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:
1. Governance: clarifying and streamlining the roles of organizations, and shifting power to low and middle income countries and regions.
- 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.
2. Financing: ensure that international financing is adapted to the needs of the countries and increase national and regional investments in health.
- Countries provide more – and better – domestic health funding, transitioning away from external support and addressing internal and external barriers to health investment.
- Make sure international financing aligns with country priorities, is well coordinated and focused on strengthening primary health care systems. This includes multilateral development banks playing a greater role.
- Strengthen regional health financing for public goods and support countries that respond to what they need.
3. Data, knowledge and products: building stronger regional data systems and shaping markets to ensure that everyone can get the health products they need.
- Strengthen regional systems for exchanging health data, information and evidence so it’s easy for countries to work closely together and make progress on shared health challenges.
- Shape health product markets through pooled procurement and manufacturing that is spread out across regions.
