What the next WHO director-general must learn from Nigeria’s health reforms, By Chinedu Moghalu

By October 2026, the National Health Insurance Authority reported that 80,000 women had received emergency maternal care by August; insurance enrolment exceeded 23 million by September. The transferable lesson is a method of accountability: follow allocations through releases to services, examine the quality of those services, and ask whether households can afford them. WHO can help countries use comparable measures and independent scrutiny, then put the consequences of missed commitments before those who control the money.

When WHO elects its next director-general in 2027, member states will also consider proposals to reshape the wider global health system. Aid is falling, the United States has withdrawn from WHO, and governments are asking international agencies to work through national plans. Such a plan can bring public authorities and partners together, but cannot ensure that funding reaches clinics or patients receive good care. The next director-general must show how WHO helps countries finance and deliver what their plans promise.

Tedros Adhanom Ghebreyesus has strengthened WHO’s tools for collective action. WHO expanded pandemic intelligence, scientific guidance, workforce training and support for technology transfer. Member states amended the International Health Regulations, adopted the Pandemic Agreement and agreed to increase assessed contributions. He led WHO through COVID-19; the funding cuts that followed have left fewer staff and a smaller budget to sustain that work.

As at 31 March, only 73 per cent of WHO’s 2026–27 base budget was financed, and just 41 per cent was projected to be financed flexibly. Earmarked contributions sustain programmes but leave gaps in independent guidance and country support. Beyond WHO, development assistance fell by 23.1 per cent in real terms in 2025, across all sectors. The World Bank projects that aid cuts could outweigh rising government health spending, leaving 80 per cent of low-income countries and 40 per cent of lower-middle-income countries with less combined government and donor funding in 2030 than in 2024. A planned transition from external support has to identify who will pay for treatment, immunisation and surveillance before a funder withdraws. The US–Nigeria health agreement maintains substantial bilateral support alongside Nigeria’s commitment to increase domestic health spending.

The Accra Reset panel proposes “One Plan. One Budget. One Platform.” It builds on the Lusaka Agenda and Africa CDC’s work on country priorities and regional capacity. Yet Gavi, the Global Fund, development banks and bilateral donors continue to use separate grant cycles, purchasing rules and reporting systems. Their governing boards control those terms and can bring them into line with costed national programmes, while the wider architecture review commissioned at WHA79 prepares its recommendations for the 2027 Assembly.

WHA79 adopted an 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.

Nigeria shows how much coordination a country plan demands. Its National Health Sector Renewal Investment Initiative and Health Renewal Compact join primary care, financing, workforce development, health security and local supply. The expanded compact gives federal, state and local authorities, partners and civil society responsibilities within a sector-wide approach, with joint reviews and independent verification. Yet, a federal agreement 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 enrolment exceeded 23 million by September. The transferable lesson is a method of accountability: follow allocations through releases to services, examine the quality of those services, and ask whether households can afford them. WHO can help countries use comparable measures and independent scrutiny, then put the consequences of missed commitments before those who control the money.

WHA79 adopted an 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 assure quality and buyers can secure reliable products at affordable prices.

The benefit-sharing annex remains unfinished, preventing the Pandemic Agreement from opening for signature. Its financing provisions envisage surge support from the start of an emergency, but the coordinating mechanism still needs operating rules and assured finance. The next director-general should bring governments and existing funds together around plans that are costed and rehearsed: sustained surveillance and laboratories, agreed triggers for releasing money and procuring medical supplies, equitable access to diagnostics, vaccines and treatments, and continuity of routine care during an outbreak.

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.

WHO’s 2025–28 programme includes climate-related health risks, prevention, primary care and financial protection, as well as emergencies. The next director-general will need to show member states which technical functions require dependable funding and which country activities WHO is best placed to perform.

Among the seven candidates listed by WHO, Belgium’s Hans Kluge proposes stronger country offices and more flexible finance. Saudi Arabia’s Hanan Balkhy emphasises scientific independence, emergency readiness and regional capacity. Indonesia’s health minister, Budi Gunadi Sadikin, would use WHO’s convening 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 gives prevention and environmental health prominence. The Armenian paediatric oncologist, Gevorg Tamamyan, has urged closer attention to patient outcomes. China’s Song Li has been presented by her government as a supporter of multilateral cooperation; a detailed public programme has not yet appeared. Each candidate must explain how WHO would finance its core functions and influence grant decisions affecting 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.

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.