Turning Global Health Norms into Action: Evidence from WHO Country Impact Pilots

The 2025 WHO report presents a new, practical approach to track whether WHO guidelines are actually disseminated, used and making a difference in countries, based on pilot studies in Ethiopia and Pakistan. It shows that impact depends not just on publishing guidance, but on adaptation, training, stakeholder ownership and strong national systems that translate global norms into real-world health improvements.

Developed by the World Health Organization’s Product Design and Impact Unit, in collaboration with technical departments across WHO headquarters, regional and country offices, Addis Ababa University, the Institute of Resilient Health Systems at the Liverpool School of Tropical Medicine, and the impact advisory firm Impact46, the 2025 report tackles a long-standing challenge for global health governance: understanding whether WHO guidelines actually make a difference in countries. WHO produces hundreds of normative products, guidelines, standards and technical recommendations that are widely cited and respected, yet until recently, the Organization lacked a consistent way to track whether these products reach decision-makers, are used in practice, or lead to tangible improvements in health systems. Growing pressure from internal evaluations, Member States, and World Health Assembly resolutions pushed WHO to move beyond anecdotal evidence and develop a structured way to document impact at the country level.

A Simple Framework to Track What Happens After Publication

To address this gap, WHO designed an “impact approach” that focuses on what happens after a guideline is released. The approach does not evaluate national health programmes or judge country performance. Instead, it asks whether WHO’s normative products are disseminated effectively, used meaningfully and capable of contributing to change. The framework is built around three connected dimensions. Dissemination looks at how guidelines are shared and whether they reach their intended audiences at global and national levels. The use examines how recommendations are adapted to local contexts, integrated into policy and implemented through training and systems. Impact focuses on longer-term effects, such as changes in regulations, professional behaviour, and health outcomes. Evidence is collected through desk reviews, quantitative indicators and interviews with government officials, health workers, academics, partners and WHO staff.

Testing the Approach in Ethiopia and Pakistan

The approach was pilot-tested in 2024 through three country studies: the WHO Technical Report Series on the Control of the Leishmaniases in Ethiopia, and the WHO Abortion Care Guideline in Ethiopia and Pakistan. These pilots were chosen to reflect different diseases, political contexts and levels of sensitivity. In Ethiopia, the leishmaniasis case showed how a long-standing WHO guideline can become deeply embedded in national systems. A national guideline adapted from the WHO report has guided prevention and treatment for more than a decade, supported by regular training, strong partner involvement and integration into national health strategies. Dissemination relied heavily on printed materials and in-person training to overcome digital barriers, while use was reinforced through advisory committees and routine monitoring systems.

What the Abortion Care Cases Revealed

The abortion care cases highlighted both opportunities and constraints. In Ethiopia, the 2022 WHO Abortion Care Guideline was rapidly adapted through a participatory process led by the Ministry of Health and endorsed in 2024. Dissemination was supported by national workshops, professional associations and innovative digital tools. The guideline influenced task-sharing reforms, expanded provider roles and strengthened alignment with national laws and policies. In Pakistan, however, the WHO guideline was not adopted as a stand-alone document. Instead, its recommendations were integrated into broader sexual and reproductive health frameworks and provincial policies. This led to uneven dissemination and use, with stronger uptake in urban areas and provinces supported by well-resourced NGOs, and weaker reach in rural and underserved regions. Stigma and fragmented monitoring systems further limited consistent implementation.

Lessons for the Future of Global Health Guidance

Across all three pilots, the report draws several clear lessons. Simply publishing guidelines is not enough; dissemination must be paired with training, monitoring and sustained institutional support. Co-design with national stakeholders is essential to ensure relevance and ownership. Aligning WHO indicators with national data systems makes it far easier to track use and impact. While it remains difficult to directly attribute health outcomes to guidelines alone, the report shows that credible evidence of contribution can be assembled through mixed methods. WHO concludes that this impact approach is practical, scalable and adaptable across technical areas, but its value will depend on whether it is embedded into routine corporate monitoring. If mainstreamed, the approach could help the WHO design better guidance, support countries more effectively and strengthen accountability for how global norms translate into real-world change.