Countries move to strengthen public health institutions and services amid mounting pressures

As health challenges grow more diverse and complex, and public budgets tighten, WHO Member States are increasingly looking to more integrated public health capacity and services that can better promote and protect people's health, prevent illness and respond to emerging threats. More than 120 countries have identified building institutional capacity to deliver essential public health functions (EPHFs) as a medium-to-high priority for WHO support.

The shift comes as fragmented programmes, uneven workforce investment, and reliance on external financing in low- and middle-income countries make public health capacity harder to sustain. These pressures can also limit the ability of governments to respond effectively to both everyday health needs and emergencies.

"Countries need public health systems that can do more with limited resources," said Dr Kalipso Chalkidou, Director of the Performance, Financing and Delivery Department at WHO. "Essential public health functions provide a practical and tested way to bring core capabilities together at the country level, using resources more efficiently while placing promotion, prevention and preparedness at the heart of health systems."

Building the foundations of resilient health systems

Building national institutional capacity to deliver EPHFs is a dedicated output of WHO's Fourteenth General Programme of Work (GPW14) - WHO's global strategy for 2025-2028. EPHFs are the core public health actions and services countries need to keep people healthy and safe. They bring together four broad areas:

• promoting health
• preventing illness
• protecting people from health risks
• preparing for and responding to emergencies.
  

Their delivery also depends on effective leadership, workforce, governance and coordination between health and allied sectors.

Too often, these functions are planned, financed and delivered separately. WHO's EPHFs framework therefore helps governments connect them across sectors and levels of the health system, so that keeping people healthy receives sustained attention, alongside treating people when they become ill. National Public Health Institutes (NPHIs), ministries of health and other public health authorities have a central role in putting this approach into practice, from subnational to national levels and across primary, secondary and tertiary care.

Connecting public health and universal health coverage

EPHFs focus on population-based services as well as building capacities within health systems and societies for tackling crises and emergencies. This ensures that the general population, including hard-to-reach communities, has access to needed health services and commodities before, during and after crises. Achieving this requires a strengthened public health role across primary care and other front-line facilities, which at the same time protects other core health systems functions including secondary and tertiary care. An EPHF lens can support the design and financing of universal health benefit packages that cover population health services, as well as direct service delivery needs for individuals.

Growing international momentum

The EPHF agenda is also gaining momentum through multilateral cooperation. The 16th BRICS (Brazil, Russia, India, China and South Africa) Health Ministers' Declaration, adopted in July 2026 under India's chairship, recognized NPHIs as National Centres of Excellence for essential public health functions and endorsed an operational framework for the BRICS Network of NPHIs.

The Declaration highlights the importance of universal health coverage (UHC) packages as a foundation for sustaining the pathway towards health for all, health security and other social development goals (SDGs). Moreover, it underscores technical cooperation among public health institutes as a shared priority. WHO's existing work on EPHFs provides a basis for engagement with the BRICS Network of NPHIs and other multilateral initiatives including the International Association of National Public Health Institutes. It also creates opportunities to expand South-South cooperation and institutional partnerships, including with India, China and other BRICS members and partners.

Financing stronger public health capacity

Sustained financing is critical to maintaining the institutions, workforce and systems needed to deliver EPHFs. Current budgets allocated to the health sector are insufficient and largely skewed towards curative services. Allocation towards EPHFs is typically donor driven and function-specific and hence does not benefit sector-wide capacity development.

Amid growing resource constraints, multilateral development banks (MDBs) have a critical role to play in financing on the right terms and with the right priorities, aligned with the UHC mission and governments' own systems and plans. The prospect of a BRICS New Development Bank financing window dedicated to digital determinants and social determinants of health (DD-SDH) health infrastructure - supporting primary health centres; water, sanitation and hygiene (WASH); and housing with a pro-poor focus - is a welcome development.

Partnerships in action

WHO-supported initiatives are already putting the EPHF approach into practice. Through projects supported by China's Global Development and South-South Cooperation Fund, WHO is working with Iraq, Morocco and Pakistan to apply EPHFs through locally adapted service platforms including facilities providing primary care and traditional medicines. At the same time, efforts in Maldives, Papua New Guinea, Thailand and Timor-Leste focus on building national workforce capacity for EPHFs.

Through the EU-funded Team Europe Initiative on Public Health Institutes, WHO is also supporting the establishment of national public health institutes in Central African Republic and Zimbabwe, improving EPHF coordination in Guinea-Bissau, and supporting federal-state coordination on EPHFs, workforce and public health services in Nigeria. These initiatives combine national capacity-building with South-South and North-South institutional partnerships.

Connecting resilience, innovation and economic development

Health systems resilience builds capacity to tackle small crises from the source, before they escalate into major emergencies, while maintaining trust in and access to essential health services and functions. This strengthens confidence in health systems, boosts national self-reliance and shields economies from the broad disruptions to trade, commerce and industry caused by health crises.

Brazil's health-industrial nexus offers a clear example of this self-reliance in action. By placing domestic production, research and innovation at the center of its Unified Health System (SUS), the country exemplifies the WHO Economics of Health for All strategy. This approach demonstrates how strong public sector leadership can drive local health innovation and ensure equitable access to essential medical supplies - a core pillar of the global resilience agenda.

The growing focus on EPHFs reflects a broader shift towards building public health capacity that is integrated, nationally owned and sustainable. By bringing public health functions together, strengthening the institutions and workforce that deliver them, and aligning domestic and international investment behind them, countries can build systems better equipped to advance and protect health gains, respond to future threats and deliver healthier lives for all.

About WHO

Dedicated to the well-being of all people and guided by science, WHO leads and champions global efforts to give everyone, everywhere, an equal chance at a safe and healthy life. We are the United Nations' agency for health that connects nations, partners and people in more than 150 locations - leading the world's response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to support all countries to promote, provide and protect health. "Together for health. Stand with science", the theme of World Health Day 2026, marks a year-long campaign to highlight science as the foundation for protecting health and well-being worldwide.