EU and Like-minded Donors’ Reflection Process on Reform of the Global Health Architecture
Global consultations have underscored the urgent need to reform the global health architecture. Key challenges include limited country sovereignty, fragmented systems, unpredictable financing, weak donor coordination, and insufficient voice for low- and middle-income countries.
In response, a report prepared by the consultant team contracted through the Knowledge Hub for Health, Inequalities and Social Protection (HISP), and led by hera, proposes reforms across five priority areas: normative guidance; financing and resource mobilisation; market shaping and equitable access; data and surveillance; and coordination and governance. It calls for strong political leadership, genuine country co-creation, streamlined efforts and clear accountability to deliver meaningful progress in 2026.
The European Union and Like-Minded (EU/LM) Donors' Reflection Process on Global Health Reform was commissioned by the European Commission’s Directorate General for International Partnerships (DG INTPA) to enable 11 European Union Member States (EU MS) and five aligned countries to facilitate the identification and discussion of options around how they might jointly advance global health architecture reform in the context of declining development assistance for health (DAH). The process of elaborating reform ideas and options engaged almost 500 stakeholders using several consultation methods.
Consultations identified urgent reform needs in several functional areas: country sovereignty over health plans and budgets; global governance structures that currently exclude meaningful low-and middle income country (L/MIC) voices; the balance between vertical and integrated approaches; system fragmentation across too many actors; external financing modalities that lack predictability; domestic resource mobilisation and transition challenges; the World Health Organisation (WHO)'s role and effectiveness; technical assistance delivery; success metrics focused on short-term results; and weak donor coordination.
As a result of these inputs, as well as through advice from an Expert Group and the donor Reference Group, reform options at the country, regional and global level are proposed within five priority areas:
Normative guidance and standard setting.
Financing and resource mobilisation.
Market shaping, procurement and equitable access.
Data analytics, surveillance and early warning.
Coordination, accountability and governance.
Moving beyond content to the process for driving forward global health architecture reform through an inclusive, legitimate, global reform approach: effective reform requires securing senior political leadership from both LMIC and donor countries, ensuring LMICs genuinely lead and co-create reform, enlisting bold reform champions at political level willing to drive radical change, streamlining parallel reform efforts, maintaining momentum through concrete action and visibility, adequately resourcing implementation and establishing robust accountability mechanisms from the start. Reform should insist on making substantial progress during 2026 through an inclusive, legitimate global process, that builds on and brings together existing reform initiatives and is able to consider concrete reform options, make decisions and ensure their timely implementation.
The path forward requires acknowledging difficult realities—institutional incentives favour preservation over transformation—but these challenges are not insurmountable. They demand honest dialogue about trade-offs, judicious solutions protecting demonstrated value while advancing genuine reform, and political courage to prioritise long-term effectiveness over short-term institutional comfort.
The report is authored by the consultant team contracted by the Knowledge Hub for Health, Inequalities and Social Protection (HISP), of which hera is the consortium lead. The consultant team was composed of David Salinas, Hind Khatib-Othman, Louisiana Lush and was supported by the HISP team: Grégoire Lacoin, Allison Beattie, Allison Kelley, Diana Isabel Sotomayor