Lessons for the Next WHO Leader from Nigeria's Health Changes

When the World Health Organization (WHO) picks its next director-general in 2027, countries will also look at ways to change the global health system. Aid is decreasing, the United States has pulled out of WHO, and governments want international agencies to work through their national plans. While such a plan can bring public authorities and partners together, it cannot guarantee that money gets to clinics or that patients receive good care. The new director-general must show how WHO helps countries finance and deliver what their plans promise.

Tedros Adhanom Ghebreyesus has made WHO’s tools for collective action stronger. WHO has improved pandemic intelligence, scientific guidance, workforce training, and support for technology transfer. Countries updated the International Health Regulations, adopted the Pandemic Agreement, and agreed to increase their contributions. Tedros led WHO during COVID-19. The funding cuts that followed have left the organization with fewer staff and a smaller budget to keep that work going.

As of March 31, only 73 percent of WHO’s 2026, 27 base budget was financed. Just 41 percent was expected to be financed flexibly. Earmarked contributions support programs but leave gaps in independent guidance and country support. Outside of WHO, development assistance fell by 23.1 percent in real terms in 2025, across all sectors. The World Bank warns that aid cuts could be more than rising government health spending. This could leave 80 percent of low-income countries and 40 percent of lower-middle-income countries with less combined government and donor funding in 2030 than in 2024. Before a funder withdraws, a planned shift from external support must figure out who will pay for treatment, immunization, and surveillance. The US, Nigeria health agreement keeps substantial bilateral support while Nigeria promises to increase its own health spending.

The Accra Reset panel suggests “One Plan. One Budget. One Platform.” This builds on the Lusaka Agenda and the Africa CDC’s focus on country priorities and regional capacity. Still, Gavi, the Global Fund, development banks, and bilateral donors use different grant cycles, purchasing rules, and reporting systems. Their boards control these terms and can align them with national programs that have costs. Meanwhile, the wider architecture review from WHA79 is working on recommendations for the 2027 Assembly.

WHA79 has accepted an Economics of Health for All strategy. This gives health ministers a way to engage finance and planning authorities on investment and financial protection. The updated health-worker recruitment code encourages countries to invest measurably in the systems that train the staff they hire. Nigeria’s Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) combines procurement and regulation into one discussion.

Nigeria shows how much coordination a country plan needs. Its National Health Sector Renewal Investment Initiative and Health Renewal Compact connect primary care, financing, workforce development, health security, and local supply. The expanded compact shares responsibilities among federal, state, and local authorities, partners, and civil society. This is done through a sector-wide approach with joint reviews and independent verification. Yet, a federal agreement alone cannot staff a clinic or release a state budget.

By October 2026, the National Health Insurance Authority reported that 80,000 women had received emergency maternal care by August. Insurance enrollment exceeded 23 million by September. The important lesson is about accountability: track allocations through releases to services, check the quality of those services, and see if households can afford them. WHO can help countries use similar measures and independent checks, then show the results of missed commitments to those who control the money.

WHA79 adopted the Economics of Health for All strategy, giving health ministers a way to engage finance and planning authorities on investment and financial protection. Its amended health-worker recruitment code encourages measurable investment by destination countries in the systems that train the staff they recruit. Nigeria’s Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) brings procurement and regulation into the same discussion. Regional production and pooled purchasing will strengthen health systems only when regulators can ensure quality and buyers can secure reliable products at prices they can afford.

The benefit-sharing annex is still not finished, which stops the Pandemic Agreement from opening for signature. Its financing plans expect surge support at the start of an emergency, but the coordinating mechanism still needs operating rules and guaranteed finance. The next director-general should unite governments and existing funds around costed plans. These should include continuous surveillance and laboratories, agreed triggers for releasing funds, procuring medical supplies, fair access to diagnostics, vaccines, and treatments, and keeping routine care going during an outbreak.

Many governments that vote on WHO’s budget also sit on the boards of Gavi, the Global Fund, and development banks. Nigeria’s Compact allows them to compare the terms they approve with state budget releases, the quality of care, and what households pay. The next director-general should extend that scrutiny beyond Nigeria, with WHO’s own country support examined alongside the grants and public budgets that national plans rely on.

WHO’s 2025, 28 program includes health risks from climate change, prevention, primary care, financial protection, and emergencies. The next director-general will need to show member states which technical functions need reliable funding and which country activities WHO is best suited to handle.

Among the seven candidates listed by WHO, Belgium’s Hans Kluge proposes stronger country offices and more flexible finance. Saudi Arabia’s Hanan Balkhy emphasizes scientific independence, emergency readiness, and regional capacity. Indonesia’s health minister, Budi Gunadi Sadikin, would use WHO’s role to support costed national plans and regional cooperation on procurement. Qatar’s Hanan Mohammed Al-Kuwari calls for an independent, sustainably financed WHO and a review of its three levels. Spain’s María Neira highlights prevention and environmental health. The Armenian pediatric oncologist, Gevorg Tamamyan, has called for more focus on patient outcomes. China’s Song Li is presented by her government as a supporter of multilateral cooperation, but a detailed public program has not yet been shared. Each candidate must explain how WHO would finance its core functions and influence grant decisions that affect poorer countries.

Many of the governments that vote on WHO’s budget also sit on the boards of Gavi, the Global Fund, and development banks. Nigeria’s Compact gives them a basis for comparing the terms they approve with state budget releases, care quality, and what households pay. The next director-general should carry that scrutiny beyond Nigeria, with WHO’s own country support examined alongside the grants and public budgets on which national plans depend.