A transformative journey

The historic transformation journey was kicked off in March 2019 with the launch of a new unified operating model across the three levels of WHO: the 150 country offices, the 6 regional offices and headquarters. It was developed through a period of extensive engagement of WHO staff and consultations with Member States, and a review of lessons learned from previous reform efforts and best practices across the Organization.

In parallel with the Thirteenth General Programme of Work (GPW 13), covering the period 2019–2025, the transformation of WHO was from the outset aimed at aligning all three levels of the Organization to deliver on the ambitious strategic goals of improving health and well-being for all people everywhere.

Since the adoption of the Sustainable Development Goals in 2015, the world has changed – and will continue to change – in fundamental ways that have profound implications for human health and well-being in every country and community, and particularly for the poorest and most vulnerable.

The COVID-19 pandemic highlighted the fragility of health systems worldwide. Major interruptions to essential health service delivery continued after the pandemic. Routine immunization coverage is falling for the first time in three decades: 20 million children missed doses in 2022 alone. Inequities in access to safe, effective, quality-assured and affordable health products persist, especially in low- and middle-income countries. Health and care workforces will have an estimated gap of 10 million personnel globally by 2030.

Climate change and environmental degradation have emerged as major threats to human health in the 21st century. Human migration and displacement have reached unprecedented levels. Demographic shifts with ageing populations and increased urbanization leave basic public services struggling to keep up. Changing geopolitics with a growing number of crises further complicates efforts to leave no one behind. In parallel, scientific and technological advances have brought the world into a new scientific and digital era, with huge potential to further advance human development.

With the central role of WHO in the COVID-19 pandemic, systems put in place under transformation were tested under great pressure. A new level of understanding was achieved globally, from political leaders and the public, about the centrality of health and well-being to social and economic development. The Fourteenth General Programme of Work (GPW 14), covering the period 2025–2028, has been developed based on lessons learned from the COVID-19 pandemic and evaluation of the Thirteenth General Programme of Work.

It will carry forward its three strategic shifts of stepping up WHO’s health leadership, focusing global public goods for health and delivering differentiated country support to drive public health impact in every country.

Building on the first six years of the Transformation Agenda, WHO will continue to transform under GPW 14 through the three overarching objectives that have underpinned the agenda.

The first is to ensure that the Organization is fully focused and aligned for impact at the country level. Anchored in the strategic shifts and novel results-based framework of GPW 13, this has included introducing the output scorecard to measure organizational performance and new approaches to impact measurement to institutionalize a culture of measurable results and data-driven ways of working. Changes to planning, budgeting and implementation processes, such as three-level output delivery teams, have also been introduced to facilitate a coordinated approach across the Organization. Several key WHO processes continue to be improved as part of the Transformation, including a new Business Management System (BMS) and an integrated and professionalized supply chain.

The second objective has been a strong focus on changes to enable the full potential of WHO to provide authoritative advice and leadership on critical health matters in a rapidly changing environment. As part of the Transformation, the position of Chief Scientist was created in 2019 to consolidate, lead and coordinate WHO’s vast scientific and research capacities. The data and analytic strengths of WHO have been developed, including through the new World Health Data Hub, to better support countries and build capacity in priority areas such as health emergency preparedness and response; antimicrobial resistance; and on diversity, equity and inclusion.

The new three-level operating model, launched in 2019, aimed to flatten hierarchical structures, break silos, optimize managerial spans of control and enable more seamless and agile ways of working across the Organization. The roles and responsibilities at each level of WHO were clearly delineated, and the structures of WHO’s headquarters and regional offices were aligned around four pillars (programmes, emergencies, external relations, business operations) to enhance collaboration. In 2023 WHO started rolling out a new country-level operating model to substantially strengthen core capacities in WHO’s 150 country offices, and this will be further enhanced under GPW 14.

The third objective of the Transformation agenda, leveraging partnerships to fully engage the global community, has elevated and professionalized WHO’s engagement for health in multilateral forums through the establishment of an Envoy for Multilateral Affairs and a strengthened WHO Office at the United Nations in New York. The WHO Civil Society Commission and the WHO Youth Council were created in 2023 as new mechanisms for drawing on the expertise of the key constituencies of civil society and young people.

A milestone of GPW 13 and the Transformation Agenda was achieved with the historic decisions and commitment of Member States in 2022 to incrementally increase assessed contributions to eventually cover the equivalent of 50% of the 2022–2023 base budget by the biennium 2028–2029, and to undertake an investment round in 2024 to further broaden the financing base.

Underpinning the entire Transformation Agenda process is the work to ensure that WHO has a diverse, motivated, empowered and fit-for-purpose workforce – WHO’s most important asset. Key changes already introduced as part of the Transformation have been the establishment of a new career pathways model, strengthening of internship and mentoring opportunities, and new flexible working arrangements.

Going forward, new mechanisms to support geographical mobility of WHO staff will continue to be rolled out, and new contractual modalities will be introduced to ensure greater equity, transparency and fairness for the entire WHO workforce, while better supporting WHO’s business needs. Under GPW 14, WHO will develop an ambitious people strategy and take further initiatives to institutionalize change management in the Organization.