Insights on global health reform discussions, trends and perspectives: March 2026
The third in our ongoing series of Insights papers on global health reform discussions, trends and perspectives is now available.
We note that the boundaries between what initially emerged as siloed global health reform initiatives are softening, with greater awareness and exchange across different conversations. While it is vital to continue pursuing alignment, it needs to occur at a productive and pragmatic level resulting in tangible improvements.
Cost-cutting across global health institutions is increasingly perceived as an effort to remain, not reform. Most of the attention has so far been paid to the future of Gavi, Global Fund and WHO, with less being said about reforms of other global health financing institutions as well as disease-specific partnership, all of which contribute to the current fragmented landscape. Finding a solution for the three major institutions alone is unlikely to resolve the complexity and verticalization within the global health system.
South-led coalitions have the best prospects for cultivating the legitimacy required to drive global health reform. The Accra Reset stands out in this regard, having secured high-level international backing. Nevertheless, equally crucial for its success will be sustained and unified backing from African leadership as well as from other regions.
Across the reform discussions, the point of contention does not seem to be whether health sovereignty is desirable, but whether it can be combined with enhanced multilateral cooperation. Proposed mechanisms for transitioning to self-sufficiency might falter not because of technical flaws or insufficient data, but due to a lack of underlying trust, both trust within countries and trust between actors.
The prevailing dynamics may help explain growing calls for transactional and reciprocal partnerships, with equality being demonstrated through transparent articulation of benefits for all parties and ‘win-win’ arguments. However, the very duplication and inefficiency that deter some actors from reinvigorating multilateral cooperation risk being reproduced amidst the proliferation of ‘minilateral’, ad hoc partnerships.
ODA is not only diminishing in LMICs’ health financing budgets; it is also gradually receding from most high-income countries’ diplomatic toolkits. The transition away from aid should therefore not be seen as a one-sided process but a shift affecting stakeholders across the global health ecosystem leading to different kind of partnerships build on mutual interest and responsibilities.
We will continue to share regular updates and analyses around key issues and decisions in what will be a critical 12 months for shaping the future of global health.