Bold ideas for a reformed global health system | Reports

Discussion papers at a glance

These discussion papers were commissioned by Wellcome and authored by innovative thought leaders. The views and opinions expressed in these papers are solely those of the authors and do not necessarily reflect the official policy or position of Wellcome. The bold ideas in these papers are intended as a starting point, to kickstart ambitious and inclusive conversations with a broad range of stakeholders at regional and global levels.

Published:: 4 September 2025
Strategic programme:: Advocacy and partnerships: influencing policy change
What's inside:: Bold ideas for global health reform according to five thought leaders from around the world.
Who this is for:: Policy makers, decision-makers in government and the wider global health policy community.
Creative commons:: Creative Commons (CC BY)

Summary

Global health is undergoing significant change with shifts in politics and funding. For example, governments are cutting overseas development aid and focusing more on priorities at home. This presents an unprecedented challenge to global health, but also a unique opportunity to consider the current system and rethink how it can meet the needs of a changing world.

That’s why we’ve commissioned five thought leaders from different regions around the world to reimagine the global health architecture. By global health architecture, we mean the systems, structures, institutions, rules and processes that collectively guide, coordinate, finance and implement efforts to improve health on a global scale.

Five regional perspectives

These innovative thought leaders outline ambitious visions for global health reform across five discussion papers, rooted in different regions:

Khor Swee Kheng (Asia and the Pacific)
Catherine Kyobutungi (Africa)
Kelley Lee (Europe and North America)
Paola Abril Campos Rivera (Latin America and the Caribbean)
Shadi Saleh (Middle East and Central Asia)

Emerging themes

The papers offer a diverse and ambitious range of perspectives on an equitable, sustainable future for global health and how to achieve it. Some key themes include:

Shift power to regions and countries most affected by health challenges: how to reform global health governance structures and enable regional and country leadership to make the future system more effective, efficient and equitable in serving the health needs of local communities.

Justice and fairness: how to embed fairness in the reformed design of the global health architecture.

Innovation: how global health products, processes and institutions must radically change to fit the challenges of the coming decades.

Coordination across sectors: how to tackle global health, climate change and global financial inequality through joint and mutually reinforcing governance and financing mechanisms.

What unites all five discussion papers is clarity about the need for substantive global health reforms. They envision significant change to correct failures of the past and present, and to better prepare for challenges of the future.

These initial proposals are not expected to be representative, or consensus based. Rather, they set an ambitious trajectory for global dialogue based on the perspective of leading experts in the field from different regions of the world. They are a starting point to provoke ambitious and inclusive conversations among a broad range of stakeholders at regional and global levels.

Key takeaways

Below are key takeaways lifted directly from each thought leader’s discussion paper, organised by region.

Asia and the Pacific

'Proposing a Global Commons Coordinating Council and A Set of Six Enablers for the Global Health Architecture'

by Khor Swee Kheng

Swee Kheng is the CEO of Angsana Health, which builds integrated digital-first primary care systems in Southeast Asia, Malaysia. He is also a Visiting Assistant Professor at the School of Public Health, The University of Hong Kong.

"The main role of any new global health architecture or new actor may not be ‘to act’, but ‘to create the conditions for many others to act, to coordinate collective action and to build checks-and-balances for large forces’.

Creating a brand-new global health institution with meaningful powers is less realistic in a nationalist world in the 2020s, so it is more realistic to create a Global Commons Coordinating Council. This won’t be a new institution but is a coordinating mechanism for five existing institutions: the World Health Organization, the United Nations Framework Convention for Climate Change Secretariat, the World Bank, the International Monetary Fund and the International Association of Insurance Supervisors."

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Africa

'Rethinking the Global Health Architecture in Service of Africa's Needs'

by Catherine Kyobutungi

Catherine is the Executive Director of the African Population and Health Research Center in Kenya. She is also the Co-Director of the Consortium for Advanced Research Training in Africa.

"I propose a radical transformation of the global health architecture to better serve Africa's health needs, advocating for a shift from a ‘saviorism’ approach to one rooted in equity, self-determination and systemic transformation."

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Europe and North America

'A Proposal for Transforming the Global Health Architecture'

by Kelley Lee

Kelley is a Tier 1 Canada Research Chair at the Global Health Governance. She is Professor of Global Public Health for the Faculty of Health Sciences at Simon Fraser University in Canada.

"We propose three types of innovation to transform global health cooperation:

We need to leapfrog to an innovative institutional design that is more connected, agile and responsive to evolving needs.

We must reconfigure representation and decision-making power and strengthen transparency accountability and public trust.

Beyond technological innovation and issue-specific health financing, transformation requires reflecting critically on what the core functions of the global health architecture should be."

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Latin America and the Caribbean

'Rebalancing the Scales: A New Architecture for Global Health Justice'

by Paola Abril Campos Rivera

Paola is a Research Professor and Director for Evidence and Action for Health Equity School of Government and Public Transformation at the Institute for Obesity Research at Tecnológico de Monterrey in Mexico.

"A new global health architecture must be restructured around three core functions:

producing global health goods that advance health justice

enabling collective action focused on the most affected populations

holding actors accountable to shared norms of fairness, transparency and inclusion

These functions must be supported by institutions explicitly designed to correct power imbalances."

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Middle East and Central Asia

'Designing a New Global Health Architecture for the Middle East and Central Asia Region'

by Shadi Saleh

Shadi is Founding Director of the Global Health Institute. He is also a Professor of Health Systems and Financing at the American University of Beirut in Lebanon.

"The Middle East and Central Asia have a disproportionate burden of refugees as well as displaced and marginalised populations, mostly from conflicts, but also due to economic factors and more recently climate factors. A main function of a reimagined global health architecture should consider that and acknowledge that proactive efforts are needed to address inequities among those hard-to-reach populations."

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Conclusion

These ideas are only the beginning. The next step is to have inclusive conversations among regional and global stakeholders.

Wellcome commissioned partners in each of the five regions to lead inclusive regional dialogues on global health reform towards the end of 2025. The above papers, alongside other inputs and processes, should provoke discussion and more ideas from a wide range of stakeholders. They will discuss what is needed to enact changes to the global health system and how this can be made possible on a coherent reform path.

This will feed into a global dialogue, where the goal will be to encourage agreement and identify actions to take forward.

Downloads

Download the discussion papers from each region in seven different languages:

Arabic
Chinese
English
French
Portuguese
Russian
Spanish

Asia and the Pacific discussion papers

Africa discussion papers

Europe and North America discussion papers

Latin America and the Caribbean discussion papers

Middle East and Central Asia discussion papers