.7 trillion in tax revenue worldwide, with more than half of that generated in low- and middle-income countries, enough to cover 40% of health budgets.

Over five years, this solution would produce an additional $3.7 trillion in tax revenue worldwide, with more than half of that generated in low- and middle-income countries, which is enough to cover 40% of health budgets. 

With crisis comes opportunity. Despite industry opposition and interference, conflicts of interests, and implementation challenges, now is the time to mobilize action around this solution.

Health taxes have the potential to boost budgets and save lives, particularly in the current funding crisis.

How to mobilise around health taxes – lessons learnt

At Vital Strategies, our partnerships with governments and civil society across more than 35 countries to help implement tobacco, alcohol, and sugary beverages taxes has provided some perspectives on how to overcome these barriers.

Our key message: We can apply lessons from multiple successful efforts to advance health taxes to tackle these barriers. Health taxes are achievable and deliver immense returns for population and financial health. Here are some important steps to success.

Rapid modelling

First, rapid modeling and assessment can create country-specific guidance on projected revenue gains and health benefits — data needed by decision-makers and legislators across health, finance, trade, and other ministries. Painting a picture of how these taxes yield tangible benefits  to make the case to policymakers and the public for action, or to document benefits of a new policy recently undertaken, should be part of this exercise.

In the Philippines, for example, taxes on tobacco and alcohol are helping to fund universal health care, while in Guatemala, revenue from alcohol taxes supports family planning programs. In Philadelphia, a sugary drink excise tax introduced in 2017 had generated more than $500 million by early 2024, helping to fund universal pre-kindergarten education for children across the city.

Prepare for pushback from industry

Secondly, anticipate and prepare for opposition from industry actors, who will inevitably work to block policies that threaten their profits.

Their tactics often include exaggerating claims of economic harm, denying the health harms of their products, and spreading disinformation on taxes’ impact on the economy, jobs, illicit trade, and the well-being of lower-income people.

But in country after country, smart tax policies demonstrate that these claims don’t hold up. When the prices of harmful products increase, worker productivity improves, and people shift their spending to other sectors, resulting in a net impact on employment and economic growth that is neutral or positive.

And taxes are not the primary drivers of illicit trade. Non-price factors, such as governance status, a weak regulatory framework, and the availability of informal distribution networks appear to be far more critical.

Effective dialogue with the public 

When Mexico launched it’s one-peso soda tax, it also launched a campaign explaining that a single 600ml soda had an average of 12 teaspoons of sugar. Sales of sugary drinks decreased 6.3% in the first year.

The final step is to build broad public support by highlighting how these measures benefit children, families, and communities, creating the momentum needed to overcome industry resistance and drive political buy-in.

We know that public support for health taxes is strong when benefits are clearly communicated. A Gallup study across India, Colombia, and Tanzania found up to 74% of adults supported higher taxes on alcohol, tobacco, and sugary drinks. Effective dialogue with the public fosters trust and aligns fiscal policies with community priorities.

In the Philippines, for instance, a concerted public campaign reframed ‘sin’ taxes as a means to help fund universal health care.

Guatemala’s experience offers a similar lesson. After a law was enacted allocating 15% of alcohol tax revenues to family planning programs, communication campaigns were launched to inform citizens about the benefits of this allocation. 

The introduction of a tax on sugary drinks was strategically communicated as a means to fund universal pre-kindergarten education in Philadelphia. This framing resonated with the public, leading to the tax’s approval and the generation of over $500 million by early 2024, with a portion allocated to early childhood education programs. ​

In December 2024, Brazil’s National Congress approved a tax on tobacco, soft drinks and alcohol. Health taxes in Brazil were framed as a mechanism to address deep-rooted health inequities, designed to shift the burden of harm from society back to the industries profiting from it, and using policy to reduce disease burden where it’s most concentrated: low-income and underserved communities. 

When there are clear benefits to be gained, such as better health and better social services, the public supports taxation on unhealthy products. 

Few African countries tax tobacco, alcohol and ultraprocessed food effectively, in part due to massive industry pushback.

Altering the trajectory of health inequities 

Non-communicable diseases such as cancer, heart disease, and diabetes, once mostly occurring in wealthy nations, is shifting to emerging markets.

Africa is witnessing some of the fastest growth rates in the consumption of unhealthy commodities; this increase is concentrated in lower-income households and among youth. Currently, consumption of these commodities is linked to 3 million deaths a year. NCDs account for an estimated  29% of all deaths in Nigeria, 38.5% in Kenya, and 51% in South Africa. If we allow the status quo to continue, low- and middle-income countries will see about a 50% increase in NCD deaths by 2030, with Africa a major contributor, resulting in $500 billion to $1 trillion in economic losses by 2030.

This does not have to be our future. Young people and lower-income households are especially sensitive to price.

After the implementation of the Health Promotion Levy in 2018, South Africa saw the sugar content of beverage purchases fall by 32%, with greater reductions seen in lower-income households. In Mexico, after the introduction of a soda tax, sales of sugary drinks fell by 6.3% in the first year. Within two years, rates of overweight and obesity among adolescent girls dropped by 3%. With an average population age of 19, price increases on unhealthy commodities can have an outsized impact on Africa’s development trajectory.

Sugary drinks have become popular in Africa, and are driving NCDs including obesity and diabetes.

In the case of Brazil’s new tax on tobacco, soft drinks and alcohol, rather than taking a piecemeal approach, Brazil’s reform adopted a comprehensive reform grouping  tobacco, alcohol and sugary drinks with other harms like coal and betting. 

The reform established an equity-driven National Basic Food Basket (CBNA) exempt from taxation to promote healthier consumption, including meat, poultry, fish and minimally processed foods. 

The legislation also includes annual tax adjustments tied to inflation to maintain the effectiveness of these taxes over time, and this year, lawmakers will determine the specific tax rates on harmful products. The tax rates it adopts and the resulting changes in consumption, health outcomes and health disparities will be something to watch, as Brazil must establish those rates at levels that significantly reduce consumption to generate real public health benefits.

What are we waiting for?

Health taxes remain an undervalued and underutilized solution to address the triple shocks of contracting donor funding, domestic fiscal tightening, and the growing health care burden, providing governments with a unique opportunity to improve both long-term population and fiscal health. Now, when there is political and economic pressure to establish more stable and sustainable sources of domestic revenue for health, is the time to come together across sectors and mobilize for health taxes. Future generations will thank us.

What are we waiting for?

Dr Mary-Ann Etiebet is the President and CEO of the New York City-based Vital Strategies, a global health non-profit working in more than 80 countries to advance  equitable public health systems, including through stronger action on the drivers of non-communicable diseases. 

Image Credits: Kerry Cullinan, Bllomberg Philanthropies, Alianza por la Salud Alimentaria, Leo Zhuang/ Unsplash, Heala_SA/Twitter.

A nurse tests a patient for hypertension. Two-thirds of Africans with high blood pressure are unaware of their condition.

Three key issues feature in the United Nations zero draft of the political declaration on non-communicable diseases (NCDs) and mental health, published on Thursday in preparation for the High-Level Meeting on 25 September.

Tobacco control, hypertension and improving mental health care are the cornerstones of proposed action to contain NCDs. The draft proposes 2030 global targets of 150 million fewer people using tobacco, 150 million more people controlling their hypertension and 150 million more people having access to mental health care.

Five sub-targets are included in the 10-page draft as the pathway to achieving the three “150 million” targets by 2030.

The first focuses on at least 80% member states countries implementing excise taxes on tobacco, alcohol, and sugar-sweetened beverages at levels recommended by the World Health Organization (WHO).

The second is for 80% of public primary health care facilities in all countries to have “uninterrupted availability” of at least 80% of World Health Organization-recommended essential medicines and basic technologies for NCDs and  mental health conditions at affordable prices by 2030.

Other targets relate to limiting the cost of essential NCD and mental health “services, diagnostics, and medicines”, integrated country-based frameworks and surveillance and monitoring.

Member states have a tight window – until 27 May – to submit written comments on the draft ahead of the first round of negotiations on 5 June. 

No mention of fossil fuel

The NCD Alliance (NCDA), which has been leading civil society mobilisation ahead of the HLM, told Health Policy Watch that it is currently studying the draft and will formulate its response early next week, and will share its analysis at a public webinar on 20 May.

However, an NCDA advocacy briefing outlines its key asks, including universal health coverage (UHC) and achieving the Sustainable Development Goal (SDG) target on NCDs. 

Seventy percent of deaths are caused by NCDs, as unhealthy diets, lack of exercise, smoking, air pollution, and poor mental health take their toll globally. Yet only 19 countries are on track to achieve SDG 3.4 to reduce premature mortality from NCDs by one-third by 2030.

Several of the NCDA asks are in the draft, but perhaps not as strongly stated as it would like.

For instance, while the draft identifies the need to reduce air pollution – the second biggest driver of NCD deaths after tobacco –  there is no mention of the cutting back on fossil fuel use.

The draft proposes that a reduction in air pollution can be achieved through clean urban transport, reducing burning of agricultural residue, and access to “affordable and less polluting fuels for cooking, heating and lighting”.

The NCDA wants interventions to “reduce air pollution and fossil fuel use” – and for government policies to be protected from the influence of the fossil fuel industry. 

The draft’s only reference to climate change is its acknowledgement that countries’ resources are strained by several emergencies including “climate crises” – whereas the NCDA wants policies to cost health and climate, reduce fossil fuel use, and ensure funding for vulnerable countries, particularly Small Island Developing States (SIDS). (The draft does acknowledge the “unique vulnerabilities” for people living in SIDS.)

Increased funding

“The last decade has been coined as a policy success, but an implementation failure. This HLM has to change this, renewing commitments to cost-effective policies that we know work to reduce the risk factors and improve access to care,” Katie Dain, NCDA CEO, told a recent multi-stakeholder hearing called by the UN Secretary General ahead of the HLM.

Dain added that the HLM “must address the glaring mismatch between the scale of the burden of NCDs and the level of funding”.

“We urge governments to increase sustainable financing for NCDs by adopting specific and measurable financing targets for NCDs and improving financing data and tracking, as well as committing to health taxes that have a triple win of raising revenue, improving health outcomes and reducing long-term healthcare costs.”

The draft devotes five points to increased budgets, which call for increased domestic resources (helped by funding from the excise taxes), more donor resources and strategies such as pooled procurement for medicines.

It also calls on countries to “urgently scale up the percentage of public health budgets dedicated to mental health with the aim to increase the current global average of 2% to at least 5% by 2030”.

Human rights approach

Importantly, the draft stresses the importance of adopting a human rights-based approach, acknowledging that people living with NCDs and mental health issues are “routinely and unjustly deprived of such access and discriminated against”.

It also calls for measures to decriminalise suicide, which was a key demand made by civil society groups at the recent multi-stakeholder hearing.

Image Credits: Hush Naidoo Jade Photography/ Unsplash.

Jubilant and exhausted members of the Intergovernmental Negotiating Body (INB) pose after marathon pandemic agreement talks finally resulted in agreement in the early hours of 16 April.

The final draft of the pandemic agreement for the World Health Assembly (WHA) next week was published by the World Health Organization (WHO) on Wednesday – along with a document outlining the long road member states still have to travel before it is enforced.

This follows the historic agreement reached on the text in the early hours of 16 April after three years of talks on how to prevent, prepare for, and deal with, future pandemics in an equitable manner – unlike what happened during COVID when wealthy nations hoarded vaccines at the expense of low- and middle-income countries.

The procedural document outlining the steps to adoption, which will be done in terms of Article 19 of the WHO Constitution, makes sobering reading.

While the agreement needs a two-thirds vote to pass, “adoption of the text by consensus automatically fulfils this requirement”, it notes.

Once the WHA has adopted the agreement via a resolution, it will be deposited with the Secretary-General of the United Nations, who will ensure it is prepared in various languages for signature.

Member states are expected to notify the WHO Director General on whether they intend to accept the agreement within 18 months of its adoption by the WHA.

Still more PABS negotiations

But member states’ signature of the pandemic agreement will only happen after the adoption of an annex on the much-contested Pathogen Access and Benefit-Sharing (PABS) System – a mechanism on how to share information about pathogens with pandemic potential and any possible benefits (such as vaccines and therapeutics) that might arise from sharing this information.

This annex – called the PABS instrument – still has to be negotiated, and it deals with a range of issues including “the provisions governing the PABS System, definitions of pathogens with pandemic potential and PABS Materials and Sequence Information, modalities, legal nature, terms and conditions, and operational dimensions”.

This means the PABS can of worms will be reopened in the coming months and member states will once again have to find agreement on this highly contested subject.

Only once the annex has been agreed, will the WHO Pandemic Agreement be open for signature by heads of state.

But even once the heads of state have signed the agreement, countries are not bound by its provisions. 

Instead, by signing, a head of state would be “expressing political approval of the treaty concerned, and raises an expectation that the signatory will in due course take the appropriate domestic actions to become a contracting party”. 

However, before domestic ratification, member states that have signed the treaty will be expected not to undermine the agreement.

Countries that have ratified the pandemic agreement will then be expected to deposit instruments of ratification with the UN Secretary-General and once 60 countries have done so, it will come into force and the first Conference of Parties will be held.

The entire process is likely to take several years, during which time another pandemic can engulf the world.

The Pandemic Agreement still has to pass through several hoops, including more negotiations on a PABS System, before it comes into force.

 

Image Credits: Thiru Balasubramaniam.

In the shakeup, only four members of WHO’s existing senior leadership team remain: Farrar, Ihekweazu, Nakatani and Pendse.

A brand-new World Health Organization (WHO) leadership team has been announced, including a dramatically reduced number of leaders and a major shake-out of longstanding faces including Dr Mike Ryan, the Deputy Director General and emergencies director, and Dr Bruce Aylward, who helped the Director-General steer the organization through the COVID-19 crisis but also got the heat for some of the mistakes made by the organization in the process.

In Ryan’s place, Dr Chikwe Ihekweazu, a Nigerian-German who is currently head of Health Emergency Intellience and Surveillance at a WHO pandemic hub in Berlin, will take over as head of the entire health emergencies operation at headquarters, the largest department in the organization, Health Policy Watch learned from an internal email sent by DG Dr Tedros Adhanom Ghebreyesus to staff Wednesday morning.

A formal WHO announcement followed shortly afterwards during remarks by Tedros at the opening meeting of the Programme Budget and Adminstration Committee (PBAC), a member state group convening ahead of next week’s World Health Assembly.

Dr Jeremy Farrar, a well-respected British scientist and former head of Wellcome Trust, will take on the second biggest appointment as Assistant Director-General (ADG) of Health Promotion, Disease Prevention and Control – one of the major pillars of the new organization – which will consolidate the 10 existing divisions into four.

New WHO organizational plan, announced 22 April, reduces 10 divisions at headquarters to just four.

Farrar will be replaced as Chief Scientist by Dr Sylvie Briand, former director of WHO’s Epidemic and Pandemic Preparedness and Prevention Department and current director of the Global Pandemic Preparedness and Monitoring Board, an independent body co-convened by the WHO and the World Bank to ensure preparedness for global health crises.

Sylvie Briand, far right, to become WHO Chief Scientist.

Japanese national Dr Yukiko Nakatani will remain on the team as head of the third new programme division, ADG of,Health Systems.

Raul Thomas, of Trinidad and Tobago, will remain as WHO’s ADG of Business operations along with Razia Pendse, an Indian national, as the ‘Chef du Cabinet.’

In his announcement to staff, Tedros said that the appointments would take effect on 16 June. Speaking shortly afterwards to the PBAC, he added, “The new team has been chosen after very careful consideration, and to ensure gender balance and geographical representation.

“I am confident that this new team, under the restructured organization, is best positioned to now guide WHO as we face the challenges of the coming years.”

Early reactions to new team

Dr Tedros Adhanom Ghebreyesus on 10 April – facing tough budget cuts.

Very initial reactions from staff inside the organization and outsiders seemed to be positive.

“It was a difficult decision for the DG, because he had to ensure, gender, geographical equity, and that donors priorities were also met,” said one long-time WHO insider, “but overall it seems like a good balance,” noting that most of the new appointees have solid professional reputations.

The sweep out of old leadership long associated with Tedros’ tenure may help improve the organization’s image and help press “reset” for further changes, the source added.

Notably, there is neither a Chinese nor an American in the new leadership team – reflecting perhaps an attempt to sidestep the fraught geopolitical tensions that have plagued the organization since COVID.

Along with Ryan, Aylward, ADG for Universal Health Coverage, who served WHO for 30 years, including leadership of its Global Polio Eradication initiative and the WHO Emergencies Programme, is also gone. Aylward, a Canadian physician, also led some of the Organization’s early response to the COVID pandemic. Although rightly or wrongly, Aylward, like Tedros and other senior WHO leadership, also later came under fire for being too deferential to China, or even praising China’s handling of the outbeak in its early days – as the crisis swept across the world, paralyzing travel and shutting down economies.

Farrar, meanwhile, has emerged as an even more senior figure in the agency shake-up and someone to watch for the future.

Briand, a French national, as head of research offers the WHO the opportunity to strengthen its organizational links to European research institutions at a time when the United States is cutting funding for science research and innovation both at home and abroad.

“In that context, it’s historic to see a French national become head of research,” said one WHO scientist.

WHO Organization as of January 2025 boasted 10 divisions and 76 department directors.

The new team now faces the big challenge of reducing the number of WHO directors at headquarters by more than half, in line with a plan to dramatically cut WHO’s budget in the face of the loss of funds due to the US withdrawal, WHO’s largest donor, from the agency, announced by new US President Donald Trump in January.

Facing a $600 million shortfall in 2025 and a $1.7 billion funding gap for the 2026-27 biennium, according to the latest estimates, the WHO reorganisation would cut the number of departments at headquarters by nearly half – from 76 department directors as of January 2025 to around 34 departments and directors, according to the new organogram.

The number of directors at headquarters would be slashed by more than half, from 76  to 34, according to Tedros, speaking to PBAC.

“Decisions about which directors will lead which departments will be made following the World Health Assembly. That, I know, will also be tough, given the downsizing from 76 to 34 departments,” Tedros said in his message to PBAC members.

“I emphasize that our focus on strengthening our country offices is unchanged, although we do plan to close some offices in high-income countries that no longer need in-country support.”

Options for programme relocation outside of Geneva HQ

Illustrative options for WHO programme relocation to less-expensive settings in Europe and Africa, presented to the member state Planning, Budget and Administration (PBAC) meeting today.

At the closed-door PBAC meeting, Tedros also provided member states with an initial review of possibilites for relocating certain WHO departments and teams now based in Geneva to other existing WHO or UN hubs in more affordable locations – in Europe as well as Africa, Health Policy Watch learned.

Such “illustrative” options include: the relocation of certain health workforce teams to Lyon, two hours from Geneva in nearby France; moving more health emergency functions to Berlin, where WHO already has a pandemic surveillance office co-supported by the German government; relocation of IT support to an existing UN hub in Valencia; and finally, relocation of critical WHO infectious disease programmes to South Africa, Nairobi or Addis Ababa. This could bring those programmes “closer to the world regions with heaviest disease burden” alongside other major UN and African policy and research hubs.

Such relocations could help mitigate some of the fallout at headquarters, were as many as 30-40% of WHO’s 2600 rank-and-file staff could reportedly be facing layoffs, based on WHO’s existing budget shortfall there, the biggest  in the organization.

“We anticipate that the most significant staff reductions will be at headquarters, while regional offices will also be affected to varying degrees,” Tedros told PBAC, although he has so far provided no exact projections as to how many would be laid off, saying that will only become clear once a more detailed organizational “prioritization” exercise is completed. Tedros added, however, that WHO already has introduced “a range of support mechanisms, and we are committed to supporting the mental health and well-being of all our colleagues.”

Salary gap by region for 2025 as presented to WHO member states in March, shows more than half of the deficit is in headquarters.

“Now they have to cut down 50% of the directors, so the work is only begun,” one observer said. “”In any case this is a transitional team because the Director-General will complete his term in two years time.”

The retrenchment follows years of expansion during the COVID pandemic, and post-COVID outbreaks and humanitarian crises, when the number of WHO’s most senior directors nearly doubled, along with the ranks of consultants. See related story:

https://healthpolicy-watch.news/exclusive-number-of-who-senior-directors-nearly-doubled-since-2017-costs-approach-100-million/

Image Credits: WHO , WHO, Fletcher/HPW , WHO, 2025, WHO .

Scarcity of food in Gaza is increasingly causing malnutrition and severe hunger as the war continues.

All 2.1 million people in Gaza face hunger and diseases while life-saving supplies sit just beyond the borders, denied entry after nine weeks of a total blockade, Dr Hanan Balkhy, World Health Organization (WHO) regional director for the Eastern Mediterranean, told a media briefing on Tuesday.

“The Israeli authorities propose to shut down the UN-led aid distribution system and deliver aid under conditions set by the military, but WHO and the United Nations will not participate in any initiative that violates humanitarian principles. Aid must reach those in need, wherever they are, and the blockade must end,” she added.

Dr Hanan Balkhy, World Health Organization (WHO) regional director for the Eastern Mediterranean.

The entire population is facing high levels of acute food insecurity, while half a million people (one in five) are facing starvation, according to the Integrated Food Security Phase Classification (IPC) report released on Monday.

Three quarters of Gaza’s population are at “emergency” or “catastrophic” food deprivation, the worst two levels of IPC’s five level scale of food insecurity and nutritional deprivation.

Since the blockade began on 2 March, 57 children have reportedly died from the effects of malnutrition. 

If the situation persists, nearly 71 000 children under the age of five are expected to be acutely malnourished over the next 11 months, according to the IPC report.

Dr Richard Peeperkorn, WHO Representative in the occupied Palestinian territory.

Dr Richard Peeperkorn, WHO Representative in the occupied Palestinian territory, told the media briefing that 70,000 pregnant and lactating women “are expected to require treatment for acute malnutrition”, with their children facing long-term effects including stunted growth and impaired cognitive development.

The United States announced last week that it supported food aid being channelled to Gaza via a private company un by US contractors, the Gaza Humanitarian Foundation. 

The Israeli government has said that it supports the plan, but the UN has described it as “weaponizing aid”.

Peeperkorn said that there needed to be an immediate lifting of the blockade but that aid needs to be delivered via “One UN action” in terms of the “global humanitarian principles of humanity, impartiality, independence and neutrality”.

“There is a well established and proven humanitarian coordination system led by the UN and its partners that is already in place and must be allowed to function fully to ensure that aid is delivered in a timely and equiptable manner,” said Peeperkorn.

He added that discussions are ongoing between the UN, Israel and the US and he hoped this would result in the resumption of aid as the WHO, World Food Programme and UNICEF were all ready with “massive amounts of food, medicine and water and hygiene supplies”.

US President Donald Trump addresses the US-Saudi investment conference

US President Donald Trump arrived in Saudi Arabia on Monday night for a three-day visit to the Middle East focused on economic partnerships.

Addressing a US-Saudi investment forum on Tuesday evening, Trump said that he hoped Saudi Arabia will rejoin the “Abraham Accords”, agreements the US negotiated between Israel and some Arab countries during his first term. However, Saudi Arabia has ruled out normalising relations with Israel while it is at war with Gaza.

On the eve of Trump’s visit, The Guardian reports that his Middle East envoy Steve Witkoff said that the US “want to bring the hostages home, but Israel is not willing to end the war. Israel is prolonging it”.

‘Forgotten crises’

Yemen is also facing one of the world’s largest cholera outbreaks with over 270,000 suspected cases and 900 deaths in the past year, said Dr Ahmed Zouiten, acting regional emergency director for WHO EMRO.

Some 19.6 million people in Yemen are in need of humanitarian aid after 10 years of war.

Recent escalation in violence has threatened the country’s main port and airport, key gateways for humanitarian aid.

WHO only received 8% of $56 million funding it needs to address the crisis in Yemen.

“We need to secure further funding as soon as possible otherwise one mother and six newborns will continue to die every two hours already,” said Zouiten.

Meanwhile, Sudan is facing the world’s worst hunger crisis in terms of scale,with  an estimated 24.6 million people facing food insecurity this month, including 770,000 children suffering from severe acute malnutrition, said Balkhy.

“Some 8.2 million people are losing or at risk of losing access to health because of the shrinking funding for WHO and the health cluster partners. So we need support in Yemen. We need support in other forgotten crisis – Afghanistan and Pakistan, Syria and Somalia.”

Image Credits: WHO.

A young boy with type 1 diabetes gets his blood glucose level tested. Such non-invasive tests aren’t readily available in many countries.

Access to insulin remains elusive and expensive for many children and young people (CYP) living with type 1 diabetes (T1D) in low- and middle-income countries (LMICs), according to a report released Tuesday by the Access to Medicine Foundation.

The report evaluates 11 company-supported initiatives targeting children and young people by the market’s three dominant insulin producers – Lilly, Sanofi, and Novo Nordisk – and biosimilar manufacturer Biocon.

All four companies donate “vital” products or funding for insulin in 71 of 113 LMICs covered by the report, but as these are sustained by donations, “long-term, affordable diabetes care remains a critical challenge”, according to the foundation.

“While these contributions are meaningful and vital to the success of the initiatives, the heavy reliance on donations from industry partners creates a long-term uncertainty,” says the report.

“The lives of CYP depend on these initiatives, and any reduction or withdrawal of support could result in a sudden loss of access to critical products for hundreds of thousands of CYP.”

Ten of the 11 initiatives have set end dates or specific goals, with several scheduled to conclude by or before 2030, which “underscores the uncertainty of sustained access”. 

 “Hundreds of thousands of children and young people in low- and middle-income countries face significant barriers to accessing essential insulin, supplies and care for managing type 1 diabetes. While the pharmaceutical industry is engaged in the effort to bridge access gaps, as needs grow, initiatives must prioritise widespread coverage, sustainability and affordability to save lives, says Claudia Martínez, the foundation’s research director.

High cost of insulin

While Lilly and Novo Nordisk are adapting their models to “better align with local needs and are collaborating with partners to transition T1D care towards government ownership”, it won’t be possible to scale up access if the cost of insulin is not addressed, the report asserts.

For many children, the 11 industry initiatives remain their only way to access treatment, but in 2023, these collectively reached only about 8% of the estimated 825,000 children and youth in need across the 71 countries covered. 

Given that a significant proportion of diabetes in LMICs remains undiagnosed, it is highly likely that this represents an even smaller portion of young people who need access to insulin. 

“The public sector does cover the cost of insulin in some LMICs – either directly or through reimbursement. However, approximately 34% of people in LMICs still pay out of pocket for healthcare, and in many African nations, individuals cover the full costs themselves,” the report notes.

“The need for support remains overwhelming, and for those who are unable to access initiatives, access to the lifesaving care they need remains out of reach.”

A small percentage of initiatives in LMICs have evolved from providing insulin in vials for injection to insulin analogues and insulin pens, which are easier to administer to children and widely accessible in wealthier countries. There is also a lack of access to diabetes monitoring tools 

Some initiatives also include education and training. Seven support training for healthcare professionals to tackle the high rates of misdiagnosis and undiagnosed T1D in LMICs, while Lilly and Novo Nordisk also support investments in infrastructure and equipment.

“Sanofi’s KiDS stands out as the only programme educating not just children and families, but also teachers and school staff,” according to the report.

Solutions

The pharmaceutical companies can scale up access and reach by ensuring that the diabetes treatments and technologies best suited to children are available where they are needed most, moving away from the donation-based models, and addressing affordability and product availability to facilitate the successful transition to government-owned type 1 diabetes care in LMICs, the report concludes.

“This way, all CYP, regardless of where they live, can have access to lifesaving diabetes care products.”

Image Credits: UC Davis health.

Fatmata Bamorie Turay (left) and Elizabeth Tumoe, registered nurses look after newborns at the Princess Christian Maternity Hospital in Freetown Sierra Leone

Although the international nurse workforce has increased by about two million between 2018 and 2023, there is still a huge global shortage concentrated in poorer nations, according to the State of the World’s Nursing 2025 report published on Monday.

There was a global shortage of around 5.8 million nurses in 2023, an improvement on 2018 when there was a 6.2 million shortage, but the shortage is felt most acutely in low-and middle-income countries (LMICs).

Close to half (46%) of all 29.8 million nurses globally are concentrated in high-income countries (HICs), which represent only 17% of the population, according to the report.

The shortage of nurses is felt most acutely in poor countries, particularly in Africa and South East Asia.

LMICs face “challenges in graduating, employing and retaining nurses in the health system” and need to raise domestic investments to create and sustain nursing jobs, according to the report, which was compiled by the World Health Organization (WHO) and the International Council of Nurses (ICN).

Meanwhile, HICs need to “manage high levels of retiring nurses and review their reliance on foreign-trained nurses, strengthening bilateral agreements with the countries they recruit from”, it adds.

In 20 mostly high-income countries, retirements are expected to outpace new entrants, which raises “concerns about nurse shortfalls, and having fewer experienced nurses to mentor early career nurses”.

Migration is depleting fragile workforces

Almost a quarter (23%) of nurses in high-income countries are foreign-born, in contrast to upper-middle-income countries (8%), lower-middle-income countries (1%), and low-income countries (3%).

“When wealthy countries recruit from low-income nations, they risk depleting already-fragile nursing workforces,” warns the ICN, noting that migration is also driven by the under-employment of nurses in low-income countries. 

“The combination of workforce shortages, poor working conditions and compensation, and imbalanced distribution all fuel the vicious cycle of inequitable migration patterns,” notes the ICN.

The report stresses that all countries need to adhere to the WHO Global Code of Practice on the International Recruitment of Health Personnel, and where recruitment from one country to another occurs, there should be “bilateral agreements that translate into mutual and proportional benefits for source countries”.

Although low-income countries are increasing nurse graduate numbers at a faster pace than high-income countries, in many countries, this is “not resulting in improved densities due to the faster pace of population growth and lower employment opportunities”.  

To address this, countries should create jobs to ensure graduates are hired and integrated into the health system and improve working conditions.

“The report clearly exposes the inequalities that are holding back the nursing profession and acting as a barrier to achieving universal health coverage (UHC),” said ICN president Pam Cipriano. 

“Delivering on UHC is dependent on truly recognising the value of nurses and on harnessing the power and influence of nurses to act as catalysts of positive change in our health systems.”

“We cannot ignore the inequalities that mark the global nursing landscape. On International Nurses Day, I urge countries and partners to use this report as a signpost, showing us where we’ve come from, where we are now, and where we need to go – as rapidly as possible,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

At a media briefing on Monday, Howard Catton, ICN CEO, said real progress has been made in areas such as “advanced practice nursing, increased Chief Nursing Officer roles, increased graduate preparation of nurses, and reducing outdated gendered associations and attracting more men to the profession”. 

But little progress has been made on “the global health emergency of nursing shortages, hugely worrying indicators of inadequate working conditions and pay, troubling patterns of inequalities and nurse migration, and continued failures to fully enable nurses as leaders working to their full scope of practice and influence”, he added.

Pay and working conditions

Countries that regulate working conditions

The global median entry-level wage of nurses in 2023 was $774 per month in 82 countries, with significant differences by WHO region and by income group. 

Median wages in HICs were twice as high those of upper-middle-income countries, and three times as high LICs. 

Wages adjusted for purchasing power parity indicated that the European and Eastern Mediterranean regions have the highest median entry wages, and the WHO African and South-East Asia regions have the lowest. 

Most countries reported laws on minimum wages (94%), social protection measures (92%) and health worker safety (78%).  But only 55% had regulations on working hours and conditions, and even fewer had provisions for mental well-being.

“Mental health and workforce well-being remain areas of concern. Only 42% of responding countries have provisions for nurses’ mental health support, despite increased workloads and trauma experienced during and since the COVID-19 pandemic,” according to the report.

Policy proposals include empowering nurses to contribute to the climate agenda through education, advocacy, climate-conscious practice in health settings and leadership. 

South East Asian countries had the highest percentage of protections in place (70%) while Western Pacific countries had the lowest (21%). 

By income group, HICs had the most countries (63%) reporting provisions regarding working conditions and hours, while LICs had the fewest (48%). Other sources have described a related pattern in that excessive working hours, defined as working over 48 hours per week, were more frequently reported by nurses and midwives in low- and lower middle-income countries, many in Africa.

Attacks on healthcare workers

An attack on ambulance outside Al-Shifa hospital in Gaza in November 2023.

Measures to prevent attacks on health workers were reported in 59% of the responding countries, representing an increase from the 37% of countries reported on this in 2020. 

This was found to be highest amongst the responding countries in South-East Asia (90%) and lowest in the Americas (36%)

“Data from WHO’s Surveillance System for Attacks on Health Care indicate that between 1 January 2018 and 31 March 2025, there were more than 8,300 incidents of attacks reported from 22 countries/territories with over 3,000 deaths and over 6,000 injuries of health workers and patients,” according to the report.

The report recommends measures to support nurses and other health workers in post-conflict settings and reduce attrition including providing opportunities for professional development, incorporating financial incentives and allowing flexibility.

Image Credits: World Bank/Flickr, WHO, MSF/ Dr Obaid.