Devex CheckUp: WHO has undertaken massive reforms. Are they enough?

How do you solve a problem like the World Health Organization?

It depends on what problem you’re talking about because the agency has plenty, as my colleague Jenny Lei Ravelo reports. WHO remains top-heavy and overly reliant on a handful of donors while continuing to face growing allegations of sexual exploitation and abuse.

This is despite specific attempts to address the horrific problem of harassment and abuse, alongside broader reform efforts that include revamping WHO’s organizational infrastructure, strengthening its country offices, and pursuing nearly 100 reforms focused on transparency, efficiency, and effectiveness.

There’s no doubt that funding remains a huge — if not the biggest — problem. For its investment round that ends in May 2025, WHO has so far raised nearly $1.7 billion. Even with other funding sources, this is still far from the $7.1 billion the agency was looking for.

The unprecedented fundraising effort was launched to give WHO more flexibility and to free it from the priorities of specific donors and the accusations, driven by U.S. President Donald Trump, that the organization lacks any independence. Whether the initiative will actually succeed remains to be seen. But consider that the U.S. withdrawal from the agency leaves it facing a $600 million shortfall this year, even as Trump continues to accuse WHO of being a Chinese puppet.

Staff reforms could possibly help to reduce this crisis, particularly if the agency could get rid of underperforming people who have stuck around too long. There is a push to reduce an expanding number of high-level officials, while focusing on strengthening local and regional offices in line with localization goals. But all of that is easier said than done in the bureaucracy of a U.N. agency.

The agency has allocated the largest portion of its flexible funding to its country offices —  a signal of how seriously it takes the goal of localization.

Meanwhile, the ongoing allegations of sexual abuse and harassment continue to chip away at the integrity of the organization. Agency officials stress that they are taking these issues seriously and that an increase in reported cases of harassment and abuse of authority “is a good thing in itself” because it shows increased staff confidence in the system. But even their own staff are demanding more.

In a perverse way, the withdrawal of the United States from WHO will force the institution to confront many of these issues, particularly the questions around funding. But the future of the organization is still very much up in the air.

Read: Inside WHO’s reforms — progress, failures, and unfinished business

Background reading: Tedros refutes Trump’s claims of WHO’s lack of independence

What not to do

In Washington, there seems to be a general agreement among lawmakers that the President’s Emergency Plan for AIDS Relief cannot last forever. That is the $110 billion program that has saved the lives of 25 million people living with HIV.

After more than 22 years, lawmakers at a National Security, Department of State, and Related Programs Subcommittee meeting Tuesday made it clear that they wanted to see governments take more responsibility for funding their own response. Or potentially seek out other sources.

It now becomes a question of how fast that transition takes place and how to effect it in a way that doesn’t undo decades of progress. If that’s the goal, then the Trump administration definitely doesn’t have the right approach. Here in Uganda, the freeze on foreign funding has left many PEPFAR programs suspended, despite a waiver that allows the resumption of lifesaving treatment and a few other initiatives.

Instead, on Tuesday, experts presented an idea of developing compacts with governments that would slowly ease them off of PEPFAR and into a more sustainable future.

Read: PEPFAR at crossroads — lawmakers debate future of global AIDS program

More with less

As the Trump administration axes global health programs, the European Commission has made it clear that no one should look to them to fill all of the funding gaps. But they do have concerns, which may translate into actually meeting some of those needs.

My colleague Vince Chadwick got access to a memo from Koen Doens, the director-general of the commission’s development department, who laid out his chief concerns about the U.S. funding retreat, including around global health.

Top of the list was the impact on programs that address disease outbreaks with pandemic potential, followed closely by efforts to strengthen country abilities to prevent, prepare, and respond to pandemics. No surprise that Europe does not want to contend with an outbreak of Ebola or Marburg. Doens also expressed concern about the future of the response to other infectious diseases such as HIV, tuberculosis, and malaria.

Doens suggested that if the commission steps in, there might even be opportunities to achieve greater efficiency than the United States. Time will tell.

Exclusive: How Europe is planning for life after USAID (Pro)

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A treaty, at last?

After three years of negotiations, could a pandemic treaty finally arrive ahead of the upcoming World Health Assembly in May? In an opinion piece for Devex, Alexandra Finch, Lawrence O. Gostin, and Dame Barbara Stocking say it is possible, but only if some final hurdles can be overcome.

The parties still haven’t come to an agreement on what steps they are willing to commit to when it comes to pandemic prevention. The global south wants to avoid anything too specific unless those measures come with funding commitments, for instance.

The issue of voluntary versus obligatory technology transfer also remains contentious, as does how to actually set up an equitable pathogen sharing system.

Finch, Gostin, and Stocking have ideas for how all of these issues can be resolved to keep the parties on track to finally reaching an agreement.

Opinion: Failing to finalize a pandemic treaty is not an option

Before it’s too late

It will not shock readers of this newsletter that women make up the majority of the global health workforce. The official rate is 70%. With the cuts to global aid, they face a double crisis: The potential loss of jobs or salary, as well as the rollback of investments in gender equity.

Women are already being employed in positions that are not as well recognized as their male counterparts and that pay worse.

Aid cuts inevitably mean that women will be asked to take on more work for potentially less money, as Dr. Shubha Nagesh and Dr. Magda Robalo explain in a recent Devex opinion piece. In addition, initiatives to point out the value and increase the pay for the jobs women are doing will also be reduced during a global aid downturn.

You should read the piece for important suggestions on how not only to avoid some of these repercussions, but to actually strengthen support for female health workers around the world at this time.

Opinion: Women health workers face a double bind as aid dwindles

What we’re reading

Israel appears to have executed 15 Gaza aid workers and buried them in a mass grave, despite traveling in clearly marked ambulances and fire trucks with their emergency lights on. New videos contradict Israeli claims about the incident. [The New York Times]

As wealthy countries cut aid, women face rapidly escalating rates of dying during pregnancy and childbirth. [The Guardian]

Cuts to USAID have devastated services for pregnant women in Afghanistan, including forcing the closure of more than 200 health facilities. [NPR]