This chapter addresses the World Health Organization’s (WHO) years-long reform process, analysing its successes and failures to adapt to the shifting global health landscape. It presents an overview of the organisation’s history since its establishment in 1948. Despite key achievements such as the eradication of smallpox, and response to the 2003 severe acute respiratory syndrome outbreak, the organisation faces tremendous governance challenges in sustaining its leadership in global health in the twenty-first century. The chapter examines the reform process by discussing how the reform was conceived, what measures were pursued, and their effectiveness. Particular attention is paid to the role of the global South in pushing for these reforms. Closely associated with the issue of institutional identity is a crisis in funding, which exacerbates the gap between the WHO’s mandate and actual capabilities. The WHO’s identity and funding issues are exacerbated by problematic director-general leadership. Other organisational and institutional issues have widened the internal governance gap.