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. 

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?  

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.  

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. 

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? 

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 and 75 directors as of January 2025 to around 33 departments – depending on exactly how you count the boxes in the organigrams.  

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 $4.9 to $4.2 billion.  

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

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