Rethinking Global Health Reform: Building a Fairer Future

The Urgent Need for a Decentralised Global Health System

The Wellcome report, From Rethinking to Reform: The Way Forward for the Global Health System, draws on five regional dialogues involving participants from over 114 countries. The findings are clear: the current global health system has delivered progress but is now unfit for purpose.

Stakeholders identified persistent flaws such as inefficiency, power imbalances, fragmented financing, and inequitable data systems. These weaknesses undermine the ability to respond effectively to health crises and to ensure equitable access to care worldwide.

A shared vision emerged across regions: a decentralised, country-driven system anchored in regional hubs. This model would empower countries to set priorities, strengthen regional cooperation, and reserve global institutions for technical standards, global public goods, and coordinated responses to transnational threats.

Key areas for reform include:

• Governance: Streamlining roles, reducing overlapping mandates, and shifting power toward regions and low- and middle-income countries.
• Financing: Aligning international funding with country priorities, boosting domestic investment, and strengthening regional financing mechanisms.
• Data and Products: Building robust regional data systems and reshaping markets through pooled procurement and distributed manufacturing to ensure equitable access to health products.

The report emphasizes that success will depend on political will, coalition-building, and iterative progress. Early wins must be secured while pushing for long-term structural change.

What’s next? Wellcome will convene a high-level global meeting to align actions and build coherence across reform efforts, complementing initiatives like the Lusaka Agenda, Accra Reset, and WHO-led processes.

Ultimately, the goal is a responsive, equitable, and sustainable global health system—one that empowers countries, strengthens regions, and ensures the world is better prepared for future challenges.