The World Health Organization (WHO) is confronting an unprecedented financial crisis, with a projected shortfall of $2.5 billion for the 2025–2027 period. In his official remarks to the Programme, Budget and Administration Committee (PBAC) on 14 May 2025, WHO Director-General Dr Tedros Adhanom Ghebreyesus stated that the Organization may be forced to close certain country offices as a cost-saving measure, a signal of just how serious the current funding crisis has become.

In addition, senior WHO officials have also spoken recently about the possibility of moving more key WHO functions and staff from Geneva headquarters to WHO regional or country offices, both as a cost-saving measure and to be more responsive to needs at the grassroots.  So a closer look at WHO’s country office structure is important to evaluate if, how, and in what way such shifts might make sense programmatically as well as economically.

110 WHO country offices – dispersed in countries rich and poor

WHO currently operates 110 country and territorial offices globally. Among these, at least 11 high-income countries (HICs) host full-fledged WHO country or liaison offices, such as Cyprus, Greece, Chile, Uruguay, and Panama, as well as several Eastern European states.

In addition to these formal offices, WHO also maintains technical hubs, project offices, or collaborating centres in other high-income settings, including Denmark, France, Germany, Italy, Japan, South Korea, the United Kingdom, and the United States, in addition to its headquarters in Geneva, Switzerland.

Taken together, this amounts to 17 WHO institutional outposts in HICs, when counting both full-fledged country offices and other technical or liaison presences.

In addition, WHO has 36 offices in upper-middle-income countries (UMICs), such as Argentina, Brazil, China, Indonesia, Mexico, South Africa, and Turkey.

The health body has offices in 57 lower-middle-income countries (LMICs), including India, Bangladesh, Kenya, Nigeria and Nepal, according to publicly available data on WHO’s country presence portal and World Bank income classifications. Many of the latter are large-scale operations that play critical roles in strengthening national health systems.

Traditionally, countries host WHO offices through basic legal agreements, which grant privileges but rarely entail financial responsibilities. In practice, WHO is usually left to fully fund its own in-country presence.

Particularly for high-income countries, this is no longer sustainable in light of the current budget crisis. And even in the case of middle-income countries, an argument can be made for recruiting more national support to WHO country offices, especially when many host governments, some with substantial fiscal capacity, leave large portions of their national health budgets unspent each year.

When Contributions Fund the Contributor: The HIC Paradox

In high-income countries (HICs), the conversation around WHO country office sustainability should begin not with unspent national health budgets, which are closely monitored nationally, but with a sharper look at how much of the country’s assessed contribution to WHO is being consumed by maintaining their own WHO office.

While data on country office costs are not always available, an analysis of selected offices, in comparison with available data, suggests that some HICs hosting WHO country offices are effectively seeing a significant share of their own assessed contributions to WHO consumed in maintaining those offices.

This raises questions about equity and strategic allocation of WHO resources in a time of budget constraints.

For example, this analysis found that of five HIC countries considered, all had country offices financed by the equivalent of half or more of their assessed contributions. In the case of Cyprus and Panama, most of the assessed contribution was spent, effectively, on the country office.

While exact breakdowns of country office costs remain limited due to confidentiality or aggregated budget reporting, it appears that at least in some countries, a considerable portion of HIC contributions to WHO may be locally absorbed in cases where country offices are maintained – limiting the net benefit to global health of country contributions.

In these contexts, a paradox emerges: a portion of these countries’ assessed contributions, meant to support global health efforts, is effectively recycled to maintain WHO’s presence in their own territory. This raises legitimate questions about cost-efficiency and fairness, particularly when lower-income countries face operational cuts to WHO support that is often vital to their national health systems.

The paradox of unspent national budgets and an underfunded WHO

A similar, though more complex, case can be made for certain upper-middle-income countries (UMICs)—such as Mexico, Brazil, or China—which have increasing fiscal capacity, growing health budgets, and an ability to co-finance WHO presence.

While in the case of MICs, it could be argued that host governments simply can’t afford to support WHO country offices, in light of their own significant public health needs, data from WHO’s Programme Budget Portal and the World Bank provides a somewhat different narrative.

That data reveals that quite a few UMIC and LMIC host governments consistently leave large portions of their health budgets unspent – even while WHO country offices in those same countries face curtailed operations due to the budget crisis.

Unspent National Health Budgets (%) by Country

This paradox becomes even more striking when comparing these unspent funds with WHO’s modest operating budgets in those countries.

Unspent Health Budget vs WHO Country Office Budget by Country

This comparison, based on budget figures, shows that in countries like Brazil, Egypt, and Mexico, WHO’s country office budget accounts for less than 5% of their unspent national health budgets, demonstrating potential fiscal space to fully support WHO’s presence.

Even in more financially strained countries, such as Pakistan or Kenya, WHO’s needs represent only a modest share of what goes unused.

Why a new cost-sharing model is urgent and fair

These findings underscore the importance of considering a new cost-sharing model for WHO’s country office presence – one that looks transparently at costs versus ability to pay and ensures all countries, especially those with fiscal space, contribute to WHO not just as hosts, but as true global stewards.

It also underscores the need, as the WHO Director General has rightly asserted, to reassess whether WHO presence in HICs is cost-efficient and programmatically justified when compared with needs in lower-income settings.

But rather than arbitrary office closures, a transparent assessment should first be undertaken to evaluate:

• How much each HIC’s country office cost relative to its assessed contribution?
• What is the critical regional or global health mission of the WHO country offices located in HICs, and could funds spent there be more effectively used to support countries with urgent health capacity gaps?
• In the case of UMICs, and some LMICs, what is the fiscal space, based on unspent health expenditures or other indicators for exploring cost-sharing arrangements?

Other UN agencies have embraced cost-sharing frameworks

Other UN agencies have already embraced cost-sharing frameworks with host countries.

For example, in 2023, UNICEF required 23 UMIC host countries to cover 30–100% of their office operational costs, including Brazil and Mexico contributing 40% toward local staff salaries. In Turkey, the government financed 40% of UNICEF’s Syrian refugee health response (UNICEF Executive Board Report, 2023).

WHO has lagged behind in this regard. While WHO Member States have committed to incrementally increasing assessed contributions to cover 50% of the organization’s core budget by 2030, progress has been slow. WHO Director-General Dr. Tedros Adhanom Ghebreyesus has publicly stated that “WHO cannot fund itself to perform its mandate,” and has called for sustainable financing.

The time has come for a clear, equal cost-sharing model across all income groups based on the principle that every host country, whether HIC, UMIC, or LMIC, should contribute to WHO’s operating costs, based on its capacity.

High- and upper-middle-income countries should provide full or majority financial support to country offices based there. Lower-middle-income countries may contribute partially, in-kind, or through shared infrastructure support.

Countries that host WHO offices, especially those with significant unspent health funds, should consider that supporting WHO’s presence is not a budgetary burden, but a strategic investment in global and national health security. The alternative is an organization diminished in reach and relevance, unable to operate effectively where it’s needed most.

This model reflects a principle of shared responsibility, while still recognizing economic diversity. Countries like India, South Africa, Thailand, and Mexico, each with substantial national health budgets, regional leadership roles, and established WHO country offices, are well-positioned to illustrate how contributions from LMICs and UMICs can be both feasible and impactful.

No health without sustainable finance

WHO’s country offices have played indispensable roles, from controlling pandemics and delivering vaccines to strengthening primary health systems and guiding policy.

But the idea that WHO alone should shoulder the financial burden of country offices from its central budget allocations is outdated.

As the 78th World Health Assembly (WHA) opens in May 2025, Member States have an opportunity to consider this issue, the status quo, and potential alternatives, including a capacity-based cost-sharing model.

Any discussion of the division of budget responsibility should also be accompanied by a review of accountability mechanisms. Basic agreements between WHO and host countries must ensure that country offices retain their independence, not always a given even today. WHO country offices should be funded and empowered to act on behalf of the Secretariat, in response to country needs, while maintaining their distinct institutional mandate.

With the pending WHO reorganization and the likely relocation of certain HQ functions to the country or regional level, it’s a timely moment to take a closer look at how country offices are budgeted, governed, and empowered. Their future, as one of WHO’s core pillars of delivery, will depend not only on technical necessity but on whether Member States are willing to back that presence with a financing model grounded in both equity and economic realism.

Pragyan Ghale is a global health policy consultant, affiliated with the  Public Health and Infectious Diseases Research Center (PHIDReC), Nepal. He holds a master’s degree in Global Health Policy from the London School of Economics and Political Science (LSE). 

Image Credits: WHO Nepal / Facebook post, WHO Assessed Contributions (2024–2025); WHO Voluntary Contributions – Specified; WHO Programme Budget Portal., Photo credit: WHO Nepal / Facebook post.