During 2014, the World Federation of Public Health Associations (WFPHA) conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. Responses were received from 62 PHAs. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA’s leaders (77%) and the competence of people serving on the PHA’s governing body (76%). Lack of financial resources was considered the most important factor that negatively affected organizational governance effectiveness (73%). Lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health leaders.