The new partnership-led global health architecture: implications for talent and organisational effectiveness

A world at a turning point

Every year, more than 3.3 billion people, over 40% of the world’s population, face heightened health risks due to climate change, according to The Rockefeller Foundation. At the same time, the World Health Organization reports that donor contributions to low-income countries have stagnated or declined, even as demand for services surges. The COVID-19 pandemic exposed deep vulnerabilities in health systems, eroding public trust and underscoring the urgent need for reform. As populations age and become more diverse, systems must serve more people, for longer, with increasingly complex needs.

The shift: from fragmentation to partnership

The traditional, top-down model of global health, rooted in post-war assumptions of endless growth and Northern leadership, can no longer meet today’s challenges. Fragmentation, diminished multilateralism, and the rapid emergence of new technologies demand a different approach. Recent initiatives such as the Lusaka Agenda, the African Health Sovereignty Accra Initiative, and proposals under the UN80 reforms signal a decisive move towards partnership-led, country-driven health governance. These efforts prioritise local ownership, accountability and efficiency, building resilient, equitable systems shaped by those they serve.

Key forces shaping this shift include:

• Climate crisis: Disrupting unprepared health systems and demanding new approaches at the climate–health nexus. In response, Wellcome and the Climate and Health Funders Coalition recently committed US$300 million to climate–health solutions, citing that 3.3 billion people are at risk due to climate change.
• Fragmentation of care: Health systems are insufficiently coordinated to the scale of challenges such as non-communicable diseases and pandemics, making effective responses harder to deliver.
• Emergence of new technologies: Innovations such as digital health and artificial intelligence require stronger ethical governance and implementation capacity.
• Diminished multilateralism: Reduced cooperation among nations has led to significant cuts in global health funding, including declines from historically major donors.
• Demographic change: Growing populations, higher child survival and longer lifespans mean systems must cope with more people, for longer, with increasing comorbidities. Most are not adequately prepared. According to the Global Health Expenditure Database (April 2025), in many low-income countries over 25% of health expenditure remains donor-funded, with governmental health spending accounting for less than 10% of national budgets.
  
  

These dynamics have brought the “golden age” of global health to a close and introduced instability across the sector. Attempts at reform have repeatedly highlighted persistent problems: lack of strategic vision, weak regional leadership, poor accountability and inefficient partnerships across international organisations, funders, governments and local providers.

The sector needs more than institutional reform; it requires a fundamental shift to a partnership-led framework. That means building consensus on priority reforms and driving health sovereignty at the local level. A diverse group of stakeholders, including governments, funders, multilaterals, NGOs, civil society, thought leaders and researchers, is beginning to lead this transformation.

Principles for a new global health architecture and areas of transformation

A shift towards country-led, partnership-driven governance, emphasising local ownership, accountability and efficiency, is underway, with clear evidence of change emerging:

1. The Lusaka Agenda: a blueprint for country-led health

• Initiated in December 2023 by Norway and Kenya, the Lusaka Agenda brings together major global health organisations (including Gavi, the Global Fund, CEPI, FIND and Unitaid) to drive structural transformation. It focuses on five axes: strengthening primary care; sustainable, domestically financed public health; joint approaches for health equity; strategic and operational coherence across initiatives and R&D; and increased regional manufacturing. Implementation is being tracked by the African Constituency Bureau and Africa CDC, with a continental scorecard for African Union Heads of State.

2. African Union endorsement and implementation

• In February 2024, the African Union endorsed the Lusaka Agenda. Implementation involves national accountability frameworks and health system reform roadmaps, supported by organisations such as Africa CDC and WHO. Key strategies include boosting domestic financing, aligning external aid with national plans, strengthening primary healthcare and fostering collaboration with development partners, with an emphasis on country leadership and ownership. Coordination is supported by a multi-stakeholder working group co-chaired by Canada, Ghana and Amref Health Africa.

3. WHO’s role: governance reform

• WHO is advancing change through its 5Cs framework for health emergency preparedness and advocating for a fairer, more accountable global health architecture. In May, the 78th World Health Assembly adopted a resolution (led by Nigeria and co-sponsored by more than 25 countries) calling for increased domestic investment and deeper governance reform. At a joint event on the sidelines of the Assembly, The Rockefeller Foundation announced a US$5.2 million grant to the World Meteorological Organization to support the WHO–WMO Climate and Health Joint Programme, matching Wellcome’s US$6.3 million grant announced last October.

4. African health sovereignty: the Accra Initiative in action
   

• The Health Sovereignty Summit in Ghana launched the Accra Initiative, focusing on financial and programme sovereignty for Africa. Several pledges were made to rebalance inequities in global health governance and move decisively towards prevention, wellness and resilient systems rooted in African priorities. The Initiative also emphasised the need to reform global health governance and accountability to amplify African voices in decision-making.

5. UN80: reforming multilateralism for the 21st century

• The UN80 agenda recognises inefficiencies from overlapping programmes among UN health agencies. To improve efficiency and outcomes, the UN proposes aligning responsibilities (notably across WHO, UNICEF and WFP), including joint knowledge hubs, integrated support platforms and shared operational, data and training services.

    6. Wellcome’s proposals

• Wellcome has commissioned five proposals across international regions, covering leadership, governance, justice, innovation and coordination frameworks necessary for the new global health architecture.
  

Implications for talent search

Health sovereignty and the demand for domestic leadership are becoming non-negotiable. Countries want, and are ready, to co-create solutions. External actors must follow national priorities and strengthen, not supplant, domestic systems. This has several implications:

• Prioritise local leadership and diaspora engagement: Organisations are seeking strong local expertise and strategies to attract international diaspora talent back to their home countries, particularly for roles spanning climate, health and data systems.
• Build sustainable payer mixes and risk pools: Effective systems depend on a balanced payer mix across users, private and public sectors, with sufficiently broad risk pools so the healthy can subsidise the less healthy. Talent with health financing expertise will be critical.
• Strengthen performance, risk and data governance: Donation-dependent models are insufficient for future pandemics. Measurable performance frameworks and integrated risk and data management should inform funding and operational decisions. Leaders with the capability to build these systems are in high demand.
• Recruit for “One Health” capabilities: Health can no longer be addressed in isolation. The climate crisis, new agricultural models, non-communicable diseases and technological advances (e.g., AI, mRNA platforms) demand cross-sector collaboration. Candidates who can operate at the climate–health nexus and build partnerships across public, private and civil society actors will be essential.

Implications for organisational effectiveness

The ongoing change signals a broader vision for health sovereignty that demands clear institutional mandates, cooperation over competition and a coordinated architecture where organisations play to their strengths. Implications include:

1. Decentralised leadership models

Localisation will require the decentralisation of leadership and management teams. This is an opportunity to diversify leadership and increase relevance to local stakeholders. It will also require careful organisational design and focused team and leadership effectiveness to ensure new local models are fit for purpose and implemented well.

2. Reframing the role of IGOs and NGOs

Rather than acting solely as conveyors of centralised funding and priorities, the new architecture requires IGOs and NGOs to work closely with governments and local partners, developing ongoing consultative partnerships with vibrant local societies.

3. Rethinking country footprints

Organisations will need to reassess whether their local operations have the appropriate footprint to be effective, impactful and reflective of local realities. This includes considering the right presence model: a fully-fledged local office; hybrid presence in partnership with regional actors; or operating under the umbrella of a larger local stakeholder (such as a government, multilateral, donor or civil society actor). For example, the partnership between the Gates Foundation and Nigeria’s Ministry of Finance on several initiatives represents a possible model for effective country footprints.

4. Culture and power dynamics

In global health, “decolonisation” involves critically examining and reforming power imbalances and systemic inequities rooted in colonial histories. This includes addressing the dominance of high-income countries in setting research agendas, funding priorities and governance structures for countries in the Global South. Examples of this ongoing shift include the Accra Initiative’s principles of inclusivity and leadership, as well as WHO’s substantive local engagement informing a global declaration on non-communicable diseases endorsed at the World Health Assembly. Other INGOs should follow suit.

How SRI Executive can help

We are active participants in this transformation. Our team has placed over 200 leaders in 35 countries, supporting reforms aligned with the Lusaka Agenda and the Accra Initiative. We have worked alongside organisations such as WHO, the Global Fund and leading NGOs to design and implement talent strategies that prioritise local expertise and diaspora engagement.

Our consultants bring deep sector knowledge and cross-cultural fluency, bridging global best practice and local context. We have advised on national accountability frameworks, supported recruitment for regional manufacturing initiatives and facilitated partnerships between governments, donors and civil society. Our approach is evidence-based, impact-driven and tailored to the unique needs of each client.

SRI Executive’s network includes thought leaders and innovators at the forefront of global health, climate and development. This helps us anticipate trends, identify emerging opportunities and offer insights that go beyond conventional wisdom. Whether supporting organisational redesign, leadership development or governance reform, we are committed to helping partners build effective, resilient and inclusive health systems.

Key takeaways for boards and C-suite leaders

• The centre of gravity is shifting towards country-led, partnership-driven models, with health sovereignty as a guiding principle.
• Talent strategies should prioritise local leadership, diaspora engagement and “One Health” capabilities that bridge climate and health.
• Organisational effectiveness depends on decentralised leadership, clear mandates, coherent country footprints and cultures that address systemic power imbalances.
• Robust performance, risk and data governance are non-negotiable to secure sustainable financing and deliver results.
• Trusted partnerships, across governments, funders, multilaterals, NGOs, the private sector and communities, will determine success.
  

Vision for the future: success and a call to collaboration

Achieving this vision will require courage, collaboration and a willingness to embrace new ways of working. It means moving beyond silos, investing in local leadership and holding ourselves accountable for results. The reforms underway are only the beginning. By working together, governments, funders, NGOs, the private sector and communities, we can build a global health architecture that is fit for the future and equal to the climate–health challenge. If you would value a conversation about what this means for your leadership, governance or organisational design, we are here to listen and share perspectives.