A new, and near final iteration of WHO’s reorganization will shrink its programme divisions even further than previous drafts – from 10 to only four – with health systems emerging as one key pillar of the revamped organization. 

At the same time, disease control departments and preventive health teams – such as health promotion and environment, climate and health, will all fall under one division – for the first time in years, according to a copy of the plan, obtained by Health Policy Watch.   This is in contrast to a previous “straw draft” that that had etched out five divisions, including health systems and health workforce rolled into a division with environment and health promotion. 

And along with the four mainstream divisions – the office of the Chief Scientist and “Chef de Cabinet, i.e. external relations,” would be retained as separate entities. 

The new plan for WHO’s headquarters, which boasts 34 departments as compared to nearly 60 now, was presented by WHO Director General Dr Tedros Adhanom Ghebreyesus to both WHO staff as well as to WHO member states at separate, closed sessions on Tuesday. 

Key takeaways from the latest plan include the combining of HIV and TB operations – two political powerhouses with deeply interlinked patterns of prevention, diagnosis and treatment that could generate co-benefits from a merger. There’s also the apparent disappearance of the health and migration department, which had been preserved in earlier iterations, under the now-extinct division of Healthier populations. Antimicrobial resistance (AMR), previously paired with One Health as a department in Healthier Populations, is now in Health Systems, on its own. One Health is relegated to yet another team or unit in the Department of Environment, Urban Health and Climate Change.  Critics will find that the decision to treat AMR strictly as a health sector issue ignores mounting evidence about the deep interlinkage between AMR prevention, One Health and environment – including the urgent need to address animal health – particularly the livestock sector – which consume the lion’s share of the world’s antibiotics.  

No projection about numbers of staff to remain in Geneva

Tedros made no projections as to how deeply WHO’s staff at headquarters, now numbering 2,600 people, would have to be slashed – although observers have said it could be by more than 40% in light of the fact that WHO’s Geneva-based operations also have the highest costs and the deepest deficit.

The new plan also does not relate explicitly to the possibility, discussed previously, of relocating some headquarters departments or teams wholesale to a WHO regional office. Polio eradication, however, remains a separate department under the Office of the Director General, leaving relocation as a possibility, at least in theory. And WHO’s head of Business Operations, Raul Thomas, also affirmed at the Town Hall meeting that regional relocation remains a possibility – even if the functions remain under a headquarters-based division. 

“There is a committee that is looking into what programmes can be relocated, how we can make synergies across the organization, relocating a programme from x, to y, on the …basis that programme continues to be a headquarters progamme, it does not become regional, and what kinds of synergies regions can make in terms of technical support – and how regions can capitalize on the fact that they have that support closer to the countries, and with reduced travel costs, ” Thomas said. 

Globally, WHO faces a looming $600 million budget shortfall for 2025 and a $1.9 billion budget gap for the 2026-2027 biennium budget of $4.2 billion – following January’s announcement by US President Donald Trump that he intends to withdraw from the global health agency.  Although that withdrawal would not formally take effect until January 2026,  the United States has so failed to pay its dues for 2024, even before January’s change in administration, and is unlikely to do so now, WHO officials have conceded.  

Opportunity from crisis

Despite the stark shortfall, Tedros sought to put a more optimistic light on the crisis, noting that by 2030-31, member state assessed contributions to WHO would nearly double, from $895 million in 2024-25 to $1.7 billion in 2030-31 – even without the United States’ participation.   

“The refusal of the U.S. to pay its assessed contributions for 2024 and 2025, combined with reductions in official development assistance by some other countries, means we are facing a salary gap for the 2026–27 biennium of between US$ 560 and US$ 650 million,” Tedros said, addressing member states just after the staff Town Hall. 

“This is the reality we are facing, and which is driving the prioritization and realignment, the new structure, and the reduction in our workforce – although when we do this, we see it as an opportunity to change the organization. However, we need to realize that this reality would have been much worse if Member States had not agreed to increase assessed contributions progressively to 50% of our budget – and we thank you for that historic commitment.”

That’s providing that WHO member states continue to honour that commitment to gradually raise the level of member state assessments, as per a WHA decision reached in 2023.  At the upcoming World Health Assembly, May 19-27, WHA members will be asked to approve yet another stepwise increase in assessed contributions.  

Another report to go before this year’s WHA shows member states in arrears by more than $215 million on their payment of 2024 assessed contributions – of which the United States’ portion comprises only about one quarter, or $58 million.  Member states voting rights can be temporarily suspended, if payments aren’t made.

Along with that WHO remains heavily reliant on voluntary contributions, which amounted to some $2.5 billion in 2024, including $446 million in donations from the United States.

New senior leadership team by end April, directors in May

As next steps, the new division heads at Headquarters would likely be named by the end of April, Nicollier said. 

That would be followed by the appointment of directors of the surviving departments at headquarters and at Regional Offices over the course of May, in line with Division head recommendations and an Ad Hoc Review Committee.  Directors not retained at headquarters or in Regions would be offered reassignment elsewhere. 

In March, Health Policy Watch published an investigation of WHO’s dramatic expansion of high-level directors (D2) positions between 2017, when Tedros first took office and 2024, estimating that their costs amount to nearly $100  million annually, worldwide.  However, directors at headquarters whose posts are cancelled will have to be offered jobs found elsewhere, if they are on long-term contracts, as most are.  See related story.

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

Drilling down further over the course of June and July, detailed department organizational charts for each department would be developed – with a “matching and mapping” exercise to choose staff for the positions that remain. 

For rank and file staff, as well, Nicollier pledged to honor existing contract terms – which mean that staff on long-term (continuing) contracts or fixed-term contracts for more than 10 years would be offered reassignment and relocation options if their current post is abolished.  He also pledged to involve the WHO staff and its Staff Association in the next stages of the “matching and mapping” exercise. 

Senior Leadership – competency versus political balance? 

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.

But with senior leadership at headquarters being reduced from 11 to just six officials, not including the Director General, the next big question looming in the minds of WHO staff, member states and observers is who will remain? 

“There is no problem in merging and going back to a simpler organizational map, like at the time of [former WHO Director]  Margaret Chan. It’s a critical time, putting together prevention, control and response is not a problem,” said a WHO senior scientist, who spoke with Health Policy Watch on condition of anonymity.  “The problem is that we still don’t really know yet what functions or teams (out of nearly 60) will be prioritized or deprioritized.” 

“And now more than ever, with just seven senior staff, including the DG, Chief Scientist, Chief of Cabinet, and four Division heads, and in a time of crisis, we need to make sure that this new WHO leadership has the reputation and clout to represent WHO.   

“But because Tedros needs to go for a balanced team in terms of gender, geographical representation, etc, I’m afraid that the selection could wind up being one that doesn’t represent the organization as well – simply because some members of his existing team are  not perceived as strong leaders.”

WHO staff are also asking questions about why the Organization wasn’t able to anticipate the crisis earlier – given the fact that US President Donald Trump’s election occurred in November 2024 – and his hostility to WHO was a known factor even before the decision in January to withdraw. 

“There are many other questions about why we reached this point, without an earlier analysis of the situation.  What are the lessons that we need to learn?” said one staff member.  

“It’s been four months, and now what we have is just an organigram.” 

-Updated Wednesday, 23 April with the published text of the WHO Director General’s remarks to member states.

Image Credits: Salvatore di Nolfi/EPA, WHO, WHA78/A78_23, WHO .