From rethinking to reform: the way forward for the global health system
This paper brings together reflections and takeaways from five regional dialogues involving participants from over 114 countries about global health reform. Led by regional partners, the dialogues tackled pressing questions about the changes needed in the global health system and how they might be achieved.
Report at a glance
This paper was authored by Fabian Moser, with support from Clare Battle and Beck Smith, from Wellcome's Policy team. The following members of the organisations leading the regional dialogues provided critical reviews and input for the paper: Yousef Khader (for the Middle East and Central Asia regional dialogue), Angkana Lekagul and Afifah Rahman-Shepherd (Asia Pacific dialogue), Pablo Villalobos Dintrans (Latin America and Caribbean dialogue), Julia Roper and Sanne Wendes (Europe and North America dialogue), and Rispah Walumbe and Frida Ngalesoni (Africa dialogue).
- Published:
- 18 March 2026
- Strategic programme:
- What's inside:
- Outcomes from the regional dialogues on global health reform led by partner organisations
- Who this is for:
- Policy makers, decision-makers in government and the wider global health policy community
- Creative commons:
Summary
Significant changes to the global health system are now inevitable. It is not a question of if the system will change. It is a question of when, in which direction and who shapes this future system.
That’s why, from August to November 2025, Wellcome supported regional partners to lead five dialogues where stakeholders from over 114 countries discussed global health reform.
Dialogues involved consultations, in-person convenings and engaging governments, civil society and other actors to discuss global health priorities and how to make reform a reality.
This synthesis paper captures insights and outcomes from these dialogues, drawing on reports published by each of our regional partners.
These include the key areas of global health most in need of reform, where regional priorities align or diverge, and common recommendations that emerged.
The current system is no longer fit for purpose
All regions agreed that today’s global health system has delivered important benefits. However, regions also highlighted that the current system is now unfit for purpose and there are persistent flaws hindering progress. For example:
- the system’s incoherence and inefficiency
- power imbalances in decision-making and agenda-setting
- accountability and implementation gaps
- fragmented international health financing and dependence on external funding
- inequitable data systems
Countries are demanding urgent and major reforms to make the global health system more equitable, effective and sustainable.
A decentralised, country-driven global health system
Over the course of these dialogues, a shared vision for the future emerged: a decentralised, country-driven global health system, anchored in regional hubs and supported by a leaner and streamlined global health system. Achieving this vision means sticking to core principles like sovereignty, subsidiarity, equity and coherence.
What could this look like in practice at the country, regional and global levels?
Countries are the primary place where health is protected, provided for and promoted. They drive priorities in the global health system to ensure local relevance and ownership.
The regional level would coordinate shared health strategies, technical cooperation and financing to tackle common challenges as closely as possible to where they are.
The global level would focus on providing global technical standards, global public goods for health, stewardship to manage global threats and financing aligned with countries’ priorities.
This system would aim to improve health for everyone by:
- supporting regional and global public goods
- providing fast and coordinated international responses
- offering targeted assistance that aligns with each country’s priorities
It would also be flexible enough to adapt to shifting health challenges and different local contexts.
Key takeaways
The regional dialogues identified three key areas that urgently need reform:
Governance: clarify and streamline the roles of organisations, and shift power towards regions and low- and middle-income countries
- Ensure a clearer split between what’s done globally and what’s done regionally and get rid of overlapping global mandates.
- Make regional organisations and systems stronger so that countries can work together more closely and effectively on shared health issues.
- Give low- and middle-income countries and civil society more power in key decision-making and accountability processes.
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Conclusion
Collectively, the dialogues set out clear next steps that are centred on shifting power and decision-making from the global level towards countries and regions. The goal is to build a more responsive and equitable global health system that is decentralised yet interconnected.
But the dialogues raised important questions that need to be addressed in upcoming discussions on global health reform. They also noted that agreeing on how to make change happen will remain difficult.
Success will depend on:
- aligning strong technical proposals with political support
- building coalitions that can advocate for and deliver change
- taking an iterative approach that secures early wins while pushing for long‑term improvements
Governments, regional bodies, global organisations and civil society each have a vital role to play.
What's next?
As a next step following the regional dialogues, Wellcome is hosting a high-level global meeting that will aim to encourage agreement around the actions needed to move forward. This includes how these can be done collectively.
This work complements other ongoing reform efforts. For example, the Lusaka Agenda, Accra Reset, the emerging WHO‑convened process, the EU and like‑minded donor reflections, Sevilla Platform for Action, HEAR civil society, and the wider UN80 discussions.
The Wellcome global dialogue will not aim to duplicate these initiatives. Instead, it should build on existing momentum and support greater coherence across shared efforts.
By continuing to work together, the global health community can use this moment to build a system that is more equitable, more effective and better prepared for future challenges.
Downloads
Read the five reports published by our regional partners:
Contact us
For more information, contact Fabian Moser, Policy Adviser, Global Health Policy at Wellcome.
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