Kigali, Rwanda – As donor funding declines and global risks intensify, a new report by African health and finance leaders and a former UNAIDS chief calls for a fundamental reset of the global health ecosystem.
For a quarter of a century, global health has been one of the quiet success stories of international cooperation. Since the year 2000, annual child deaths have fallen from nearly 10 million to fewer than five million.
New cases of the world’s deadliest infectious diseases have been reduced by half. These gains did not occur by chance. They were driven by strong national leadership, scientific breakthroughs, and unprecedented international solidarity.
Yet as the world enters 2026, this progress stands at risk. Abrupt declines in donor funding in 2025 have exposed deep structural weaknesses in the global health system and raised fears that hard-won gains could be reversed.
Against this backdrop, a new report titled Transforming the global health ecosystem for a healthier world in 2026 argues that the moment demands for a fundamental redesign of how global health is governed, financed, and delivered.
The report is authored by the former Executive Director of UNAIDS, Michel Sidibé, alongside African health and finance officials including Muhammad Ali Pate, Peter Piot and Rwanda’s very own Dr. Donald Kaberuka.
Drawing on lessons from the past 25 years and consultations across regions, the authors contend that the global health ecosystem has reached a historic inflection point. The question is no longer whether reform is needed, but whether it will be strong enough to meet today’s realities.
They argue that health must be reframed as a core pillar of national development and infrastructure, rather than a stand-alone aid sector.
In many low- and middle-income countries, external assistance still plays a vital role, but overreliance on volatile foreign funding has left systems exposed.
As donor priorities shift and fiscal pressures mount in high-income countries, hoping for a return to previous funding levels is no longer realistic.
Instead, the report calls for a new balance in which countries lead the definition of health priorities, supported by regional bodies and global institutions that act as enablers rather than drivers.
Primary health care, the authors say, should become the default organizing principle for health systems, anchoring investments in prevention, early detection, and community-based services.
Why the global health model must change
Low- and middle-income countries have repeatedly called for greater efficiency and equity, from the African Leadership Meeting on Investing in Health in 2019 to Africa’s New Public Health Order in 2022.
These demands gained renewed momentum at the Accra Summit on Africa Health Sovereignty in August 2025, which launched the “Accra Reset” as a rallying call for country ownership and systemic reform.
While development assistance for health has delivered dramatic results, particularly in the fight against HIV, tuberculosis, and malaria, it has also produced unintended consequences.
Vertical, disease-specific funding has at times fragmented national systems, increased administrative burdens, and limited domestic investment in long-term health infrastructure.
In some cases, critical data generated by externally funded programs has remained inaccessible to national authorities. The report acknowledges these tensions while emphasizing that international support remains essential, especially for global public goods.
Surveillance systems, epidemic preparedness, research and development, pooled procurement, and equitable access to innovation cannot be sustained by countries acting alone. Preserving and strengthening financing for these shared priorities is central to any credible reform agenda.
A leaner, country-centered ecosystem
Rather than calling for wholesale dismantling of existing institutions, the authors advocate for a more coordinated ecosystem with clearer mandates and stronger accountability.
Consolidation, they argue, should be a means to improve efficiency, not an end in itself. Where missions align, shared governance structures, back-office functions, and country offices could reduce duplication and ease the burden on health ministries.
The report urges United Nations agencies to refocus on their core roles, particularly the World Health Organization’s mandate on norms, standards, surveillance, and emergency coordination.
Financing institutions such as Gavi and the Global Fund, while still indispensable for the poorest countries, are encouraged to streamline operations and reduce administrative complexity.
Closer alignment with multilateral development banks, including the World Bank, is also seen as critical to mobilizing blended finance for health infrastructure, digital systems, and innovation.
At the same time, the authors caution against reforms that unintentionally weaken disease-specific programs or marginalize vulnerable populations, including communities affected by HIV.
Protecting continuity of essential services, especially during humanitarian and epidemic crises, remains non-negotiable. The report warns that failure to act now, will only prolong dependency on unstable aid and leave countries ill-prepared for future shocks.
But if reforms are co-created with countries, guided by clear timelines, and grounded in political commitment, a transformed global health ecosystem could emerge within the next three years.
The past 25 years have shown what is possible when leadership, resources, and innovation converge. The next 25, the authors argue, must deliver a global health order that empowers countries, strengthens resilience, and advances a healthier and more just world for all.
