Methodology
How the edition was made: methods, the model card, the evidence cut and its age, the acceptance record and the glossary.
Contents
- ·Edition home
- ·Executive summary
- 1Health is where the systems meet
- 2Key findings
- 3Systems and sectors at baseline
- 4Risks and capability
- 5Outbreak, funding gap and heat season in fragile health systems
- 6Readings from the other desks
- 7The 2027 agenda
- 8Systems in depth
- AMethodology
- BData appendix
- CReferences and record
- ·Complete edition, for print
A.1Methods
The global baseline uses published values and four simple derivations. Each is shown in full so that any reader can reproduce it.
| No. | Derivation | Calculation | Result |
|---|---|---|---|
| (1) | Deaths from three infections in the latest reported year | 1.23 + 0.61 + 0.57 million (2024, 2024, 2025) | ≈2.4 million |
| (2) | Share of deaths in the latest period that occurred in communities | 307 ÷ 482 | ≈64% |
| (3) | Change in aid for health, 2021 to the 2025 estimate | 38.4 ÷ 80.3 | ≈ −52% |
| (4) | Growth in confirmed Bundibugyo cases in the Democratic Republic of the Congo, 26 August to 23 September 2026 | 7 890 ÷ 5 794 | ≈1.4 times |
| Strength | Definition |
|---|---|
| STRONG | a disruption in the source system has historically changed the target system’s service or output within one season, in more than one region |
| MODERATE | an effect is documented but buffered or slower |
| WEAK | an effect is plausible but not documented at global scale |
| Label | Rule |
|---|---|
| Reported | value as issued by its source, with year |
| Inferred | reasoned from cited evidence; never a measurement |
| Estimated | Nexus analytical value with stated method |
| Scenario | conditional on stated assumptions |
| Expert input | structured editorial judgement awaiting evidence |
A.2Model card, Health Sector Model v0
- Model ID
- MDL-GS04-HEALTH · v0.1
- Purpose
- represent the global health and One Health system and its couplings to water, energy, food, climate and biodiversity
- Family
- graph-based system of systems
- Inputs
- the cited sources of this edition; no proprietary data
- Method
- expert-specified coupling strengths (STRONG · MODERATE · WEAK) from assessments and analogue events
- Validation
- none yet, first validation against federation evidence in 2027
- Uncertainty
- qualitative; strengths are hypotheses, not measurements
- Domain of validity
- global scale; not for asset-, site- or country-level use
- Reproducibility
- strength table and sources published in this edition
20couplings
typed in v0
4strong
documented within one season
8moderate
documented, buffered
8weak
plausible, undocumented
A.3The baseline evidence cut
Every Nexus edition is published from a frozen evidence cut. The global baseline cut is documentary: it pins the exact edition of every source cited. Federation cuts begin with the first national Foundry cuts in 2027.
- Cut ID
- DC-SECTOR-HEALTH-GLOBAL-2026-B0
- Type
- baseline documentary cut
- Resolution policy
- pinned · as of 30 September 2026
- Sources pinned
- 56 cited sources, each at the edition and access date in the references
- Model runs
- none at baseline, analytical values are stated with their method
- Digest
- computed at freeze and recorded in the publication record
- Supersedes
- nothing, first cut of the series
- Superseded by
- the 2027 health annual cut
Lineage
- 01
source edition
- 02
pinned citation
- 03
finding
- 04
page
- 05
publication record
| Element | Baseline 2026 | 2027 global annual |
|---|---|---|
| Sources | cited global publications, pinned by edition | national, regional and sector cuts through one graph |
| Analysis | stated methods and editorial estimates | typed analysis specifications |
| Models | Health Sector Model v0 specification | model runs with receipts |
| Findings | twelve baseline findings | findings re-bound to federation evidence |
| Review | five passes scheduled | five passes on the exact digest |
A.4Evidence age and coverage
A 2026 global edition rests on evidence observed in many different years. This page shows each time base, so that no single year label hides older evidence.
| Indicator | Observed | Released | Cadence | Next release |
|---|---|---|---|---|
| Coverage and financial hardship | 2023 and 2022 | Dec 2025 | annual | next UHC monitoring report |
| Child and maternal mortality | 2024 and 2023 | May 2026 and Apr 2025 | annual | next UN child mortality estimates |
| TB, malaria and HIV burden | 2024 and 2025 | Dec 2025 to Jul 2026 | annual | next WHO and UNAIDS releases |
| Immunisation coverage | 2025 | Jul 2026 | annual | next WHO and UNICEF estimates |
| Resistance burden and surveillance | 2021 and 2023 | Sep 2024 and Oct 2025 | annual | next GLASS report |
| Bundibugyo outbreak position | 2026 | 23 Sep 2026 data | weekly to monthly | next Disease Outbreak News |
| Development assistance for health | 2025e | 2025 | annual | next IHME update |
| Health workforce levels | 2025 | Oct 2026 | annual | next workforce accounts |
| Heat deaths | 2023 | Oct 2026 | annual | next Lancet Countdown |
| Health spending and physician density | 2023 and 2022 | Oct 2026 database update | annual | database update |
| System | Coverage | Thinnest dimension |
|---|---|---|
| Coverage and mortality | GOOD | quality of care and deaths without a recorded cause |
| Infectious disease | GOOD | burden by country and age band |
| Resistance | PARTIAL | use in animals and the environment |
| Health security | PARTIAL | position after evidence close |
| Financing | PARTIAL | domestic spending after 2023 |
| Workforce | GOOD | cadre mix and migration |
| Facilities and services | THIN | power, water and staffing by facility |
| Resilience | PARTIAL | tested capabilities beyond emergency response |
| Field | Source that would fill it | Blocker |
|---|---|---|
| Bundibugyo outbreak position after 23 September 2026 | WHO Disease Outbreak News and WHO regional office situation reports56 | later releases fall after the 30 September close; the 8 October and 23 October notices are held as post-close, context only24 |
| First determination date of the public health emergency of international concern for the Bundibugyo outbreak | WHO IHR Emergency Committee statements25 | the August notice states the status and the 18 August meeting; the first determination statement was not opened |
| Attacks on health care, annual counts and deaths | WHO Surveillance System for Attacks on Health Care43 | the dashboard needs an account; only the method note was readable |
| Power, safe water and staffing in health facilities, globally | WHO and UNICEF facility monitoring; WHO facility assessments | not retrieved; figures held in memory are not used |
| Antimicrobial use in animals and its trend | WOAH animal antimicrobial use report48 | the report page returned an access error and was not opened |
| Heat deaths in 2024 and 2025 | Lancet Countdown and WHO heat estimates4529 | the 2025 report full text was blocked; the 2026 report was read only as a WHO summary |
| Share of emerging infections that are zoonotic, reconciled across issuers | UNEP and ILRI report49; WHO fact sheet17 | the UNEP page returned an access error; the WHO figure is shown alone |
| Evidence linking biodiversity change to infectious disease risk | IPBES nexus assessment50 | the page returned no readable text |
| National health spending and physician density after 2023 and 2022 | World Bank World Development Indicators42; WHO expenditure database | the 2024 and 2025 values were empty in the database at access |
| Full tuberculosis and malaria report tables by country | WHO Global TB Report 202546; World Malaria Report 202547 | full reports not opened; fact sheets used |
| Cyber incidents against hospitals and health data | national authorities; sector reports | incident data are not published on a common basis |
| Digital and AI use in health systems | WHO guidance and country surveys | not retrieved; no figure used |
| Deaths by cause, by country | WHO Mortality Database1 | only about one third of 2023 deaths are reported with cause; country tables not retrieved |
| Capability rungs beyond emergency response | ministries, regulators, providers | not reviewed |
A.5Evidence cards, two anchor sources
Issued by the World Health Organization (13 May 2026) from the Global Health Estimates and the Mortality Database. Annual. Role: binds the data-gap reading and the goal-progress statement.
EVD-GS04-001
WHO World Health Statistics 20261
Issued by WHO from notifications by the affected ministries of health, with data to 23 September 2026. Irregular, about every two weeks during the outbreak. Role: binds GOV-008 and the outbreak card. Figures change with each release.
EVD-GS04-002
WHO Disease Outbreak News, 25 September 202656
| Dimension | EVD-GS04-001 | EVD-GS04-002 |
|---|---|---|
| Completeness | modelled where national data are missing; cause of death known for about one third of deaths | confirmed cases only; community deaths and unreported cases are not counted |
| Timeliness | about 3 years after the data year for mortality | about 3 days after the data date |
| Revision | each edition supersedes the last | counts revised in each notice |
| Method transparency | estimation methods published | case definitions in the notice |
| External validation | country consultation before release | notifications from ministries; WHO assessment |
Evidence cards to follow in 2027
A.6Publication acceptance record
Editorial self-check at evidence close. Every applicable item carries a disposition; the remaining items are review, approval and deposit.
| Group | Area | Items | Pass | N/A | Pending |
|---|---|---|---|---|---|
| D1 | Identity and scope | 8 | 8 | 0 | 0 |
| D2 | Source and data | 12 | 9 | 1 | 2 |
| D3 | Analysis and models | 12 | 3 | 8 | 1 |
| D4 | Findings and claims | 9 | 8 | 0 | 1 |
| D5 | Figures, tables, maps | 10 | 6 | 2 | 2 |
| D6 | Editorial and citations | 10 | 8 | 0 | 2 |
| D7 | Review and approval | 13 | 0 | 0 | 13 |
| D8 | Artefact and design | 12 | 7 | 0 | 5 |
| D9 | Registry and release | 9 | 0 | 0 | 9 |
Publication gate
- Conditions met
- 14 of 23 at evidence close
- Blocking problems
- none recorded
- Open conditions
- reviews, approval of the exact digest, deposit, registry pointer
Not applicable at baseline
- Model runs
- first runs in Q1 2027
- Maps
- plates in Q2 2027
- Waivers
- none
A.7Status words
| Status | What it means |
|---|---|
| Observed | Measured directly and published by the source. |
| Reported | Published statistics of an official or institutional source. |
| Declared | Stated by the body concerned; not independently measured. |
| Estimated | A Nexus estimate from cited evidence, with its method in Annex A. |
| Modelled | Produced by a stated model from cited inputs. |
| Inferred | Reasoned from cited evidence; not measured. |
| Forecast | A projection by the cited source. |
| Simulated | A simulation result under stated assumptions. |
| Scenario | A conditional statement under stated assumptions; never a prediction. |
| Expert input | Expert judgement, recorded with its basis. |
| Candidate | Proposed for a later edition; not yet evidence. |
| Evidence-quality levels (EQL 1 to 5) grade the source behind a value; they are not a score of the subject. | |
A.8How the edition is made, released and corrected
Every edition is built from a sealed evidence cut, reviewed under three keys, signed and deposited before any site shows it as published; corrections go to Nexus Standards as change proposals and feed the next cut.
| Step | What happens | Source |
|---|---|---|
| 01 Evidence arrives from the pillars | Foundry seals observations and indicator series, Universe hands over after-action and scenario findings, and contributions are screened at every gateway, including this site’s. | |
| 02 The cut is sealed | On the cut date the evidence is pinned under one identifier, so anyone can rebuild the edition from exactly what it was built on. | |
| 03 The edition is assembled | The edition is drafted from its template and content pack. Agents may draft; they never publish and never decide. | |
| 04 The keys turn | At the publisher of record the truth key comes first: every value is checked against its source or stated method before the meaning and capital keys turn. No edition moves on until every key has been turned by a named steward. | |
| 05 The gate opens | A named approver releases one exact digest of the edition; any change after this point is a new version, never a silent edit. | |
| 06 Signed and deposited | The PDF, the web edition and the data bundle are signed together with a manifest and an RO-Crate description, and deposited on Zenodo with a concept and a version DOI. | |
| 07 Published on its desk’s site | Only then does the edition show as published on its desk’s Reports site, and the Collection lists it as a part. | |
| 08 Corrections go to Standards | Method and correction findings go to Nexus Standards as change proposals; citations, corrections and new contributions feed the next evidence cut. |
A teaching model of the process, not a forecast and not a record of any run; dates and counts on this page come from the programme record. Sources: Reports governance at GCRI Canada (2026); Zenodo, repository of record for Reports deposits (2026).
Lifecycle, one state at a time: Draft, Computed, Evidence bound, Reviewed, Approved for release, Published, Corrected, Superseded. This edition is a draft.
A.9Glossary and abbreviations
| Term | Meaning |
|---|---|
| Baseline Edition | the inaugural annual edition that fixes the reference state for the series |
| WEFH+B | health, energy, food, health and biodiversity, the national nexus core |
| Coupling | a typed dependency through which one system transmits to another |
| Protection gap | the share of losses not covered by insurance |
| Capability ladder | LISTED → EXISTS → ADEQUATE → TESTED → DEMONSTRATED |
| EQL | evidence-quality level, 1–5 |
| Evidence cut | a frozen resolution of exact sources and versions |
| NNC · NLC · NWG | National Nexus Consortium · National Leadership Council · National Working Groups |
| Abbreviation | Expansion |
|---|---|
| AMR | antimicrobial resistance |
| ART | antiretroviral therapy |
| DAH | development assistance for health |
| GLASS | Global Antimicrobial Resistance and Use Surveillance System |
| IHR | International Health Regulations (2005) |
| IHME | Institute for Health Metrics and Evaluation |
| NCD | noncommunicable disease |
| PABS | Pathogen Access and Benefit Sharing |
| PHEIC | public health emergency of international concern |
| TB | tuberculosis |
| UHC | universal health coverage |
| WOAH | World Organisation for Animal Health |
A.10Technical annex
| Item | Annex | Contents | Status |
|---|---|---|---|
| A.1 | Indicator definitions | the global indicator set, with units and sources | IN THIS EDITION |
| A.2 | Coupling strengths | the twenty-cell matrix and its rationale | IN THIS EDITION |
| A.3 | Scenario specification | SCN-GS04-OUT-01 assumptions and signposts | IN THIS EDITION |
| A.4 | Capability placements | rung evidence for fifteen functions | IN THIS EDITION |
| A.5 | Model diagnostics | first runs and validation | 2027 |
| A.6 | Sensitivity analyses | influence of coupling strengths | 2027 |
| A.7 | Outbreak and route notes | cards for the major cross-border outbreak zones and shared disease systems | WITH REGIONAL EDITIONS |
| A.8 | Review statements | pass-by-pass review record | AT RELEASE |
A.1 · indicator definition: universal health coverage service index
- Construct
- a composite of essential service coverage across reproductive, maternal, newborn and child health, infectious disease, noncommunicable disease and service capacity
- Unit
- index from 0 to 100
- Method
- custodian indicator based on national surveys and administrative data
- Source
- WHO universal health coverage fact sheet2
- Uncertainty
- modelled where survey data are missing
- Known limits
- measures contact with services, not the quality or timeliness of care
Notes
Numbers are the edition’s reference numbers, so a note reads the same in every chapter. The full list, with every source and its licence, is in Annex C. Annex C, references
- 56WHO (ed.), Disease Outbreak News: Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo (25 September 2026, data to 23 September 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
- 24POST-CLOSE, context only: WHO (ed.), Disease Outbreak News: Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo, Kenya and Nigeria (23 October 2026, data to 20 October 2026; released after the 30 September evidence close and cited as the position at access). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
- 25WHO (ed.), Disease Outbreak News: Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo (28 August 2026, data to 26 August 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
- 43WHO (ed.), Surveillance System for Attacks on Health Care, dashboard and method note (the dashboard data require an account and were not read). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
- 48UNVERIFIED, not opened: WOAH (ed.), Annual report on antimicrobial agents intended for use in animals (ANIMUSE); the report page returned an access error and no figure is used. World Organisation for Animal Health, Paris. Observation year 2022. Accessed 2026-11-03.back
- 45UNVERIFIED, not opened: Romanello, M. et al., The 2025 report of the Lancet Countdown on health and climate change, The Lancet 406 (10521), December 2025; the bibliographic record was read, the full text was blocked and no figure from it is used. Lancet Countdown, London. Observation year 2024. Accessed 2026-11-03.back
- 29POST-CLOSE, context only: WHO (ed.), Climate change is a growing health emergency, Lancet Countdown warns, departmental update summarising the 2026 Lancet Countdown on Health and Climate Change (28 October 2026; the report itself was not opened; released after the 30 September evidence close and cited as the position at access). World Health Organization, Geneva. Observation year 2023. Accessed 2026-11-03.back
- 49UNVERIFIED, not opened: UNEP and ILRI (eds.), Preventing the next pandemic: zoonotic diseases and how to break the chain of transmission, 2020; the page returned an access error and no figure is used. United Nations Environment Programme, Nairobi. Observation year 2020. Accessed 2026-11-03.back
- 17WHO (ed.), One Health, fact sheet (8 May 2026). World Health Organization, Geneva. Observation year 2026 (current text; the share of emerging infections is undated in the sheet). Accessed 2026-11-03.back
- 50UNVERIFIED, not opened: IPBES (ed.), Thematic Assessment Report on the Interlinkages among Biodiversity, Water, Food and Health (Nexus Assessment), 2024; the page returned no readable text and no figure is used. Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, Bonn. Observation year 2024. Accessed 2026-11-03.back
- 42DATA VINTAGE AFTER CLOSE: World Bank (ed.), World Development Indicators, data service queried for current health expenditure (percentage of GDP), out-of-pocket expenditure and physicians per 1 000 people, world aggregate (database updated 2026-10-08). World Bank, Washington. Observation year 2023 (spending) and 2022 (physicians). Accessed 2026-11-03.back
- 46UNVERIFIED, not opened: WHO (ed.), Global Tuberculosis Report 2025. World Health Organization, Geneva; cited for the tables behind the opened fact sheet [4], with no figure taken from it. Observation year 2024. Accessed 2026-11-03.back
- 47UNVERIFIED, not opened: WHO (ed.), World Malaria Report 2025. World Health Organization, Geneva; cited for the tables behind the opened fact sheet [5], with no figure taken from it. Observation year 2024. Accessed 2026-11-03.back
- 1WHO (ed.), World Health Statistics 2026: A visual summary and report page (monitoring health for the SDGs, 13 May 2026). World Health Organization, Geneva. Observation year 2023 (deaths and life expectancy). Accessed 2026-11-03.back
- 40Apeagyei, A.E. et al., Tracking development assistance for health, 1990 to 2030: historical trends, recent cuts, and outlook, The Lancet, 2025; abstract read through Europe PMC. Institute for Health Metrics and Evaluation, Seattle. Observation year 2025 (estimate). Accessed 2026-11-03.back
- 39POST-CLOSE, context only: WHO (ed.), One in four doctors nearing retirement age as WHO warns of global health workforce gap, news release on National health workforce accounts: health workforce levels and trends 2026 (19 October 2026; released after the 30 September evidence close and cited as the position at access). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
- 2WHO (ed.), Universal health coverage (UHC), fact sheet (5 December 2025). World Health Organization, Geneva. Observation year 2023 (service coverage) and 2022 (financial hardship). Accessed 2026-11-03.back