Reforming World Health Organization governance in a changing global health architecture: An integrated governance...

Between January 2025 and early 2026, the World Health Organization (WHO) faced three interrelated structural pressures: a budget shortfall exceeding US$1.05 billion triggered by the announced United States withdrawal; a weakening of strategic governance functions at the Executive Board (EB) and the Programme, Budget and Administration Committee (PBAC); and the parallel emergence, outside WHO, of multiple Global Health Architecture reform agendas, including the Lusaka Agenda, the Accra Reset, the UN80 Initiative, and the America First Global Health Strategy. This study presents an integrated governance analysis using four complementary data sources: participant observation of WHO governing-body sessions (EB158, February 2026; the 79th World Health Assembly, WHA79, May 2026); semi-structured interviews with 10 professional staff serving at WHO headquarters and in regional and country offices; policy mapping of relevant reform-agenda documents, classified into four domains; and a companion quantitative analysis of governing-body document release timing. Triangulation revealed late release of budget documents, an unprecedented proposal to draw over US$ 400 million from the Programme Support Cost, contested governance reform, field-level constraints in prioritization, human-resource management and financial accountability. The findings suggest a bidirectional problem in which constraints on Secretariat function and difficulties in substantive Member State deliberation reinforce each other, while reforms remain headquarters-centric and may contribute to implementation gaps at regional and country levels. As a policy implication, the forthcoming Director- General selection and the UN80-linked reform cycle offer an opportunity for governance reform. These developments may offer opportunities for WHO Member States, including Japan and the Global South, to strengthen WHO's coordinating role.