The number of WHO programme divisions would be reduced from 10 to just five and the number of directors in headquarters would shrink from nearly 80 to around 30 in an emergency reorganisation plan reviewed by the agency’s executive management group at a closed-door retreat on Saturday.   

The plan, to be presented to member states this week, also proposes to move some departments housed in Geneva to WHO’s Regional Offices, where costs are far less, or HQ outposts away from Geneva even if the operations remain associated with headquarters. 

Examples include a possible move of WHO’s entire polio operation to the Eastern Mediterranean Regional Office in Cairo; the region is responsible for Afghanistan and Pakistan which are the only countries where transmissions of wild poliovirus still continues. Similarly, there are discussions about moving WHO’s Department of Traditional Medicine to India, a leader in the field, and so on. 

Other core functions or departments might be moved out of Geneva to satellite offices elsewhere in Europe, so that they can remain in proximity to headquarters, without the associated costs. Along with its regional office in Bonn, WHO already has offices or research centres in Lyon, Germany, Italy, and Denmark. Other venues could also be considered, sources told Health Policy Watch. 

But even these dramatic steps, informed observers say, will not be enough to generate the savings required to cover an expected $600 million budget deficit for 2025, along with a projected $1.9 billion gap for the upcoming budget biennium of 2026-2027 triggered by the United States’ withdrawal from the organisation in January.  

And given that the lion’s share of the WHO deficit is in its Geneva headquarters, it’s expected that staff there will likely have to be reduced by some 40% or more, from more than 2,600 people today to around 1,400-1,500 employees – some of whom may also be re-assigned to satellite offices.  

Perform, Power, Promote, Provide and Protect

The latest iterations of the WHO “straw draft” organigram, seen by Health Policy Watch on Friday, included two highly similar options presented to Saturday’s meeting of WHO’s executive leadership. The leadership will fine-tune a final option prior to the presentation of the plan to member states, in a meeting set for this week.  

Both options model WHO’s new organisation around five “P’s” said to embody the agency’s internal functions and external mission. They include: perform, power, promote, provide and protect.

The focus of each WHO division, follows intuitively from those keywords. Science, data and medical product standard-setting is centred in the “power” division; environment, nutrition, sexual and reproductive health, and health promotion fall under “promote. Communicable and non-communicable diseases, as well as the health systems and workforce are clustered in “Provide”, while health and humanitarian emergencies fall under “protect.”

The reorganisation would roll back WHO’s lumbering bureaucracy from today’s nearly 60 programme departments to about 32, slashing the number of directors as well. In the January 2025 organigram directors of departments and special programmes housed at Headquarters numbered 63. According to the last WHO Workforce Data report, of July 2024, however, there were around 80 D1 and D2 directors based at headquarters – more than the number of departments and programmes to be managed.

On a global level, the swollen number of senior directors together with even higher-earning division heads, regional directors, and the director general and his deputy, have been costing the organisation nearly $100 million a year, a 10 March Health Policy Watch investigation found.

EXCLUSIVE: Number of WHO Senior Directors Nearly Doubled since 2017, Costs Approach $100 million

Back to basics?

The new reorganisation, while seemingly radical, would in fact bring the agency’s core functions back to a template similar to the one that was left by WHO’s previous Director General Dr Margaret Chan, when she finished her 10-year tenure as head of the agency in July 2017. 

During her second five-year term in office, Chan, who ran a fiscally conservative administration, pared down operations at headquarters from eight to five divisions in a model that is not dissimilar to those featured on the “straw drafts” circulating over the past two weeks. 

After July 2017, the agency swelled in numbers of directors, departments and divisions – as well as staff and consultants – during the “Transformation” initiated by  Chan’s successor, Dr Tedros Adhanom Ghebreyesus.  

Ostensibly, that transformation aimed to shift more resources in countries and regions. It also created a new Science division, welcomed by many as a forward-looking measure that could consolidate many of WHO’s standard-setting functions with new challenges in digital health and AI. 

But as per the Health Policy Watch assessment in March, the transformation also saw the multiplication of departments and divisions at headquarters, adding costs to WHO’s uppermost layers. 

The number of WHO’s top-ranked directors (D2), nearly doubled to 75, with most of those costs associated with new or upgraded posts at headquarters. 

Along with being expensive, WHO’s new organisation turned out to be a rather cumbersome  beast, neither easy to grasp or entirely logical. WHO staff themselves often stumble over both the names and the focus of three core divisions, all bearing mutations of “Universal Health Coverage (UHC)” in their titles.  There were fears that the broad distribution of divisions and departments fostered more siloed functions, as compared to a more interdisciplinary approach to global health challenges.   

Embedded within the large and complex structure, whole new teams were created, such as the Office of the Deputy Director General, which were then equipped with significant staff – over two dozen people, according to the last detailed organigram of the DDG’s office published in 2019.   

Staff protests and discontent?

The draft new organisational mapping, while simpler, may also correct some of those knock-on effects, although it will have big political ramifications, as well, if adopted.

For instance, the deputy director general and his office is not mentioned at all in the latest iterations. Does that mean the current DDG, Mike Ryan, might even return to his previous position as executive director of health emergencies, should the new plan be implemented? Or will he possibly retire as he was rumoured to be planning two years ago?  That remains to be seen.   

What’s clear is that the tremors will be felt well beyond the senior leadership of the organisation as the cuts that Tedros pledged would “start” at the top and ripple downwards into the staff rank and file. 

A WHO Staff Association Open House is planned for Thursday to take up the issue of the pending changes, none of which have yet been discussed with Staff Association representatives. 

The Staff Association also is considering a pre-emptive, class action suit to ensure that staff rights are protected, one insider told Health Policy Watch. In 2018, staff pursued a similar action to protest a planned 7% reduction in take-home pay based on what they contended was an erroneous cost-of-living adjustment for Geneva based professional staff – and were successful.  UN-wide revisions in cost of living scales that were subsequently made, and approved by WHO’s Executive Board in February, did not result in any net loss in pay.

“Tedros, in his Town Hall presentation to staff [2 April], promised to make cuts based on functions, not based on contracts,” the source explained. “OK, you can cut the functions, but at the end of the day, WHO staff on long-term (continuing) contracts should get the first priority for the jobs that are left; those on fixed term (1-2 years), come next; then temporary staff (less than one year); and then consultants – who should go altogether. 

“The main issue is that there still is no transparency,” one WHO staff member complained. “So many people are going to lose jobs. And there are a lot of eyes on Tedros. At the end of the day, the buck stops with him.” 

–Updated 14.04.2025 to note that a member state meeting on the reorganization is expected to be held this week.

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