The (WHO) is a specialized agency of the responsible for international public health, established on April 7, 1948, following the adoption of its constitution at the International Health Conference in New York in 1946 [1]. Headquartered in , Switzerland, WHO operates through a decentralized structure with six regional offices—, the , , , the , and the —and maintains country offices in 166 of its 194 member states [2]. Its core mandate is to promote health, keep the world safe from health threats, and serve vulnerable populations by setting global health standards, coordinating responses to pandemics, and advancing universal health coverage (UHC) [3]. WHO plays a central role in global health governance through its leadership in the International Health Regulations (IHR) (2005), which legally bind 196 countries to detect, report, and respond to public health emergencies of international concern (PHEIC), such as the COVID-19 pandemic and the 2024 mpox outbreak [4]. The organization’s governance is led by the World Health Assembly (WHA), its supreme decision-making body, and the Executive Board, while day-to-day operations are managed by the Secretariat under the Director-General, currently [2]. WHO’s funding model combines assessed contributions from member states and voluntary contributions, with major donors including the and the , though this reliance on earmarked funding has raised concerns about strategic autonomy [6]. To strengthen emergency response, WHO launched the Health Emergencies Programme and the Global Health Emergency Corps, and it coordinates rapid deployments through the Global Outbreak Alert and Response Network (GOARN) [7]. WHO also shapes the global research agenda, promotes health equity, and addresses social determinants of health through initiatives like the Commission on Social Determinants of Health, while advocating for gender equity, climate-resilient health systems, and ethical governance during crises [8].
History and Establishment
The (UN) established the World Health Organization (WHO) as a specialized agency responsible for international public health in the aftermath of World War II, reflecting a broader global commitment to peace, cooperation, and human well-being [9]. The organization was formally created to address the recognition that health challenges—such as infectious diseases, maternal and child health, and environmental risks—transcend national borders and require coordinated, multilateral action. This foundational principle emerged from earlier international health initiatives and culminated in the drafting of the WHO Constitution during the International Health Conference in New York in 1946, where representatives from 61 countries participated in shaping the agency’s mandate [1].
The official establishment of WHO occurred on April 7, 1948, when its constitution came into force after ratification by 26 member states [11]. This date is now commemorated annually as World Health Day, symbolizing the global commitment to health for all. Although legally established in April, WHO officially began its operations on September 1, 1948, marking the start of its active role in global health governance [1]. The organization’s headquarters were established in , Switzerland, a city already hosting key international institutions, which facilitated diplomatic engagement and multilateral coordination [13].
The primary motivations for establishing WHO included the need for a permanent, authoritative body to set global health standards, coordinate responses to pandemics and health emergencies, promote disease prevention and health promotion, support countries in strengthening health systems, and address global health inequities [14]. From its inception, WHO focused on major public health campaigns, including efforts to eradicate diseases like malaria and smallpox, combat tuberculosis and venereal diseases, and improve maternal and child health outcomes. Over time, its mandate has expanded to encompass noncommunicable diseases, mental health, the health impacts of , and emergency preparedness and response, reflecting the evolving nature of global health threats [3].
The creation of WHO was also a strategic move within the emerging post-war international order, aligning with the broader mission of the UN to promote peace and sustainable development. As a specialized agency, WHO operates under the UN’s overarching framework while maintaining autonomy in technical and health-related decision-making. Its constitutional authority grants it the role of the directing and coordinating authority on international health, enabling it to shape the global health research agenda, articulate evidence-based policy options, and provide technical support to member states [16]. This foundational role positions WHO as a central actor in advancing health as a fundamental human right and ensuring that all people, regardless of geography or socioeconomic status, can achieve the highest attainable level of health and well-being.
Governance and Organizational Structure
The governance and organizational structure of the World Health Organization (WHO) is designed to ensure effective global leadership in public health while maintaining accountability to its 194 member states. This structure combines intergovernmental decision-making with technical expertise and decentralized operational capacity, enabling WHO to coordinate international health efforts, respond to emergencies, and support national health systems. The organization operates through a hierarchical yet collaborative framework composed of its supreme decision-making body, an executive oversight body, a central secretariat, and a network of regional and country offices.
World Health Assembly: Supreme Decision-Making Body
The World Health Assembly (WHA) serves as the highest governing authority of WHO and is composed of delegations from all 194 member states. It convenes annually in Geneva, typically in May, to set the organization’s policies, approve the programme budget, and provide strategic direction [17]. The WHA derives its authority from the WHO Constitution, which establishes it as the ultimate policy-making entity within the United Nations (UN) specialized agency for health [18].
Key functions of the WHA include determining global health policies, reviewing and adopting the biennial programme budget, appointing the Director-General for a five-year term, and supervising the work of the Executive Board [17]. The Assembly also plays a critical role in adopting international legal instruments, such as amendments to the International Health Regulations (IHR) (2005), which require formal approval by member states to become binding under international law [20].
Decisions within the WHA are typically made by consensus, reflecting the diplomatic norms of multilateral health governance aimed at preserving unity and inclusivity. However, when consensus cannot be reached, voting may occur, with a simple majority required for most matters and a two-thirds majority for constitutional or financial issues [21]. Member states influence global health policy by proposing agenda items, sponsoring draft resolutions, and engaging in negotiations through regional groups such as the African Union, European Union, and ASEAN to build broad coalitions [22].
Executive Board: Technical Oversight and Implementation
The Executive Board, composed of 34 technically qualified members elected by the WHA, functions as an intermediary body between the Assembly and the Secretariat. These members serve staggered three-year terms and are selected to represent the main geographical regions of the world, ensuring equitable regional representation [23]. The Board is responsible for implementing the decisions and policies set by the WHA, preparing agendas for Assembly sessions, and providing ongoing oversight of WHO’s activities between annual meetings.
The Board plays a crucial role in reviewing technical reports, evaluating program performance, and advising on financial and administrative matters. It also examines proposed resolutions before they are presented to the WHA and monitors the implementation of adopted policies. Through its technical expertise and regional balance, the Executive Board ensures continuity in governance and helps translate political mandates into actionable strategies [24].
Secretariat and Leadership
Day-to-day operations of WHO are managed by the Secretariat, headquartered in Geneva, Switzerland, under the leadership of the Director-General. The current Director-General is , who was appointed by the WHA in 2017 and re-elected for a second term in 2022 [2]. The Director-General serves as the chief technical and administrative officer of the organization, responsible for executing policies, managing staff, and representing WHO in global health diplomacy.
As part of ongoing reforms to enhance efficiency and responsiveness, the WHO headquarters has been restructured to streamline operations. As of 2025, the headquarters was reorganized from 10 divisions into 4 major clusters—focusing on health systems, emergencies, science, and external partnerships—with 34 departments to improve coordination and reduce bureaucratic fragmentation [26].
Regional and Country-Level Structure
WHO operates through a decentralized structure to ensure effective engagement with member states at regional and national levels. The organization is divided into six regional offices, each tailored to the specific health challenges and priorities of its region:
- Africa (AFRO) – Based in Brazzaville, Republic of the Congo
- The Americas (PAHO) – Based in Washington, D.C., United States (also known as the Pan American Health Organization)
- South-East Asia (SEARO) – Based in New Delhi, India
- Europe (EURO) – Based in Copenhagen, Denmark
- Eastern Mediterranean (EMRO) – Based in Cairo, Egypt
- Western Pacific (WPRO) – Based in Manila, Philippines
These regional offices adapt global health strategies to local contexts, coordinate technical programs, and support emergency response within their respective regions [27].
At the country level, WHO maintains a network of country offices in 166 of its 194 member states, with 153 physical offices as of 2025 [28]. Each office is led by a WHO Representative who acts as the principal liaison with national health authorities, providing technical assistance, monitoring health trends, supporting policy development, and coordinating emergency preparedness and response efforts [29].
Integration of Technical and Diplomatic Functions
WHO’s governance structure reflects a balance between scientific independence and diplomatic accountability. While the Secretariat provides evidence-based technical guidance, final decision-making authority rests with member states through the WHA and Executive Board. This duality ensures that public health recommendations are informed by science while respecting national sovereignty and geopolitical realities [30].
The organization also practices global health diplomacy, engaging in negotiations and consensus-building to advance health objectives in politically sensitive contexts. The Director-General plays a key diplomatic role, advocating for health at the highest political levels and appointing special envoys to promote priority agendas such as pandemic preparedness and health equity [31]. WHO has published tools such as A Guide to Global Health Diplomacy to strengthen the capacity of stakeholders to navigate complex political environments while advancing public health goals [32].
Governance Reforms and Accountability Mechanisms
In response to critiques of inefficiency and lack of transparency, WHO has undertaken governance reforms to enhance accountability, decision-making speed, and strategic coherence. The Agile Member States Task Group has proposed improvements to budgetary and programmatic governance, including stronger oversight by governing bodies and more inclusive engagement throughout the policy cycle [33].
To strengthen institutional integrity, WHO has updated its rules of procedure, adopted digital platforms for greater accessibility, and enhanced oversight mechanisms. The WHO Evaluation Office conducts independent assessments to promote evidence-based decision-making and organizational learning, while the Office of Compliance, Risk Management and Ethics ensures adherence to ethical standards [34]. Performance reporting through WHO Results Reports enables transparency in demonstrating impact to member states and donors [35].
Core Functions and Global Health Leadership
The (WHO) serves as the directing and coordinating authority on international health within the system, entrusted with a core mandate to promote health, keep the world safe from health threats, and serve vulnerable populations globally [16]. As a specialized agency, WHO provides strategic leadership on global health matters, shapes the international research agenda, sets evidence-based norms and standards, and offers technical support to countries in strengthening their health systems [37]. Its leadership role is reinforced by its constitutional authority to guide global health policy and coordinate multilateral responses to shared health challenges, ensuring coherence between national actions and global objectives [16].
Norm-Setting and Global Health Standards
A cornerstone of WHO’s leadership is its function in setting international health standards and legal frameworks. The most significant of these is the —a legally binding instrument adopted by 196 countries to prevent, detect, and respond to public health emergencies of international concern (PHEIC) [4]. The IHR requires member states to report potential PHEICs to WHO within 24 hours and to maintain core surveillance and response capacities. Amendments to the IHR, adopted in 2024 and entering into force in 2025, strengthened provisions for transparency, data sharing, and equitable access to medical countermeasures [40]. These updates were informed by lessons from the and aim to enhance global preparedness and accountability [41].
WHO also develops evidence-based guidelines for disease prevention, treatment, and health system performance. These include clinical protocols, vaccine recommendations, and standards for laboratory biosafety and antimicrobial resistance. By establishing global norms, WHO ensures consistency in public health practices and supports countries in aligning their policies with best practices [37].
Strategic Leadership and Global Health Diplomacy
WHO exercises leadership through active global health diplomacy, engaging governments, multilateral institutions, civil society, and the private sector to advance shared health goals. The Director-General plays a key diplomatic role, advocating for health at the highest political levels and appointing special envoys to promote priority agendas such as pandemic preparedness and health equity [31]. The organization’s launch of “A Guide to Global Health Diplomacy” underscores its commitment to building capacity for multilateral cooperation, particularly during crises [32].
The WHO’s governance structure ensures member state ownership and strategic direction. The —comprising all 194 member states—is the supreme decision-making body, responsible for setting policies, approving the program budget, and appointing the Director-General [17]. The , composed of 34 technically qualified members, implements WHA decisions and provides ongoing oversight [23]. This intergovernmental framework enables consensus-based decision-making on critical issues such as universal health coverage (UHC), antimicrobial resistance, and health equity [47].
Shaping the Global Research Agenda
WHO plays a pivotal role in identifying priority areas for health research and promoting innovation. It supports the development and equitable distribution of medical technologies, including vaccines, diagnostics, and therapeutics. During the , WHO facilitated global collaboration through initiatives like the , which accelerated the evaluation of potential treatments [48]. The organization also promotes equitable access to countermeasures via the , a global initiative co-led by WHO, Gavi, and the [49].
In 2023, WHO launched the to enhance genomic surveillance, enabling rapid detection of emerging variants and supporting the development of targeted interventions [50]. This initiative reflects WHO’s commitment to leveraging science and technology to strengthen global health security.
Coordination of International Health Efforts
WHO coordinates international responses to global health challenges through a combination of normative functions, technical assistance, and emergency response mechanisms. It supports countries through , which align national health priorities with global goals and WHO’s strategic objectives [51]. These strategies are developed in consultation with governments and partners, ensuring context-specific, results-driven interventions.
WHO also fosters strategic partnerships through formal collaborations with over 800 worldwide and alliances with organizations such as Gavi, the Vaccine Alliance, and the [52]. These partnerships enhance technical capacity, resource mobilization, and program implementation, particularly in low- and middle-income countries.
Monitoring and Assessing Health Trends
WHO collects, analyzes, and disseminates global health data to track disease patterns, evaluate health system performance, and inform policy decisions. It operates the , which provides real-time data on infectious diseases and public health events [53]. The organization also maintains the , which tracks health spending across countries and supports monitoring of progress toward UHC and the [54].
To assess national preparedness, WHO implements the , which includes tools such as the and [55]. These assessments help identify gaps in surveillance, laboratory capacity, and emergency response, guiding targeted technical support and capacity-building efforts [56].
Leadership in Universal Health Coverage and Health Equity
WHO leads global efforts to achieve , ensuring that all individuals and communities have access to essential health services without financial hardship. This includes strengthening health systems, expanding access to medicines and skilled health workers, and promoting financial protection [57]. The organization positions as the foundation of equitable and resilient health systems, advocating for integrated, people-centered services that close the gap between public health and clinical care [58].
WHO also advances global health equity by addressing social determinants of health such as poverty, education, and environmental factors. Through the , it has emphasized that health inequities are avoidable, unfair, and unjust—thereby framing their elimination as an ethical imperative [8]. The organization promotes a human rights-based approach to health, ensuring that policies are grounded in principles of justice, non-discrimination, and accountability [60].
Emergency Response and Pandemic Preparedness
The World Health Organization (WHO) plays a central role in global emergency response and pandemic preparedness, coordinating international efforts to detect, assess, and respond to public health threats that cross borders. Through a combination of legal frameworks, technical networks, and operational systems, WHO aims to minimize the health impacts of outbreaks, natural disasters, and humanitarian crises while advancing global health security and equity.
International Health Regulations and Global Governance
A cornerstone of WHO’s emergency response framework is the International Health Regulations (IHR) (2005), a legally binding instrument adopted by 196 countries to prevent, detect, and respond to public health emergencies of international concern (PHEIC) [4]. The IHR mandates that member states develop and maintain core public health capacities in surveillance, laboratory systems, points of entry, and rapid response, ensuring they can report potential PHEICs to WHO within 24 hours of assessment [62]. The regulations were significantly amended in June 2024 through Resolution WHA77.8, with the updated version entering into force on September 19, 2025, enhancing provisions for transparency, data sharing, and equitable access to medical countermeasures [63]. These amendments introduced a new definition of a pandemic emergency, strengthened solidarity mechanisms, and established new committees to improve implementation [41]. Despite their binding nature, the IHR lack a centralized enforcement mechanism, relying instead on political will, peer accountability, and monitoring tools such as the State Party Self-Assessment Annual Report (SPAR) and Joint External Evaluation (JEE) to assess national capacities [65]. As of 2024, 99% of WHO Member States submitted SPAR reports, with a global average capacity score of 64%, indicating progress but persistent gaps, particularly in low- and middle-income countries [66].
Emergency Response Mechanisms and Rapid Deployment
WHO coordinates emergency responses through a structured operational framework, including the Emergency Response Framework (ERF) 2.1, updated in 2024, which guides grading, activation, and scaling of responses based on severity [67]. The organization monitors global health events in real time through its Strategic Health Operations Centre (SHOC) and the Emergency Operations Centre Network (EOC-NET), enabling rapid risk assessment and coordination [68]. A key operational tool is the Global Outbreak Alert and Response Network (GOARN), a collaborative network of over 310 institutions—including public health agencies, laboratories, and non-governmental organizations—that mobilizes multidisciplinary teams for rapid deployment during outbreaks [69]. GOARN has conducted approximately 3,600 deployments since its inception, supporting responses to major crises such as Ebola, Zika, and the COVID-19 pandemic [70]. The network is coordinated by an Operational Support Team (OST) in Geneva and governed by a Steering Committee (SCOM), ensuring 24/7 readiness and strategic alignment [71]. In May 2023, WHO launched the Global Health Emergency Corps (GHEC) to standardize and strengthen the global emergency workforce, which was activated for the first time in October 2024 during the 2024 mpox outbreak [72]. Additionally, WHO leads the Global Health Cluster, coordinating over 900 health partners during major emergencies to ensure unified action [73].
Pandemic Preparedness and Strategic Reforms
WHO’s approach to pandemic preparedness has evolved significantly in response to major health crises. The 2014–2016 Ebola outbreak exposed critical weaknesses in global response capacity, prompting the establishment of the Health Emergencies Programme (WHE) in 2016 to unify outbreak response functions under a single accountable structure [74]. This reform included the creation of a $100 million contingency fund and a global health reserve workforce of 1,500 trained personnel to enable faster mobilization [75]. The COVID-19 pandemic further tested and reshaped WHO’s emergency architecture, highlighting challenges in timely reporting, equitable access to vaccines, and adherence to the IHR [76]. In response, WHO emphasized continuous learning through After-Action Reviews (AAR) and Intra-Action Reviews (IAR), enabling real-time evaluation and refinement of response strategies [77]. As the acute phase of the pandemic subsided, WHO transitioned toward long-term disease management, issuing guidance in 2023 and 2025 to integrate COVID-19 into routine health systems and sustain vaccination programs [78]. The Strategic Plan for Coronavirus Disease Threat Management (2025–2030) promotes sustainability, integration, and equity in global health security [79].
Data-Driven Response and Surveillance Systems
WHO leverages data-driven approaches to guide public health interventions during emergencies. The WHO Integrated Data Platform (WIDP) consolidates outbreak and health system data from multiple sources to support situational awareness and decision-making [80]. A key digital tool is Go.Data, an open-source platform launched in 2019 for managing outbreak investigations, contact tracing, and transmission chain visualization [81]. In April 2024, WHO transitioned Go.Data into a fully open-source tool, enhancing its accessibility and adaptability [82]. Complementing this, the WHO Global Surveillance and Monitoring System tracks infectious diseases in real time, while the Global Influenza Surveillance and Response System (GISRS) enables timely vaccine strain selection [83]. In 2023, WHO launched the Global Network for Pathogen Genomics to enhance genomic surveillance and support rapid diagnostics and countermeasure development [50]. Despite progress, challenges remain in data interoperability, legal frameworks for cross-border sharing, and equitable access to data infrastructure, particularly in resource-limited settings [85].
Ethical and Equitable Response Frameworks
WHO balances public health imperatives with individual rights through a human rights-based approach, emphasizing that emergency measures must be proportionate, transparent, non-discriminatory, and subject to regular review [86]. The organization provides ethical guidance on public health and social measures (PHSM) such as lockdowns and travel restrictions, advocating for social protection policies to mitigate unintended harms on vulnerable populations [87]. During the COVID-19 pandemic, WHO promoted equitable access to vaccines through the COVAX Facility, opposing vaccine nationalism and advocating for fair allocation based on need [88]. The 2025 adoption of the WHO Pandemic Agreement by the World Health Assembly (WHA) marked a landmark step toward strengthening global equity in access to vaccines, therapeutics, and diagnostics, and enhancing preparedness for future pandemics [89]. This agreement, developed alongside the IHR amendments, aims to reinforce international cooperation, data sharing, and solidarity in global health governance [90].
Funding and Financial Sustainability
The financial sustainability of the World Health Organization (WHO) is critical to its ability to fulfill its mandate of promoting global health, preventing disease, and responding to public health emergencies. WHO’s funding model is built on a dual structure that combines assessed contributions from member states and voluntary contributions from governments, private foundations, and international institutions. This hybrid approach enables both stable core funding and targeted support for specific initiatives, though it also presents challenges related to predictability, flexibility, and strategic autonomy [6].
Assessed Contributions: Core and Predictable Funding
Assessed contributions represent the mandatory dues paid by WHO’s 194 member states, calculated based on each country’s economic capacity—primarily gross national income (GNI)—and population size. These funds form the foundation of WHO’s regular budget, providing a stable and predictable source of financing for core functions such as normative work, surveillance, and technical support to countries. As of the 2024–2025 biennium, assessed contributions accounted for approximately 20% of the organization’s total budget [6]. The approved budget for this period was US$6.83 billion, reflecting a significant increase from previous cycles and signaling member states’ growing recognition of the need for robust health governance [93].
A landmark decision by the World Health Assembly (WHA) in May 2025 approved a 20% increase in assessed contributions for the 2026–2027 budget cycle, marking a strategic shift toward greater financial sustainability [94]. This reform aims to reduce the organization’s dependence on volatile voluntary funding and enhance its ability to act independently in line with global health priorities rather than donor interests. The long-term goal, set in 2022, is to raise assessed contributions to cover up to 50% of WHO’s base budget by 2030, a move that would significantly strengthen its operational and financial resilience [95].
Voluntary Contributions: Flexibility and Challenges
Voluntary contributions constitute the majority of WHO’s funding—around 80%—and are provided by member states, philanthropic organizations, and multilateral institutions. These funds can be either earmarked (restricted to specific programs or emergencies) or flexible, allowing WHO greater discretion in allocation. Flexible funding, such as contributions to the Core Voluntary Contributions Account (CVCA), is particularly valuable as it enables rapid response to emerging health threats and supports essential functions like the Health Emergencies Programme [96].
While voluntary funding allows for targeted interventions and innovation, its earmarked nature can distort WHO’s strategic priorities, often favoring high-profile diseases or donor-preferred initiatives over foundational public health functions such as surveillance, laboratory capacity, or health system strengthening [97]. This donor-driven model has raised concerns about the organization’s ability to maintain programmatic independence and address underfunded but critical areas of global health.
Key Contributors and Funding Trends
The largest financial contributors to WHO include the United States, which historically has been the top donor, contributing approximately $958 million during the 2024–2025 period—about 18% of total funding [98]. The Bill & Melinda Gates Foundation is a major non-state donor, contributing around $646 million in the same period, making it one of the most significant funders overall [98]. Other major government donors include the United Kingdom, Germany, Japan, and Norway, while international institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, also play key roles in financing global health initiatives through WHO partnerships [52].
Despite these contributions, geopolitical developments can impact financial stability. In early 2025, the United States announced its intention to withdraw from WHO, a move that could affect future funding and cooperation [101]. Such decisions underscore the vulnerability of WHO’s financial model to shifts in national policy and the importance of diversifying funding sources.
Reforms and the Path to Sustainable Financing
Recognizing the limitations of its current funding structure, WHO has launched several initiatives to improve financial sustainability and accountability. The organization has promoted the expansion of core voluntary contributions and thematic funding mechanisms to increase financial agility and reduce reliance on restricted grants [96]. In 2022, the WHA endorsed a strategic goal to increase assessed contributions, and the 2025 budget approval marked a major step toward this objective [95].
The Agile Member States Task Group has proposed governance reforms to enhance transparency, streamline planning, and strengthen long-term strategic prioritization [33]. Additionally, WHO has introduced digital platforms for budget tracking and performance reporting, such as the Programme Budget Digital Platform, to improve accountability and stakeholder engagement [105].
Emergency and Pandemic Financing
In response to growing health threats, WHO has established dedicated financing mechanisms for emergencies. The Contingency Fund for Emergencies (CFE), with a $100 million reserve, enables rapid deployment of resources during outbreaks [75]. The Health Emergency Appeal mobilizes additional funds for specific crises, such as the 2024 mpox outbreak, during which the newly activated Global Health Emergency Corps (GHEC) was deployed for the first time [72].
Negotiations for a WHO Pandemic Agreement, adopted in 2025, aim to strengthen global preparedness by establishing binding commitments on data sharing, equitable access to medical countermeasures, and financing mechanisms for future pandemics [89]. This agreement, alongside the 2024 amendments to the International Health Regulations (IHR), represents a transformative effort to create a more equitable and resilient global health architecture [109].
In conclusion, while WHO’s current funding model enables broad global health action, its reliance on voluntary, often earmarked contributions poses risks to strategic independence and long-term planning. Ongoing reforms to increase assessed contributions, enhance financial transparency, and strengthen emergency financing are critical to ensuring that WHO can continue to lead effectively in an era of complex and interconnected health challenges. The success of these efforts will depend on sustained political will, equitable resource allocation, and a collective commitment to global health as a public good.
Universal Health Coverage and Health Systems Strengthening
The World Health Organization (WHO) plays a central role in advancing universal health coverage (UHC) and strengthening health systems globally, particularly in low- and middle-income countries (LMICs). UHC is a core strategic goal of WHO, defined as ensuring that all individuals and communities have access to essential health services without suffering financial hardship [57]. This vision aligns with Sustainable Development Goal 3 (SDG 3), which calls for healthy lives and well-being for all at all ages, and is underpinned by the principle that health is a fundamental human right [111].
Primary Health Care as the Foundation for Resilient Health Systems
WHO positions primary health care (PHC) as the cornerstone of equitable, resilient, and efficient health systems. The organization promotes a comprehensive, integrated, and people-centered PHC approach that ensures individuals receive coordinated care throughout their lives, close to home [58]. This model emphasizes prevention, promotion, treatment, and rehabilitation within communities, reducing fragmentation and improving continuity of care.
Key to this effort is the Operational Framework for Primary Health Care, adopted by the World Health Assembly (WHA), which translates the PHC vision into actionable steps for countries [113]. WHO also published Implementing the Primary Health Care Approach: A Primer in 2024, synthesizing global evidence and country experiences to guide reforms in governance, health financing, workforce development, and service delivery [114]. These frameworks support the integration of public health functions with clinical care to advance both UHC and health equity primary health care.
Technical Assistance and Capacity Building in Low- and Middle-Income Countries
WHO delivers targeted technical assistance to strengthen health system functions in LMICs, where disparities in access and quality of care are most pronounced. This includes support in disease-specific areas such as scaling up HIV testing and treatment, where WHO has provided implementation guidance in 18 countries to ensure equitable access to evidence-based services [115]. The organization also strengthens healthcare-associated infection surveillance through mentorship, training, and tools to improve patient safety in resource-limited settings [116].
To enhance supply security and affordability, WHO supports the local production of medicines and diagnostics through the Health Technology Access Programme (HTAP) and specialized technical assistance to manufacturers in LMICs seeking to meet international quality standards [117][118]. These efforts are critical for building self-reliance and reducing dependence on global supply chains, particularly during emergencies.
Health Financing Reforms for Equity and Financial Protection
WHO supports countries in designing and implementing health financing reforms that promote equitable access and protect populations from catastrophic health expenditures. A major focus is reducing out-of-pocket payments, which affect one in four people globally and push millions into poverty annually [119]. WHO advocates for prepayment mechanisms, risk pooling, and increased public funding to ensure that essential services are accessible at the point of care without financial barriers.
The organization provides analytical tools such as the Health Financing Progress Matrix to help countries assess the maturity of their financing systems and identify reform priorities [120]. WHO also supports political economy analysis to understand the institutional and political factors influencing reform success [121]. In response to global funding shortfalls, WHO has issued guidance urging governments to safeguard health budgets and strengthen domestic resource mobilization, especially in the face of economic shocks [122].
Strengthening Health Information Systems and Equity Monitoring
Effective health systems rely on robust data for decision-making. WHO supports countries in strengthening health information systems (HIS) through tools like the Support Tool to Strengthen Health Information Systems and the SCORE technical package, which standardize data collection and improve system performance [123][124]. Instruments such as the Service Availability and Readiness Assessment (SARA) and the Facility Assessment Tool enable countries to evaluate service delivery capacity and continuity of essential services [125][126].
To advance health equity, WHO has developed the Health Inequality Monitor (HIM), the largest global repository of health inequality data, which tracks disparities across income, education, gender, and geography [127]. The Operational Framework for Monitoring the Social Determinants of Health Equity (2024) provides methodological guidance for collecting and using disaggregated data to inform targeted interventions [128]. These tools are essential for identifying who is being left behind and ensuring that policies address the root causes of inequity.
Strategic Partnerships and Multisectoral Action
WHO fosters strategic partnerships to scale up support for UHC. The UHC Partnership, hosted by WHO and supported by over 50 partners, operates in more than 115 countries, providing technical expertise and facilitating policy dialogue to strengthen health systems [129]. The Partnership supports national UHC agendas through tailored assistance in planning, financing, and service delivery, with a focus on equity and inclusion [130].
Recognizing that health outcomes are shaped by factors beyond the health sector, WHO promotes Health in All Policies (HiAP) approaches. This framework institutionalizes equity and human rights across government sectors such as education, housing, labor, and environment, ensuring that policies contribute to healthier populations [131]. The 2023 publication Working Together for Equity and Healthier Populations outlines strategies for sustainable multisectoral collaboration, emphasizing that health equity is a shared responsibility [132].
Building Resilience and Addressing Structural Inequities
In response to global health emergencies such as the COVID-19 pandemic, which disrupted essential services in over 90% of countries, WHO has redefined UHC as intrinsically linked to health system resilience [133]. The organization has issued guidance on Planning for Health System Recovery and developed the Health System Resilience Indicators package to help countries rebuild systems while advancing UHC goals [134][135].
WHO also addresses structural determinants of health inequity, including poverty, education, and environmental factors. Initiatives such as the Commission on Social Determinants of Health have established that health disparities are avoidable, unfair, and unjust, requiring action on the unequal distribution of power, money, and resources [8]. The organization supports policies that tackle structural racism, gender discrimination, and climate change, all of which disproportionately affect marginalized populations [137].
Conclusion: Toward Integrated, Equitable, and Resilient Health Systems
WHO’s approach to UHC and health systems strengthening has evolved into a holistic vision that integrates equity, resilience, and sustainability. By anchoring PHC as the foundation, supporting health financing reforms, enhancing data systems, and promoting multisectoral action, WHO enables countries to deliver quality, affordable care to all. The organization’s work is guided by ethical principles of justice, human rights, and inclusion, ensuring that no one is left behind in the pursuit of health for all [138]. Through coordinated global action and country-tailored support, WHO continues to strengthen health systems that are not only capable of achieving UHC but also resilient in the face of future health threats.
Ethical Frameworks and Health Equity
The World Health Organization (WHO) integrates ethical principles and human rights into its global health policies to advance health equity, particularly through addressing the social determinants of health (SDH). Central to this mission is the recognition that health disparities are not only shaped by medical access but are deeply rooted in structural injustices related to poverty, education, gender, and environmental conditions. WHO’s approach is grounded in the ethical imperative to eliminate avoidable, unfair, and unjust health inequalities, aligning public health action with international human rights standards such as the right to health enshrined in the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights (ICESCR) [60].
Ethical Foundations and the Commission on Social Determinants of Health
A cornerstone of WHO’s ethical framework is the work of the Commission on Social Determinants of Health (CSDH), established in 2005. Its landmark 2008 report, Closing the Gap in a Generation, articulated a robust ethical vision centered on health equity, social justice, and human rights [8]. The report asserts that health inequities—defined as avoidable and unfair differences in health outcomes—are a manifestation of deeper social injustices stemming from unequal distributions of power, money, and resources. By framing health disparities as ethical and political issues rather than mere technical challenges, the CSDH positioned the elimination of health inequities as a moral obligation for governments and institutions. This ethical stance underpins WHO’s ongoing efforts to promote fairness, dignity, and justice in health policy.
The CSDH’s conceptual framework identifies three key action areas: improving daily living conditions, tackling the inequitable distribution of power and resources, and measuring and understanding health inequities to inform policy. These principles have been operationalized through subsequent WHO initiatives, including the 2010 Conceptual Framework for Action on the Social Determinants of Health, which guides member states in implementing multisectoral strategies to address root causes of inequity [141]. The 2024 Operational Framework for Monitoring the Social Determinants of Health Equity further advances this agenda by providing standardized tools for collecting disaggregated data and assessing policy impacts on marginalized populations [128].
Human Rights-Based Approach to Health Governance
WHO institutionalizes ethical governance through a human rights-based approach (HRBA) that permeates its policies and programs. This approach requires that all health interventions respect, protect, and fulfill human rights, including the rights to life, non-discrimination, privacy, and freedom from inhumane treatment. During public health emergencies, WHO emphasizes that measures such as quarantine, isolation, or travel restrictions must be proportionate, evidence-based, time-limited, and subject to regular review to prevent overreach and protect individual liberties [86].
The International Health Regulations (2005), legally binding on 196 countries, reflect this ethical commitment by mandating that public health responses minimize unnecessary interference with international traffic and trade while respecting human dignity [40]. The 2024 amendments to the IHR further strengthened provisions for equity, transparency, and solidarity, including improved mechanisms for equitable access to medical countermeasures [109]. WHO also supports member states through the Principles and Guidelines on Human Rights and Public Health Emergencies (2023), which provide a comprehensive framework for integrating human rights into emergency planning and response [146].
Gender Equity as a Determinant of Health
Gender equity is a central component of WHO’s ethical and equity-focused agenda. The organization recognizes that gender norms, roles, and inequalities—intersecting with factors such as poverty, race, and disability—profoundly shape health risks and access to care. To address these disparities, WHO has institutionalized gender mainstreaming through the Strategy for Integrating Gender Analysis and Actions into the Work of WHO (2009) and subsequent tools like the Gender Mainstreaming Manual (2022) [147][148].
The 2019 report Breaking Barriers: Towards More Gender-Responsive and Equitable Health Systems outlines a framework for transforming health systems to meet the diverse needs of women, men, and gender-diverse populations, including addressing gender-based violence and integrating sexual and reproductive health and rights (SRHR) into universal health coverage (UHC) [149]. In 2023, WHO announced the development of a new guideline on the health of trans and gender-diverse people, acknowledging the specific health needs and human rights violations faced by these populations [150]. These efforts reflect a shift from gender-sensitive to gender-transformative policies that challenge underlying power structures.
Addressing Structural Inequities in Poverty, Education, and Environment
WHO addresses health inequities arising from poverty, education, and environmental factors through targeted strategies that link health outcomes to broader socioeconomic conditions. Poverty is recognized as a fundamental cause of poor health, limiting access to nutritious food, safe housing, healthcare, and education. To combat this, WHO promotes UHC as a pathway to reduce financial hardship and supports progressive health financing reforms that prioritize the most vulnerable [151].
In education, WHO promotes health-promoting schools and the integration of health services into educational settings, recognizing that education improves health literacy and breaks intergenerational cycles of poverty and ill health [152]. Regarding environmental factors, WHO highlights that marginalized populations often face disproportionate exposure to air pollution, unsafe water, and climate change impacts. Tools such as the Environmental Health Inequalities Resource Package support policymakers in identifying and reducing disparities in environmental risk [153].
Translating Ethical Commitments into Action
To translate ethical commitments into actionable policies—particularly in low- and middle-income countries (LMICs)—WHO engages member states through normative guidance, technical assistance, and capacity building. The Handbook for conducting assessments of barriers to effective coverage with health services helps countries diagnose equity gaps and design reforms [154]. WHO also supports the adaptation of global guidelines to local contexts through tools like the Handbook for guideline contextualization, ensuring scientific rigor and cultural relevance [155].
Multisectoral collaboration is encouraged through the Health in All Policies (HiAP) approach, which integrates health equity into education, housing, labor, and environmental policies [131]. The Country Pathfinders initiative brings together member states to share innovations in equity-focused reforms, while the upcoming World Report on Social Determinants of Health Equity (2025) will consolidate global evidence to guide future action [157].
Through these comprehensive, rights-based, and evidence-informed strategies, WHO ensures that the pursuit of health for all remains anchored in ethical integrity, human dignity, and the principle of leaving no one behind.
International Collaboration and Global Health Diplomacy
The World Health Organization (WHO) serves as a central actor in international collaboration and global health diplomacy, leveraging its position within the system to foster multilateral cooperation, resolve geopolitical tensions, and advance shared health objectives. Through structured governance mechanisms, legally binding agreements, and strategic partnerships, WHO facilitates dialogue among 194 member states, ensuring that health remains a priority on the global political agenda even amid complex diplomatic landscapes.
Norm-Setting and Legal Frameworks for Global Health Cooperation
A cornerstone of WHO’s role in global health diplomacy is its authority to develop and enforce international legal instruments that standardize global health responses. The most significant of these is the , a legally binding framework adopted by 196 countries to prevent, detect, and respond to public health emergencies of international concern (PHEIC) [4]. These regulations require member states to report potential PHEICs within 24 hours and maintain core surveillance and response capacities, thereby promoting transparency and accountability across borders.
The IHR framework has undergone significant reforms in response to global health crises. In May 2024, the (WHA) adopted a comprehensive package of amendments to the IHR through Resolution WHA77.8, which entered into force on September 19, 2025 [63]. These amendments introduced enhanced definitions of pandemic emergencies, strengthened provisions for equity and solidarity in access to medical countermeasures, and established new committees to improve implementation [41]. Despite broad acceptance, 11 states—including the —formally rejected the amendments, highlighting the ongoing tension between national sovereignty and global health governance [161].
To monitor compliance with the IHR, WHO employs the , which includes tools such as the State Party Self-Assessment Annual Report (SPAR), Joint External Evaluation (JEE), and After-Action Reviews (AAR) [162]. As of 2024, 99% of member states submitted SPAR reports, with a global average capacity score of 64%, indicating progress but persistent gaps in preparedness, particularly in low- and middle-income countries [66].
Pandemic Preparedness and the Evolution of Global Health Governance
In parallel with IHR reforms, WHO has spearheaded negotiations toward a landmark WHO Pandemic Agreement, finalized and adopted by the WHA in May 2025 [89]. This agreement aims to strengthen international cooperation by establishing binding commitments on pathogen data sharing, equitable access to vaccines and treatments, and technology transfer. It complements the IHR by addressing broader systemic issues such as financing, research coordination, and supply chain resilience, thereby creating a more cohesive legal architecture for pandemic preparedness.
The development of this agreement was informed by independent reviews, including the 2021 report “Covid-19: Make it the Last Pandemic” by the Independent Panel for Pandemic Preparedness and Response, which called for stronger financing, improved early warning systems, and enhanced regional self-reliance [165]. Subsequent reports, such as “No Time To Gamble” (2024), have continued to monitor progress and urge accelerated action [166].
Diplomatic Engagement and Conflict-Sensitive Health Interventions
WHO actively practices global health diplomacy to navigate politically sensitive contexts, particularly in conflict zones and regions affected by geopolitical disputes. The organization emphasizes neutrality and humanitarian principles while delivering essential health services in areas such as the occupied and Ukraine [167]. In 2026, WHO launched a global emergency appeal for nearly US$1 billion to support 36 health emergencies, many in conflict-affected settings, underscoring the intersection of health, security, and diplomacy [168].
To maintain access and legitimacy in contested environments, WHO employs a strategy of localization and partnership, strengthening engagements with local health authorities, civil society, and non-state actors [169]. This approach ensures culturally appropriate and politically sustainable interventions, even when national governments are divided or non-cooperative.
The WHA itself has become a forum for broader political contestation, with votes on issues related to Palestine, Ukraine, and gender language revealing deep geopolitical fissures [170]. Nevertheless, WHO continues to advocate for health as a tool for peace, exemplified by initiatives like the Global Health for Peace Initiative (GHPI), which leverages health cooperation to build trust and prevent conflict [171].
Strengthening Multilateral Partnerships and Technical Networks
WHO fosters international collaboration through a vast network of over 800 worldwide, which serve as hubs for research, training, and technical expertise [52]. It also maintains strategic alliances with major global health actors such as , the , and the , aligning health initiatives with broader development goals, particularly the (SDG 3) [173].
One of the most effective mechanisms for international outbreak response is the , a collaborative network of over 310 institutions—including public health agencies, laboratories, and non-governmental organizations—coordinated by WHO to deploy multidisciplinary teams during emergencies [69]. Since its inception in 2000, GOARN has conducted approximately 3,600 deployments, supporting responses to Ebola, cholera, and the [70]. The network operates under a formal governance structure led by a Steering Committee (SCOM) and is managed by an Operational Support Team (OST) in Geneva, ensuring 24/7 readiness [71].
To enhance surge capacity, WHO established the in May 2023, a framework designed to standardize and strengthen the global emergency workforce [177]. The GHEC was activated for the first time in October 2024 during the , demonstrating its operational value in rapid deployment [72].
Data Sharing and Ethical Governance in International Health
WHO plays a pivotal role in promoting data-driven diplomacy by advocating for timely, transparent, and equitable sharing of epidemiological data during health emergencies. It has adopted a policy requiring the sharing of all research data generated in the context of public health emergencies, reinforcing its commitment to open science [179]. Tools like the WHO Integrated Data Platform (WIDP) and Go.Data—a digital platform for contact tracing and outbreak investigation—enable real-time data aggregation and analysis across borders [80].
However, challenges remain in global health data sharing, including legal barriers related to data sovereignty, privacy, and consent [181]. WHO is working with partners to develop global norms for data sharing that balance transparency with ethical and legal safeguards [182]. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) further support reproducibility and trust in global health data [183].
Balancing Technical Expertise and Diplomatic Realities
WHO must continuously balance scientific integrity with diplomatic considerations, particularly when addressing health issues in politically sensitive contexts. While the organization provides independent technical guidance through its Secretariat and expert committees, final policy decisions rest with member states through the WHA and Executive Board [2]. This intergovernmental structure ensures member state ownership but can slow decision-making during emergencies [185].
The Director-General, currently , plays a key diplomatic role, advocating for health at the highest political levels and appointing special envoys to advance priority agendas [31]. Initiatives such as the launch of “A Guide to Global Health Diplomacy” highlight WHO’s institutional commitment to building capacity for multilateral cooperation, especially in times of crisis [32].
Despite reforms, tensions persist between technical recommendations and political interests. For example, the United States’ rejection of the 2024 IHR amendments illustrates the limits of technical consensus in the face of national sovereignty concerns [161]. Nevertheless, WHO continues to serve as a neutral convener, facilitating dialogue and consensus-building in an increasingly fragmented global health landscape.