Reforming the global health architecture

Why it matters, what is changing, and what happens next


The current global health architecture (GHA) has brought important achievements in global health. Examples include a significant increase in life expectancy globally, 60% and 40% reductions in under-5 and maternal mortality respectively; and, since 2000, the estimated 75 million, 25 million and 13 million deaths averted due to vaccine-preventable diseases, HIV and malaria respectively.

The context in which this architecture was built has however changed profoundly. New challenges include changes in the areas of demography, economics, environment, epidemiology, and geopolicy. This changing environment brings new dynamics. Countries are asserting stronger national ownership of health priorities and financing. Regional institutions are playing a more central role. Science is advancing rapidly, with new tools and technologies reshaping how health systems operate.

These developments create opportunities, but they also create risks for widening inequalities, instead of narrowing them.

The global health architecture has not kept pace. Today, it is characterized by fragmentation, duplication, misaligned priorities, competition, gaps in financing, and persistent power imbalances.

A WHO officer is looking through vaccine records during a vaccination campaign in an outdoor setting.

Problem statement

The joint process aims to address the overarching problem that the GHA has not kept pace with evolving national health sovereignty and regional capacities, changing disease burdens, advances in science and technology and a changing financing landscape, and is constrained by power imbalances, fragmentation and duplication that limit country ownership, impact and equity.

Purpose

Development of options and recommendations to transform the global health architecture into a truly country-led, coherent and inclusive ecosystem that responds more effectively and efficiently to the specific and collective needs of countries and communities to maximize impact and equity.

Principles

The reformed GHA should reflect the principles of:

  • equity and solidarity – addresses power imbalances and prioritizes needs of populations in vulnerable settings;
  • country leadership and ownership – strengthens countries leadership of priorities and financing trajectories;
  • subsidiarity – ensures decisions sit as close to the country/regional level and impact as possible; and
  • coherence and accountability – enhances integration, respects mandates and roles; aligns with future health trends.

What is the global health architecture (GHA)?

Many organizations and agencies shape global health, including working to prevent disease, respond to emergencies, strengthen health systems and protect populations.

The GHA includes:

  • countries and governments;
  • United Nations organizations;
  • global health institutions, initiatives and partnerships;
  • regional and country-level health bodies; and
  • civil society, academia, philanthropy and the private sector.

It is an overall system of actors that is shaped by its rules, financing mechanisms, and its processes that guide, coordinate, finance and implement efforts to protect and improve health worldwide.

Considering the current weaknesses of the global health architecture as described above, a number of initiatives have been launched aiming at better defining the problem, providing research and data analysis and trying to find solutions.

Related GHA reform initiatives

Accra Reset – Resetting Global Development Cooperation for a Post-Dependency World.

Reform of the Global Health Architecture – African High-level Ministerial Committee

EU and Like-Minded Donors’ Reflection Process on Reform of the Global Health Architecture.

HEAR CSO – Reimagining Global Health Architecture.

The Lusaka Agenda – Conclusions of the Future of Global Health Initiatives Process.

MOPAN Global Health Insights Study

Wellcome Trust – From Rethinking to reform: the way forward for the global health system.


The reform process

The WHO Executive Board has requested the development of a proposal for a joint, inclusive and time-bound process to support reform of the global health architecture. In a joint process together with major global health actors (UNICEF, UNFPA, UNITAID, CEPI, Gavi, the Global Fund, the Pandemic Fund and the Worldbank) options and recommendations will be developed for the consideration and decision of WHA and the respective boards of global health institutions.

The initial objectives include but may not be limited to:

  • strengthening coordination across global, regional and country levels;
  • clarifying roles, responsibilities and comparative advantages; and
  • aligning financing and support more closely to country-led priorities.

Developing a joint proposal for a process for reform

WHO is convening stakeholders to develop a proposed joint reform process.

This proposal will be submitted for discussion at the Seventy-ninth World Health Assembly (WHA79) through PBAC44 in May 2026. Other stakeholders will consider discussions with their respective governance.

Engagement to inform the proposal includes:

  • a WHO three-level internal working group established to coordinate the development of the process and bring in country, regional and global perspectives;
  • open call for written submissions via the WHO website;
  • Member State consultation sessions;
  • Global Health Institutions working group (UNICEF, UNFPA, Pandemic Fund, World Bank, CEPI, Global Fund, Gavi, Unitaid, WHO);
  • GHA Reform Initiatives working group;
  • consultations with non-state actors, civil society, youth council and other stakeholders; and
  • planned regional consultations, thematic roundtables and deep dives.

Member States’ information sessions