When the World Health Organisation (WHO) elects its next Director-General in 2027, member states will also be weighing proposals to reshape the broader global health architecture. Development aid is shrinking, the United States has withdrawn from WHO, and governments are increasingly asking international agencies to align behind national health plans.
National plans can provide a common framework for governments, donors, and development partners. But a plan alone cannot guarantee that funding reaches frontline facilities, that clinics are properly staffed, or that patients receive quality care. The next Director-General must demonstrate how WHO can help countries not only design ambitious plans but also finance and deliver the outcomes those plans promise.
Tedros Adhanom Ghebreyesus has strengthened WHO’s capacity for collective action. Under his leadership, the organisation expanded pandemic intelligence, scientific guidance, workforce training, and support for technology transfer. Member states amended the International Health Regulations, adopted the Pandemic Agreement, and committed to increasing assessed contributions.
Having guided WHO through the COVID-19 pandemic, Tedros also inherited the difficult aftermath. Funding reductions have left the organisation with fewer staff and a smaller budget to sustain many of the gains achieved during that period.
As of 31 March 2026, only 73% of WHO’s 2026-27 base budget had been financed, and just 41% was expected to be funded through flexible contributions. While earmarked funding keeps many programmes running, it often leaves critical gaps in independent technical guidance and country support.
The challenge extends far beyond WHO. Development assistance across all sectors declined by 23.1% in real terms in 2025. Meanwhile, the World Bank projects that reductions in aid could outweigh increases in domestic health spending, leaving 80% of low-income countries and 40% of lower-middle-income countries with less combined government and donor funding in 2030 than they had in 2024.
This reality makes transition planning more important than ever. Before external funders withdraw, countries and partners must identify who will finance treatment, immunisation, disease surveillance, and other essential services. The US-Nigeria health agreement offers one example, preserving significant bilateral support while Nigeria gradually increases domestic health expenditure.
The Accra Reset panel has proposed a simple principle: “One Plan. One Budget. One Platform.” Building on the Lusaka Agenda and Africa CDC’s efforts to strengthen national ownership and regional capacity, the proposal seeks greater alignment across the global health ecosystem.
Yet major institutions, including Gavi, the Global Fund, development banks, and bilateral donors, still operate through separate grant cycles, procurement rules, and reporting requirements. Their governing boards retain the authority to harmonise these mechanisms around costed national programmes. That work should advance in parallel with the wider global health architecture review commissioned at the Seventy-Ninth World Health Assembly, whose recommendations will be considered in 2027.
Nigeria illustrates just how demanding genuine coordination can be. The National Health Sector Renewal Investment Initiative and Health Renewal Compact bring together primary healthcare, financing, workforce development, health security, and local manufacturing and supply systems under a single framework.
The expanded Compact assigns responsibilities across federal, state, and local governments while also incorporating development partners and civil society within a sector-wide approach. Joint reviews and independent verification mechanisms help reinforce accountability. Even so, no federal agreement can by itself recruit health workers, stock medicines, or ensure the release of state budget allocations.
Progress is nonetheless visible. By October 2026, the National Health Insurance Authority reported that 80,000 women had received emergency maternal care by August, while health insurance enrolment surpassed 23 million by September.
The more important lesson, however, is not the numbers themselves but the accountability model behind them. Effective reform means tracking resources from allocation to release and from release to service delivery. It requires assessing service quality and asking whether households can genuinely afford care. WHO can help countries adopt common metrics and independent oversight mechanisms, while ensuring that the consequences of unmet commitments are visible to those who control financial resources.
The Seventy-Ninth World Health Assembly also adopted an ‘Economics of Health for All’ strategy, providing health ministers with a stronger framework for engaging finance and planning authorities on investment, growth, and financial protection. Its revised code on international recruitment of health workers likewise encourages destination countries to invest measurably in the health systems that train the professionals they recruit.
Nigeria’s Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) offers another useful lesson by linking procurement, regulation, and industrial policy within a single conversation. Regional manufacturing and pooled procurement can strengthen health systems, but only if regulatory institutions guarantee quality and purchasers have access to reliable products at affordable prices.
Meanwhile, negotiations on the benefit-sharing annex remain incomplete, preventing the Pandemic Agreement from opening for signature. Although the agreement envisions rapid financing support at the onset of health emergencies, the proposed coordinating mechanism still requires clear operational rules and dependable funding.
The next Director-General should therefore bring governments and financing institutions together around plans that are fully costed, tested, and actionable. These plans should include sustained investment in surveillance systems and laboratory networks, predefined triggers for releasing emergency funds and procuring medical supplies, equitable access to diagnostics, vaccines, and treatments, and safeguards to ensure continuity of routine health services during outbreaks.
WHO’s 2025-28 programme already recognises the interconnected nature of modern health challenges, including climate-related risks, prevention, primary healthcare, financial protection, and emergency preparedness. The next Director-General must now help member states distinguish between the technical functions that require reliable, predictable funding and the country-level activities that WHO is uniquely positioned to deliver.
Among the seven candidates currently seeking the office, several themes are emerging. Belgium’s Hans Kluge advocates stronger country offices and more flexible financing. Saudi Arabia’s Hanan Balkhy emphasises scientific independence, emergency preparedness, and regional capacity. Indonesia’s Health Minister, Budi Gunadi Sadikin, highlights WHO’s convening power in support of costed national plans and regional procurement cooperation.
Qatar’s Hanan Mohammed Al-Kuwari calls for a more independent and sustainably financed WHO, alongside a review of the organisation’s three-tier structure. Spain’s María Neira places prevention and environmental health at the centre of her vision. Armenian paediatric oncologist Gevorg Tamamyan has stressed the importance of patient outcomes. China’s Song Li has been presented by her government as a strong advocate for multilateral cooperation, although a detailed public programme has yet to emerge.
Despite their differences, all candidates face the same fundamental challenge: explaining how WHO will finance its core functions while influencing the grant and investment decisions that shape health outcomes in lower-income countries.
Many of the governments that vote on WHO’s budget also sit on the boards of Gavi, the Global Fund, and major development banks. Nigeria’s Health Compact provides a practical framework for comparing the policies they approve with what actually happens on the ground: whether budgets are released, whether care improves, and whether households can afford essential services.
The next Director-General should extend that level of scrutiny beyond Nigeria. WHO’s own country support should be assessed alongside donor grants and public spending, creating a clearer line of sight between commitments, financing, implementation, and results. That is ultimately the lesson Nigeria offers the world: health reform succeeds not when plans are written, but when promises are funded, delivered, and measured.
Chinedu Moghalu is a lawyer, strategic communications expert, and public policy adviser with over two decades of leadership across government, international organisations, and development institutions. Currently, senior special adviser to Nigeria’s Coordinating Minister of Health and Social Welfare.
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