SEEK Development and Panorama Strategy: Priorities and perspectives on reforming the global health architecture

Executive Summary

The Europe and North America Regional Dialogue on Global Health Architecture Reform, one of five commissioned by Wellcome, brought together leaders from governments, multilateral institutions, philanthropy, civil society, and academia to identify reform priorities and how the region can contribute to a more effective and equitable global health system. This paper reflects insights from 40 stakeholder consultations, over 130 survey respondents, and a 1.5-day regional convening with 40 senior participants. Reflecting the roles of participating institutions, the Dialogue focused largely on how the global health architecture can better respond to the priorities articulated by low- and middle-income countries, while examining the responsibilities and constraints facing institutions in Europe and North America.

Stakeholders recognized the significant health gains of the past two decades, even as success has produced a larger, more complex system with overlapping mandates, fragmented external financing, and persistent inequities in decision-making. They also underscored seismic shifts in the global environment: the US' reassessment of its leadership and reduction in funding, major bilateral donors reshaping their health portfolios, and fiscal pressures across high-income countries challenging assumptions about future development financing. These changes amplify the need to prioritize what the system must deliver, optimize existing mechanisms, and pursue more transformational reform where needed, while protecting hard-fought gains.

Across the Dialogue, many opportunities for reform surfaced and three areas emerged as highest priority:

1. Advance sustainable and country-led financing to better align global support behind nationally led health systems, including clearer pathways for shared transition planning, domestic resource mobilization, and greater predictability of external financing;
2. Bolster global public goods through strengthened norms and standards, sustained financing for pandemic preparedness, and coordinated innovation and equitable product access, supported by shared responsibility, clearer global and regional roles, and collective action; and
3. Strengthen governance and decision-making by more clearly distinguishing institutional mandates, broadening representation, enhancing transparency, and aligning cycles, boards, and priorities.

Although many institutions were still defining their positions, the Dialogue advanced a shared understanding of top priorities for global health reform and the opportunities and tensions they raise. Stakeholders emphasized that the next two years present a critical window for pragmatic, country-led action, guided by shared principles: leadership from low- and middle-income countries and regional institutions; speed and focus; political and technical alignment; coordination across processes; and inclusivity and accountability.

They also recognized that Europe and North America have both a responsibility and opportunity to help drive this change using their political influence and financial leadership to align agendas, harmonize funding practices, and act as co-designers rather than directors of reform.

Further reading

This dialogue formed part of a series of five regional dialogues on global health reform supported by Wellcome. Additional information on the initiative as well as the reports from other regions can be found on this page and below:

-Latin America and the Caribbean
-Asia and the Pacific
-Europe and North America
-Middle East and Central Asia