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.

Nurses preparing rapid COVID-19 diagnostics in 2020. Post-pandemic, new and more affordable rapid tests for HIV and other infections remain a major R&D priority.

A Nigerian Health Tech firm, Codix Bio, has been awarded a license to develop and manufacture a new generation of rapid diagnostic tests (RDTs) royalty-free for African consumers, using technology transferred from a South Korean firm. The deal is a breakthrough for WHO’s new Health Technology Access Programme (HTAP) and the non-profit Medicines Patent Pool – which aim to facilitate tech transfer to the Global South post-COVID pandemic, when the dearth of local manufacturing left many countries short on medicines and diagnostics as well as vaccines.

Using innovative new technology supplied by South Korea’s SD Biosensor, Codix Bio will first develop and produce a new line of highly-sensitive rapid tests for HIV/AIDS, which can generate results within 20 minutes, WHO said in an announcement of the deal on Friday. But the technology can also be adapted to develop and manufacture tests for malaria and syphilis, among other diseases.

In December 2023, SDB signed a non-exclusive license with MPP to enable development and manufacture of new diagnostic tools using its cutting edge technology in low- and middle-income countries, in sharing arrangements brokered under the auspices of the WHO COVID-19 Technology Access Pool (C-TAP).

In January 2024, CTAP morphed into HTAP – with a mandate to stimulate innovation and facilitate access to new health technologies beyond COVID tools in underserved regions, by expanding local manufacturing capacity. Through HTAP, WHO and MPP issued an open call for applications by LMIC-based manufacturers to produce diagnostics using the SDB innovations, with Codix Bio selected as the first sublicensee.  According to the original SDB license with MPP, the tech transfer is royalty free for product sales in low- and middle-income countries.

The WHO announcement coincided with a gala launch of the partnership at the Codix Bio campus in Ogun State, near Lagos, with the participation of the Korean firm alongside their Nigerian counterparts.

“This landmark agreement is a defining moment in our journey of health-tech innovation and a breakthrough for local healthcare manufacturing in Africa. Being selected as the first sublicensee under this global initiative underscores our commitment to contribute meaningfully to pandemic preparedness and regional health security,” said Sammy Ogunjimi, CEO, Codix Group.

“With support from WHO and MPP, we are committed to producing high-quality, rapid diagnostic tests that can transform access to timely diagnosis, not just in Nigeria, but across the continent,” he said.

“The announcement of this sublicensing agreement with Codix Bio marks an important milestone in our partnership with WHO and MPP,” said Hyo-Keun Lee, Vice Chairman of SD Biosensor, Inc. “By coupling the technology transfer with coordinated support, this initiative not only helps Codix Bio respond to health priorities in Nigeria and the region – it also demonstrates a collaborative model for building sustainable and self-reliant local manufacturing capacity.”

Speaking from Geneva, Yukiko Nakatani, WHO Assistant Director-General, Access to Medicines and Health Products called the agreement “a major milestone in strengthening manufacturing capabilities in regions where they are needed most.

“It can help advance global commitments made at the 2023 World Health Assembly to promote equitable access to diagnostics as a cornerstone of universal health coverage and pandemic preparedness.”

Image Credits: University of Washington Northwest Hospital & Medical Center.

Nurses Appreciation Week in New York City, 2020; The applause at the height of the COVID pandemic has never been matched by improved working conditions, salaries or status.

With declining global spending on health, as the world prepares to observe International Nurses Day, Monday 12 May, there is renewed urgency to build health systems that respond to the needs of nurses and the people they serve. 

Investing in nurses yields high returns. It improves maternal and child health, HIV/AIDS prevention, and outbreak response for example, while strengthening primary healthcare systems. 

However, in many under-resourced settings throughout southern Africa health systems rest on the shoulders of an overwhelmed nursing workforce, who in addition to servicing high patient numbers in poorly equipped hospitals and clinics are sometimes forced to operate from churches, schools and other non-traditional settings where they cannot access the tools they need to effectively deliver care. They are often poorly paid, overworked, prone to burnout and constrained by limited opportunities for professional growth, yet they continue to discharge their duties with commitment, delivering much-needed care and saving millions of lives.

Despite the critical role that nurses play in keeping our already overburdened health systems afloat, a sudden decline in global health funding now poses an additional threat to the future of healthcare in Africa, with devastating impacts on health workers and the wellbeing of the communities they serve. 

African countries brace for impacts of cuts 

Nurses| Cameroon
Student nurses prepare for the morning rounds at the Ndop District Hospital in Bamenda, Cameroon

As countries in the Global North roll back commitments to fund global health institutions and initiatives, African countries must brace for the impacts of these actions on health systems that are already under immense strain. They must also urgently address the need for robust and responsive health systems that safeguard the wellbeing of caregivers while ensuring uninterrupted access to care for those most in need.

When resources meant to sustain health systems dry up, it exacerbates health disparities and increases the burden on already fragile health systems. Nurses, the backbone of healthcare delivery, often bear the brunt of these constraints. For example, the deep funding cuts have not only impacted the livelihoods of frontline health workers—mainly nurses and midwives—they have also deprived remote and marginalised communities of access to essential healthcare. 

Additionally, the cuts have disrupted nurse-led health programs focusing on maternal health, HIV/AIDS, TB, leprosy, and other infectious diseases in many vulnerable countries across Africa, collapsing essential health care services, impacting the quality of care and cutting an already limited health workforce.

Nurses need to be decision-makers as well as implementers  

Most healthcare is delivered by women- but systems continue to be led by men.

The WHO predicts a global shortage of 10 million nurses by 2030. Nurses need to be at the heart of global transformation as essential leaders and contributors to the design of healthcare policies, strategic decision-making, and effective implementation at all levels. However, in many countries, nurses are excluded from decision making and health system design. They—especially female nurses—are often seen as implementers rather than strategic thinkers, despite their experience of being on the frontlines and navigating challenging circumstances including disease outbreaks and shortages of essential medical goods. 

It is a fact that while women lead caregiving functions, they are excluded from leadership and hold only a fraction of senior decision-making roles globally, with even fewer of these roles being held by female nurses. Studies have shown that the under-representation of women in senior roles limits the development and implementation of equitable policies.

Building resilient health systems

An Ebola nurse prepares a sanitation solution in the DR Congo, September 2019.

The solution lies in building resilient health systems that are deliberate in meeting the needs of both providers and patients. Commitments to policy reforms for ensuring protection from workplace hazards and fair remuneration for overtime and high-risk duties should be prioritised. The ambitious, transformative goals of UHC become more achievable when we create clear pathways for nurses to work in environments that enable them to grow further into leadership roles. This also means increased investments in mentorship, training and structural support systems that empower nurses to lead and influence change. Academic institutions and training organisations must embed leadership and governance skills into nursing education, while the public and private sectors collaborate with professional nursing associations to co-create lasting solutions to the systemic barriers that prevent nurses from moving up the ladder.

Applause and praise are not enough

Frontlines of care: Nurses at the pharmacy of Layoune refugee camp regional hospital, Algeria, dispense prescription medicines to Sahrawi refugees.

For far too long, nurses have stood on the frontlines of care, keeping clinics running, tending to the needs of their communities, and holding together fragile health systems. They have done so tirelessly, often without adequate recognition, resources, or influence over the decisions that directly impact their daily work and the patients they serve. Applause, while appreciated, will not resolve chronic understaffing. Gratitude cannot cover living expenses or student debt. And praise alone will not promote nurses into the leadership roles most are qualified to hold.

To build robust, inclusive and responsive health systems, governments, the private sector and partners must come together in a unified effort to prioritize building a nursing workforce that is well supported and fit to propel Africa forward in its journey to achieving global health goals.

Akhona-Tshangela

 Akhona Tshangela is the WomenLift Health Southern Africa Director and a public health professional with over 15 years of service.  She has successfully implemented and led programs at both national and continental levels, demonstrating expertise in dealing with complex public health issues and contextualising these to the African continent.

Felistas-Mpachika-Mfipa

Felistas Mpachika-Mfipa is the Chief Reproductive Health Officer for the Reproductive Health Directorate, Malawi. With over 15 years’ experience, she has worked as a nurse practitioner and manager, maternal and neonatal health program manager, and researcher.

 

Image Credits: Raisa Santos , R Santos, © Dominic Chavez/The Global Financing Facility, ICN/Women in Global Health, WHO AFRO, European Union – Louiza Ammi.

US conservative Christian group Family Watch International president Sharon Slater (centre) meets with Uganda’s first lady, Janet Museveni, and other government officials in April 2023 to encourage passage of a new anti-homosexuality law.

Women’s groups and human rights organisations have raised the alarm about an African anti-rights conference taking place this weekend in Uganda, followed by another next week in Nairobi, featuring prominent US conservatives, aimed at developing “an African charter on family sovereignty and values”. 

Previous conferences have been used to mobilise for anti-LGBTQ laws and promote restrictions on sexual and reproductive rights on the continent, critics say.

Similar “African family” conferences have tried to “strip women of their basic human rights and dignity and reinforce the dominance of men within our society using ‘family values’ as a vehicle”, notes Women’s ProBono Initiative (WPI), a Ugandan women’s rights group.

The Entebbe Inter-Parliamentary Forum opened on Friday (9 May). Since its inception three years ago, it has served as a conservative platform for ultra-conservative African Members of Parliament.

Hosted by Uganda’s president and parliament, the forum has mobilised for copycat anti-LGBTQ laws in Uganda and Ghana with prison terms for those who identify as lesbian, gay, transgender, and bisexual. Conservative Kenyan MPs are working on a similar law.

Other concerning examples of shared policies are the Kenyan government’s 2023 “family protection policy” which undermined no-fault divorce, instead forcing parties into mediation even in cases of domestic abuse, says WPI. This has since been replicated by Uganda.

The Entebbe conference aims to adopt a conservative African ‘Charter’.

Notorious ‘hate groups’

The Entebbe forum taking place over the weekend is co-sponsored by Family Watch Africa, the continental branch of the Arizona-based Family Watch International (FWI), an anti-choice, abstinence-only organisation, also designated as a ‘hate group’ by the Southern Poverty Law Center in the US for its anti-LGBTQ agenda. 

Family Watch International’s Sharon Slater is due to speak at both anti-rights conferences.

FWI president Sharon Slater, who is presenting the opening session, is notorious for championing anti-LGBTQ laws in Africa and organises annual “training sessions” for African politicians in Arizona on how to lobby for conservative causes at the United Nations and other multilateral forums.

“Whenever an anti-LGBTQ law is passed in Africa, you are assured Sharon Slater had a hand in it!” says Tabitha Saoyo Griffith, a human rights lawyer and Amnesty International Kenya board member.

Last year’s forum featured addresses by two of the continent’s most vociferous anti-vaxxers, Shabnam Mohamed and Wahome Ngare, who delivered blistering attacks on several life-saving vaccines, as reported by Health Policy Watch.

Mohamed heads the Africa chapter of Children’s Health Defense, the anti-vaccine group founded by Robert F Kennedy Jr, currently the US Secretary of Health and Human Services.  

Ngare is a director of the conservative lobby group, the Kenyan Christians’ Professionals Forum (KCPF). Nine Ugandan medical professional bodies issued a statement disavowing Wahome’s misinformation after his address. 

This year’s forum will not be public, and attendees have to agree to abide by “Chatham House rules” (no disclosure or attribution of information) when registering. 

“This is worrying because these elected representatives, discussing African family values, are accountable to the people who elected them. The secretive nature of these discussions points to a sinister plan that will result in harmful decisions with life-and-death consequences,” says Joy Asasira, a sexual and reproductive health rights advocate from Uganda.

From Entebbe to Nairobi

On Monday, May 12, a day after the Entebbe forum ends, the Pan-African Conference on Family Values convenes in Nairobi, Kenya. 

Co-hosted by anti-vaxx Ngare’s KCPF, this is an even bigger gathering than Entebbe. It aims at “promoting and protecting the sanctity of life, family values and religious freedom”, as well as equipping delegates “with tools to strengthen advocacy efforts at national, regional, and global levels,” according to pre-conference publicity. 

Ironically, its keynote speakers are predominantly white conservative men from the United States and Europe. US Secretary of State Marco Rubio had even been invited to speak, but cancelled his planned visit to Kenya – reportedly in protest against Kenyan President William Ruto’s recent visit to China.

There is a proliferation of white Western men as  keynote speakers for the Pan-African Conference on Family Values in Nairobi that starts on 12 March.

The cast of speakers includes Austin Ruse, the president of the ultra-conservative Center for the Family and Human Rights (C-Fam), who describes himself as “descended of colonists” and a “Knight of Malta”, a Catholic order.

Also due to speak are Family Watch International’s Slater; Dutch conservative lobbyist Henk Jan van Schothorst; and US anti-LGBTQ politicians Robert Destro, a deputy secretary of state under the first Trump administration, and former senator John Crane; as well as leaders of the ultra-conservative Polish group, Ordos Iuris. Kenya’s Labour Ministry is also supporting the conference.

Advisors to Trump’s ‘Project 2025’ co-sponsoring events

Two of the Nairobi conference co-sponsors – C-Fam and the Alliance Defending Freedom – were on the advisory committee of Project 2025, the conservative blueprint being followed by the US Trump administration which has led to life-threatening cuts to development aid in Africa. Meanwhile, another sponsor, FWI, has worked with the Heritage Foundation, which authored Project 2025.

Project 2025’s proposals to slash US Agency of International Development (USAID) grants, prioritise funding for faith-based organisations and prohibit funding for “sexual reproductive health and reproductive rights” and “gender equality” programmes have all been implemented.

“It is outrageous that these organisations have been given a platform, when they are part of an initiative that pushed for slashing aid that is harming Africa families, and undermining the health of children, women and men and vulnerable communities,” said Dr Haley McEwan, a research associate at the University of Witwatersrand’s Centre for Diversity Studies in South Africa.

“This conference is part of decades-long activities of US Christian right organisations in the region. The fact that it features high-profile government speakers shows that they are gaining influence and power and this is even more concerning, particularly in light of the damaging funding cuts.”

Three of the sponsors of the Pan-African Conference on Family Values in Nairobi served on the Project 2025 advisory committee that proposed the Trump administration slashes development aid.

“Why are these white American men so concerned about African families? Is this not another form of colonialism? ” asks Kemi Akinfaderin, chief global advocacy officer for Fòs Feminista, a global network of over 150 organisations working for sexual and reproductive rights.

“They are trying to instil fear by claiming that there is an agenda to reduce Africa’s fertility and population rates, but this is an imposition of Western problems, such as declining fertility rates, on Africa.” 

Human rights organizations petition against use of Red Cross-owned hotel 

Over 20 Kenyan human rights organisations, backed by more than 12,000 signatories, petitioned the Red Cross, the main shareholder of Nairobi’s Boma Hotel where next week’s conference is being held, to try to persuade them to refuse to host the gathering.

In their letter, the human rights organisations point to the KCPF’s opposition to laws aimed at curbing maternal mortality in Kenya and its involvement in promoting Uganda’s Anti-Homosexuality Act. The KCPF is also opposing access to contraception for people under the age of 18.

“By giving the conference a platform, Red Cross Kenya is endorsing discriminatory ideologies that contradict the Red Cross’s commitment to alleviating human suffering and prioritising the lives of the most vulnerable,” they wrote.

However, the Red Cross, a principal recipient of the Global Fund grants in Kenya, responded that it was not involved in the day-to-day running of the hotel.

Human rights organisations have also sponsored billboards on the road from Nairobi’s airport to the hotel, stating: “True family values bring everyone together – not tear us apart.”

Billboards on the road from Nairobi’s airport protest anti-rights conferences with messages calling for an inclusive definition of families.

Narrow Western definition of ‘family’

Akinfaderin notes that the anti-rights groups have a “Western-centric, Eurocentric definition” of the family centred on a man as the head of the family, which is “not aligned with the more expansive realities of African families”.

“According to these groups, women’s rights, LGBTQI rights, access to safe abortion and comprehensive sexuality education, are anti-family initiatives,” says Akinfaderin.

“Their justification is that, if more women and girls know their rights and having a sense of value and empowerment, it means that they’re less likely to want to stay home and bear children. But women’s and girls’ aspirations are greater than their reproductive capacities. They want to go to school, work, and earn their income. They want the right to decide for themselves: physical, economic, social, and bodily autonomy,” she adds.

Anti-LGBTQ legislation was introduced in Uganda and Ghana shortly after previous year’s conferences. Ghana’s former president did not sign his country’s bill into law but conservative MPs are planning to reintroduce it under the new government. 

There are fears that this month’s events will galvanise Kenyan MPs to do the same, particularly as the conference is supported by Kenya’s Department of Labour and President Ruto is an evangelical Christian with close ties to US conservatives.

Sierra Leone is debating a Safe Motherhood Bill that will allow access to abortion to reduce its high maternal mortality rate.

Meanwhile, Akinfaderin points to several other ‘family values’ conferences in the offing in Africa in the coming months, including the Strengthening Families Conference organised by the Church of Latterday Saints (Mormons) in June in Sierra Leone. FWI’s Slater is a Mormon.

Sierra Leone’s lawmakers are currently considering the Safe Motherhood Bill, which would allow abortion up to 12 weeks (24 weeks in cases of rape, incest or danger to the mother’s health) as a measure addressing the country’s currently high maternal mortality rate. An estimated 10% of maternal deaths are due to now illegal, unsafe abortions. Lobbying by religious anti-abortion groups has thwarted a 2016 initiative to decriminalise abortion in Sierra Leone.

“It’s no mistake that they’re targeting Sierra Leone,” says Akinfaderin.

Where are the pro-family initiatives?

If these organisations and conferences are really pro-family, why are they not promoting policies that support families to thrive, ask the women’s groups and activists?

“Families need food, water, housing, access to healthcare, and protection,” says Saoyo Griffith.

“They should be talking about policies that help individuals to be able to make informed decisions about having children,” says Akinfaderin. “Pro-family policies should be about expanding access to contraception and family planning, assisted reproductive techologies like in vitro fertilisation (IVF), child care services, parental leave, social protection, and ending sexual violence in the home.” 

Women are at the core of families and if MPs want to support families, they should fast-track laws that protect women, such as the East African Community Sexual and Reproductive Health Bill, and laws on sexual offences and policies to extend social protection to single parents, says WBI.

“Families should never be a place where women’s rights are stripped away or where women live as second-class citizens who only exist to serve men. Instead, families should be a place of liberation where women can thrive and live life to the fullest on their own terms,” adds WBI.

Image Credits: Africa News.

Bill Gates observes a device used for analyzing the nutrient qualities of rice during the Innovation Tech & Science Fair in Abuja, Nigeria, on September 4, 2024. ©Gates Archive/Andrew Esiebo

On its 25th anniversary, the Gates Foundation has announced that it is winding down – but in 20 years’ time, during which it expects to spend $200 billion.

“During the first 25 years of the Gates Foundation – powered in part by the generosity of Warren Buffett – we gave away more than $100 billion. Over the next two decades, we will double our giving,” said Bill Gates,  foundation chair in post on Thursday.

“The exact amount will depend on the markets and inflation, but I expect the foundation will spend more than $200 billion between now and 2045.”

The funding pledged exceeds the foundation’s current endowment, with the balance coming over time from Gates’ personal fortune.

‘The man who dies rich dies disgraced’

Gates said he did not want to “die rich”, but that he had initially planned for the foundation to wind down decades after his death.

However, he was influenced by an 1889 essay by Andrew Carnegie called The Gospel of Wealth which “makes the case that the wealthy have a responsibility to return their resources to society” and argues that “the man who dies thus rich dies disgraced.”

This notion is as radical today as Carnegie’s article was then, given the era of widening wealth inequality and the concentration of wealth in fewer and fewer hands.

The foundation’s charter initially stated that the organisation would sunset 20 years after Gates’ death.

“There are too many urgent problems to solve for me to hold onto resources that could be used to help people. That is why I have decided to give my money back to society much faster than I had originally planned,” writes Gates.

“I will give away virtually all my wealth through the Gates Foundation over the next 20 years to the cause of saving and improving lives around the world.”

The foundation intends to “much progress as possible towards three primary goals”:

  • ending preventable deaths of mothers and babies;
  • ensuring the next generation grows up without having to suffer from deadly infectious diseases;
  • and lifting millions of people out of poverty, putting them on a path to prosperity.

Additional areas of focus will continue to be:

  • helping US students to prosperity; 
  • strengthening digital public infrastructure so more people have access to the financial and social services that foster inclusive economies and open, competitive markets
  • applying new uses of artificial intelligence, which can accelerate the quality and reach of services, from health to education to agriculture
  • Lifting up women, their families, and their communities by advancing gender equality to help women access education, health care, and financial services.

“Underpinning all our work—on health, agriculture, education, and beyond—is a focus on gender equality. Half the world’s smallholder farmers are women, and women stand to gain the most when they have access to education, health care, and financial services,” Gates notes.

Parents learn how to access information about contraception on their smartphones during a session on family planning in Makassar, Indonesia.

Urgency and opportunity

This announcement comes in the midst of tens of billions of dollars in cuts to aid funding “that stand to have devastating consequences for the world’s poorest people”, according to the foundation

“The shift in the sunset date is driven by urgency and opportunity. The foundation hopes to capitalise on the extraordinary global progress in health and development between 2000 and 2025—a period when child deaths were halved, deaths from deadly infectious diseases were significantly reduced,” according to a media release from the foundation.

“The needs at this time are greater than any we’ve seen in the lifetime of the foundation, but the achievements of the past 25 years have shown the tremendous progress that is still possible,” said Mark Suzman, CEO and board member of the Gates Foundation. 

Since 2000, the Gates Foundation has contributed to saving 82 million lives through its support for the vaccine alliance, Gavi, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

“Along with Rotary International, we have been a key partner in reviving the effort to eradicate polio. We supported the creation of a new vaccine for rotavirus that has helped reduce the number of children who die from diarrhoea each year by 75%,” wrote Gates.

The foundation has also helped develop more than 100 innovations, including vaccines, diagnostic tools, and treatments to address pressing global health problems.  

“The truth is, there have never been more opportunities to help people live healthier, more prosperous lives. Advances in technology are happening faster than ever, especially with artificial intelligence on the rise,” writes Gates. 

“Even with all the challenges that the world faces, I’m optimistic about our ability to make progress—because each breakthrough is yet another chance to make someone’s life better.

 “The work of making the world better is and always has been a group effort. I am proud of everything the foundation accomplished during its first 25 years, but I also know that none of it would have been possible without fantastic partners,” says Gates. “I believe we can leave the next generation better off and better prepared to fight the next set of challenges.”

Image Credits: ©Gates Foundation/ Prashant Panjiar, Andrew Esiebo/ Gates Archive, Gates Foundation.

WHO Director General Dr Tedros Adhanom Ghebreyesus’ Senior Leadership Team in January 2025.

Samira Asma, assistant director of Data, Analytics and Delivery since 2020, is reportedly leaving WHO in the first of an expected departure of five senior leadership team members as the Organisation sets out to dramatically shrinks its Geneva footprint and staffing. 

Of the existing 11-member team, only six would remain, if a plan shared by Director General Dr Tedros Adhanom Ghebreyesus with WHO Staff and Member States in late April is implemented in full.

The re-organization would shrink WHO’s 10 operations and programme divisions to just four. The office”s of “Chef de Cabinet” (External Relations) and “Chief Scientist” would round out a total of six senior leadership positions, as well as the director general. 

WHO ADG Samira Asma, a US national, has been at WHO since 2018. She previously led NCD and tobacco control work at the US Centers for Disease Control (CDC).

In terms of DDI, not only would the division be eliminated, but its activities would be subsumed into a single department that also includes: “Digital Health, AI, AI and ICD” (International Classification of Diseases) alongside “health metrics.” That carries a mandate so broad as to be difficult to unravel.

It’s also unclear what would happen to WHO’s new World Health Data Hub and Geospatial Centre, featured on the WHO website as a “world class interactive data platform” and a flagship DDI initiative. Despite the time and resources spent, their promised objectives have not, so far, been met, critics say.

But the recent collapse of USAID and probable dissolution of the USAID supported Demographic and Health Surveys series, which financed bread and butter data collection in low- and middle-income countries for decades, may force WHO to go refocus on a much more fundamental task that involves helping the world’s poorest nations report accurate baseline data on key health indicators – also critical to WHO’s mandate tracking the health-related Sustainable Development Goals.  

Question-marks?  

Yukiko Nakatani, ADG of Access to Medicines, is a former director of the Cancer Division in Japan’s Ministry of Health.

According to other still-unconfirmed reports, the pending leadership reshuffle is also likely to see the departure of Yukiko Nakatani, ADG of WHO’s Division of Access to Medicines and Acting ADG for the Division of Antimicrobial Resistance (AMR). Both divisions are to be folded into a consolidated “Health Systems” Division, which will also address a wide range of functions with respect to WHO product standards, health workforce, primary health care, finance and governance; as well as digital health.  

New WHO Organizational plan reduces 10 divisions at headquarters to just four.

Finally, there are question marks over the continued tenure of the ADG for Universal Health Coverage and Life Course, Dr Bruce Aylward, a Canadian physician who played a major role in the early days of WHO’s COVID response, as Tedros’ special advisor at the time. 

Bruce Aylward in February 2020 shows reporters China’s COVID infection curve in relation to lockdown measures – after leading the first WHO delegation to Wuhan.

Aylward has also served in a wide range of WHO roles since first joining in 1992, including as a past leader of polio eradication, Ebola response, WHO Health Emergencies, WHO’s Transformation Initiative, as well as key aspects of the Organisation’s COVID-19 response. Now, the 10 departments of the UHC and Life Course division that he now heads are set to be parcelled out to two other WHO divisions, as well as being merged with other departments. But Aylward is reportedly pushing back against leaving – and no formal announcements have been made yet, even internally.

“To my knowledge there’s been no final decision on the final leadership team,” one WHO insider told Health Policy Watch. “And when you take these political level/appointment roles, you are serving at the DG’s discretion – that is part of the deal.  He’s got to balance a heap of considerations in putting together his team.”

The new WHO austerity plan would also eliminate the role of WHO Deputy Director, now held by Mike Ryan in tandem with his role as Executive Director of WHO’s Health Emergencies Division.

Ryan, however, is likely to continue on in his old role as Health Emergencies Executive Director during this tumultuous phase in WHO’s history, other WHO observers  predicted. This, despite reports a year ago that Ryan, age 60, was considering early retirement. 

Asked by Health Policy Watch for a response to the early reports of the leadership reshuffle, WHO did not comment. As for an official announcement by the Director General of his new team, a WHO spokesperson said:  

“We don’t know ourselves, but we expect it before the WHA”  – referring to the 78th World Health Assembly meeting of WHO member states, which begins on Monday, 19 May. 

EU member states ask if even a $4.2 billion budget is feasible? 

Budget projection and gap from an internal briefing presented to member states in late April 2025.

Along with shrinking the number of divisions in WHO’s Geneva headquarters from 10 to four, the new WHO reorganisation would cut the number of departments at headquarters by roughly half – from 57 full-fledged departments as of January 2025 to around 33, according to the new organigram. The number of directors at headquarters would be slashed by more than half, from 76  to 34, according to Tedros, speaking at a WHO Town Hall on 22 April.

The announcement in January by US President Donald Trump that he was withdrawing support from WHO thrust the global health agency into a deep budget crisis, with roughly 15-20% of the agency’s annual budget dependent on US voluntary and assessed contributions.  

In April, WHO’s leadership revealed that the organisation was facing a $600 million budget deficit for 2025, including a salary gap of about $333 million, one half of that at headquarters. 

For the upcoming 2026-2027 biennium, the problems are even more severe, with an estimated  $1.8-1.9 billion deficit projected over the two-year budget period.  Since the crisis began, WHO officials have reduced their 2026-27 projected budget from $5.3 billion to $4.9 and then $4.2 billion as of May 2025.  

But in a WHO member state briefing on 22 April, European Union member states questioned if even the $4.2 billion budget target is feasible, in light of the current circumstances.   

“Is this a realistic budget scenario? Can WHO advise on progress towards the $1.8 billion target [of additional fund-raising], and provide details on the actions to achieve this?” the 27 EU members asked in a joint statement. 

“The information provided suggests cost savings from reorganisation and administrative cost containment could generate significant additional savings to reduce the financial gap. What are the realistic forecasts for such savings? Can the Secretariat provide details on the amounts expected?” the EU member states asked. 

UNAIDS says no merger with WHO in cards

The EU delegation also called on WHO to “lead” inter-agency reform of the UN’s multiple, and often overlapping, health institutions, in cooperation with the UN Secretary General’s UN80 initiative. Amongst its initiatives, UN80 recently proposed consideration of a merger of the financially troubled UNAIDS with WHO as well as a merger of humanitarian aid operations on the ground.  

“We reiterate our call on WHO to lead the reform of the global health ecosystem with other UN bodies as part of the UN80 initiative and global health actors,” said the EU statement from late April. “We would welcome an update from WHO on the actions undertaken and plans with regard to the coordination of mandates and operations of key actors.”

UNAIDS, however, is pushing back hard against any proposal to fold back into WHO – despite the big financial crisis both agencies face and potential economies of scale.

“No merger is in the cards right now,” UNAIDS spokesperson Charlotte Sector, told Health Policy Watch in an email Wednesday evening, while also confirming the reports Tuesday that UNAIDS would slash its staff in headquarters along with its country presence by half or more:

“UNAIDS will cut its staff from 600 to 280-300. Instead of having a country presence in more than 80 countries, we will now have a presence in half that (35-40),” she said.

But “its mandate remains relevant as long as the epidemic continues,” Sector added, saying:

“In 1996 when AIDS deaths were at their peak, UNAIDS was founded to fill policy gaps and pick up where WHO could not. WHO and the Global Fund and PEPFAR as well as governments use UNAIDS data. UNAIDS also trains community members and others to collect and monitor local, national data.

“We will continue to be the link between communities, governments, donors and the UN as well as the Global Fund. Our data and analysis is key to saving lives because our data steers programmatic work with impact.”

See related story here:

UNAIDS and HIV Sector Struggle Amid Funding Cuts

8.5.2025 -Updated with 7 May link to 2026-2027 programme budget and number of directors WHO’s Director General pledged to reduce.

 

Image Credits: WHO , LinkedIn, LinkedIn, WHO.

Vadym, a Ukranian living with HIV, with a box of ARV medication. Ukraine’s HIV response has been severely affected by the US government’s withdrawal of funds.

As countries dependent on United States aid for their HIV response report looming shortages of antiretroviral medicine, the Joint UN Programme on HIV/AIDS (UNAIDS) is also fighting for survival.

Meanwhile, more shocks may be ahead for the HIV sector as the US Health and Human Services plans to curtail research collaboration between US scientists and foreign researchers, a common occurrence in the HIV sector.

UNAIDS is cutting full-time staff by more than half – from 608 to 280 – and almost halving country offices, from 75 to 36, according to a communique sent to staff, as reported by Devex.

This follows the Trump administration’s decision to end US Agency for International Development (USAID) funds to UNAIDS, which affects around 40% of its budget.

Further cuts may be necessary if a proposal from an internal UN task force is heeded, which would see UNAIDS merging with the World Health Organization, as previously reported by Health Policy Watch.

But Farhan Aziz Haq, deputy spokesperson for the UN Secretary General’s Office, said that the UN restructuring proposals are “the preliminary result of an exercise to generate ideas and thoughts from senior officials”. The UN80 task force will report its final recommendations to the UN General Assembly in 2026.

UNAIDS executive director Winnie Byanyima and International AIDS Society chair Sharon Lewin at the launch of the UNAIDS report in Munich

Medicines, supply chains disrupted

While UNAIDS faces an internal crisis, so too do the countries and communities worst affected by HIV that it serves.

By the end of 2023, 30.7 million people were accessing antiretroviral (ARV) treatment and 61% lived in just 10 countries – South Africa, Mozambique, India, Nigeria, Tanzania, Kenya, Zambia, Uganda, Zimbabwe and Malawi.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) was one of the biggest purchasers of ARVs and the breakthrough injectable ARV, cabotegravir, that prevents HIV infection that was being rolled out as pre-exposure prophylaxis (PrEP).

PEPFAR spent almost $500 million a year on ARVs and PrEP, and any reduction in its orders is likely to push global prices up, yet another obstacle in the fight against HIV.

“Sustained predictability in HIV commodity demand forecasts is essential to guarantee a stable supply, maintain prices, and ensure the availability of affordable generic medicines for national HIV responses,” according to a UNAIDS report issued on 30 April.

PEPFAR also funded ARV supply chains and logistics in many countries, and almost half (46%) of the 56 countries most affected by HIV have reported supply chain disruptions in the past month or so, according to UNAIDS.

By the end of April, seven countries out of the 56 most HIV-affected reported that they had six or less months of stock in at least one antiretroviral line. These are Burundi, Côte d’Ivoire, Ghana, Haiti, Uganda, Ukraine and Zimbabwe.

The Democratic Republic of Congo (DRC), one of the biggest PEPFAR beneficiaries, expects both ARV and condom stockouts in the next three to six months.

It’s antenatal testing of pregnant women, delivery care for women living with HIV, early infant diagnosis and paediatric treatment services are all affected, UNAIDS reported last week.

However, 22 countries said that they were not reliant on PEPFAR funding for ARV procurements but that the loss of funds had disrupted their medicine supply chains.

Focus on ‘key populations’ is lost

The HIV sector’s focus on the “key populations” most vulnerable to HIV is likely to be lost – possibly forever – due to a lack of funds. 

Key populations comprise groups that face heavy stigma – sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs and prisoners. 

HIV is stubbornly high in these groups, who are generally difficult to reach and often face legal barriers to access treatment. 

However, the scientific consensus in the sector is that HIV can only be stopped if it is addressed in these groups – and until Donald Trump became US president, PEPFAR was prepared to fund this approach.

In South Africa, for example, only 17% of the country’s HIV response was covered by PEPFAR, but the vast majority of those funds went to providing services for key populations.

But all PEPFAR-supported services for key populations have been stopped, as these groups are pariahs for Trump Republicans.

So too has a plan to integrate mental health and HIV services, according to Dr Gloria Maimela from the Foundation for Professional Research.

However, South Africa also prioritises young women who are amongst the most vulnerable to HIV, and outreach to them has also been curtailed.

The HIV treatment centre in Bahir Dar in Ethiopia geared to helping young people and key populations has closed.

The situation is similar in Ethiopia, where centres for key populations and young people have closed as staff have not been paid.

Centres offering services to key populations and young people in Bahir Dar to Mikadra, Humera, and Dansha have stopped.

“For two months, no new clients have been enrolled in PrEP, the prevention prophylaxis taken orally that protects from HIV infection. HIV testing has dropped by 43%. More than 800 people have faced treatment interruption. And 215 survivors of gender-based violence have lost access to the support services they once relied on,” according to a UNAIDS report issued last week.

Numerous countries report longer-term closures of certain ARV dispensing points, particularly at community level and those serving key populations, according to UNAIDS

Global PrEP rollout affected

PEPFAR funding covered more than 90% of PrEP initiations globally in 2024, and numerous countries report that they have been unable to sustain high-risk patients on PrEP, including in Guatemala, El Salvador, Haiti, Ukraine, Viet Nam and Zambia.

Last year, PEPFAR purchased 95% of ViiV’s cabotegravir stock for PrEP, but it has not delivered much of this to low and middle-income countries as promised, including to South Africa which was promised 230,000 doses.

“Restrictions in eligibility to access US government-funded HIV prevention commodities effectively leaves out numerous populations at high risk of acquisition,” UNAIDS notes.

HIV-linked commodities such as condoms and opiod replacement medication have also been disrupted thanks to the dominant role of PEPFAR in their  procurement, distribution and delivery.

Close to a quarter (23%) of countries reported six or less months of condom or PrEP stocks.

A recent survey by International Network of People who Use Drugs (INPUD) reports a large-scale suspension of outreach and harm reduction programmes, including needle and syringe distribution, HIV and hepatitis C testing, overdose prevention and legal support services.

Centres distributing opioid agonist maintenance therapy (OAMT) closed for a month in Uganda and Tanzania, for example.

OAMT is often prescribed as oral medication to alleviate the symptoms of withdrawal and reduce injecting drug use. In 2022, the risk of acquiring HIV was 14 times higher for people who inject drugs than the overall adult population.

“Fearing a stock out of methadone–the OAMT medicine–we have witnessed people returning to heroin use and hitting the black market,” Banza Omary Banza, director of Community Peers for Health and Environment Organisation in Tanzania, told UNAIDS.

Millions of lives at risk

While the Global Fund is helping to address some gaps, it is unable to fill the gap left by PEPFAR. 

UNAIDS modelling predicts that the permanent discontinuation of PEPFAR-supported HIV programmes would lead to an additional 6.6 million new HIV Infections (about 2300 per day) and an additional 4.2 million AIDS-related deaths (over 600 per day) by 2029.

Image Credits: The Global Fund/ Saiba Sehmi, Global Fund, UNAIDS.