Transforming the Global Health Architecture: Reflections from the World Health Summit Keynote

Introduction

On Sunday afternoon at the World Health Summit, an unambiguous message resonated from the keynote stage: the global health architecture must adapt, urgently, courageously, and collaboratively. Under the skilful moderation of Serah Makka, Africa Executive Director at The ONE Campaign, leaders from government, multilateral institutions, and the private sector examined how to move beyond aid dependency and build a future anchored in domestic leadership, shared responsibility, and smarter investment.

The panel, Mónica García Gómez (Minister of Health, Spain), Thomas Schinecker (CEO, Roche; President, IFPMA), Dr Jean Kaseya (Director-General, Africa CDC), Bärbel Kofler (Parliamentary State Secretary, BMZ), Saia Ma’u Piukala (WHO Regional Director for the Western Pacific), and Winnie Byanyima (Executive Director, UNAIDS), brought clarity, urgency, and challenge. It was a conversation grounded in realism and animated by ambition.

Problem: From volatility to vulnerability

The context is sobering. Drastic cuts and volatility in international aid are reshaping health financing. Debt servicing is crowding out public budgets. Many countries still rely heavily on external health financing, even as populations grow rapidly, by 2050, Africa will be home to the world’s largest and youngest population. Meanwhile, in many settings, the first source of health financing is out-of-pocket spending, pushing households into poverty and undermining universal health coverage.

Several themes emerged:

• Donor bias and fragmentation: “A virus is not looking for a visa,” reminded Bärbel Kofler. Our architecture, still influenced by donor preferences and parallel structures, does not always match the needs of partner countries or the realities of cross-border threats.
• Overreliance on a few funders: Winnie Byanyima underlined the fragility of depending on a narrow donor base, noting the outsized role of the United States in financing the global AIDS response in recent years. Volatility in one capital reverberates across the system.
• Unsustainable models of access: As Thomas Schinecker stressed, donation-led approaches are not a long-term strategy. If each country optimises solely for itself, we fail the solidarity test and undermine the incentives needed for sustained innovation and reliable supply.
• Domestic fiscal constraints and inequity: Saia Ma’u Piukala highlighted pervasive weaknesses in public financial management (PFM) and the need to reduce out-of-pocket expenditure through stronger primary health care and fairer financing. The Western Pacific’s continuing burden of non-communicable diseases (NCDs) illustrates the cost of delay.

If the global health architecture remains patchworked and reactive, we will continue to lurch from crisis to crisis—failing both the most vulnerable and the promise of sustainable development.

Solution: Towards a domestically led, globally supported system

This keynote did more than diagnose problems; it offered a roadmap. The discussion, building on The ONE Campaign’s six practical pathways, explored three immediate opportunities: fair health taxes, diaspora capital, and positioning health as a driver of inclusive growth. Several cross-cutting, actionable insights stand out for boards and executive teams.

1.) Reframe health as investment, not cost

• Health is economic infrastructure. Spain’s Minister of Health urged a reframing: public health is foundational to productivity, resilience, and growth. Mission-driven public financing should safeguard essential services across the cycle—from prevention and primary care to preparedness and surge capacity.
• Climate resilience is now core. Health systems must be climate-smart: resilient facilities, heat-ready supply chains, and surveillance systems that anticipate climate-sensitive diseases. This is no longer a niche agenda; it is a fiduciary one.

2.) Build domestic fiscal capacity and fairness

• Strengthen PFM and reduce out-of-pocket spending. As Piukala noted, strengthening PFM builds trust and enables funds to flow predictably to frontline services. Reducing out-of-pocket payments is essential to protect households and accelerate universal coverage.
• Use “Best Buys” for NCDs to drive health and revenue. WHO’s evidence-based measures like taxation on tobacco, alcohol, and sugary drinks—can reduce harmful consumption and raise revenue. But Winnie Byanyima reminded us: when successful, these taxes generate diminishing returns. They must be part of a broader, progressive fiscal strategy, not the whole plan.
• Close tax loopholes and consider fairer global rules. Byanyima called attention to illicit financial flows and tax avoidance that erode domestic revenue bases. Conversations on progressive taxation, including proposals to set minimum effective tax rates for the ultra-wealthy - are not abstract. They are about the sustainability of health and social contracts.

3.) Mobilise diaspora capital—responsibly

• Diaspora bonds can complement, not replace, public financing. There is immense potential in diaspora capital—particularly for small island developing states and countries with sizeable diasporas. But, as raised in the discussion, these instruments must be transparent, fairly priced, and accompanied by robust fiscal safeguards. Private remittances are not a substitute for public obligation; they should not mask state underinvestment.

4.) Move from parallel programmes to integrated systems

• Integrate vertical programmes with system strengthening. Byanyima urged a course correction: parallel structures must give way to integrated, accountable systems. Encouragingly, Gavi, the Global Fund and the Global Financing Facility have taken steps to deepen health system investment and alignment; this momentum must continue.
• Invest in data and health intelligence. Evidence is architecture. Without robust, interoperable data systems, countries cannot make informed choices or track value for money. This is a core board-level responsibility: demand measurable results, and resource the infrastructure that makes them possible.

5.) Advance local manufacturing and regional self-reliance

• “Africa is ready, we are co-creators,” affirmed Dr Jean Kaseya. The Africa CDC is not waiting for permission. From epidemic response to regulatory strengthening, regional leadership is accelerating.
• Good governance unlocks domestic financing. The “Green Book” principle, emphasised by Dr Kaseya, good governance for domestic resource mobilisation, is key to attracting and sustaining investment, including for local manufacturing. Regional production improves security of supply and reduces dependency during crises.

6.) Align innovation, pricing, and solidarity

• Differential pricing and sustainable access. Schinecker’s point was clear: high-income markets cannot expect the same prices as low-income settings if we are to align access with ongoing innovation. This is solidarity in practice.
• Move beyond donation-dependency. Donations may help in acute crises, but they are not a durable access strategy. Long-term solutions blend tiered pricing, local manufacturing, effective procurement, and predictable financing.

7.) Keep preparedness at the centre

• “A virus does not look for a visa.” Preparedness is a collective good requiring collective action. Debt relief and concessional finance targeted at preparedness, including surveillance, workforce, and primary health care, are prudent investments that reduce future fiscal and human costs.

What this means for boards and executive leaders

The keynote put the onus squarely on leadership. For board chairs, trustees, CEOs, and senior executives in global health and development, five priorities stand out:

• Set the vision: Position health as macro-critical to growth, social stability, and climate resilience. Align organisational strategies and partnerships accordingly.
• Strengthen governance for financing: Champion transparent PFM, measurable performance frameworks, and integrated risk management. Insist on data that supports value-based decisions.
• Diversify financing intelligently: Combine health taxes (where appropriate) with broader tax reforms, earmarked levies with general revenue support, and explore diaspora instruments with robust safeguards.
• Integrate and coordinate: Move away from parallelism. Align with national priorities, pool capacities, and co-create with regional institutions like the Africa CDC.
• Invest in people and primary care: From community health workers to supply chain managers and data analysts, people are the system. Ensure fair remuneration, continuous learning, and retention strategies that reduce harmful attrition.

Key takeaways

• Domestic leadership is non-negotiable: Countries want, and are ready, to co-create solutions. External actors must follow national priorities and strengthen, not supplant, domestic systems.
• Fair finance beats fragile finance: Progressive taxation, better PFM, and reduced out-of-pocket spending create sustainable pathways to universal health coverage and resilience.
• Integration is efficiency: Parallel structures may deliver quick wins, but integrated systems deliver lasting value, equity, and accountability.
• Solidarity has a price, and a payoff: Tiered pricing, concessional finance for preparedness, and fair global tax rules are not charity; they are smart design choices for a safer, more prosperous world.
• Data is destiny: Health intelligence underpins effective prioritisation, efficient spend, and trust with citizens and funders alike.
• Innovation must be sustained: Donation-dependent models cannot carry future pandemics. Align industrial policy, pricing, and procurement to ensure access and continuous R&D.

Conclusion

This was not a session of easy answers, but it was a session of real direction. The path forward is clear: a domestically led, globally supported health financing architecture that is integrated, fair, and future-ready. Leaders spoke with candour about the trade-offs; they also showed what courage looks like in policy and practice.

At SRI Executive, we were in the room because these conversations matter—and because the organisations we partner with will shape what happens next. Our purpose is to enable organisations to maximise their impact and lead lasting change. In global health, that means championing leadership, governance, strategy, and organisational effectiveness that rise to this moment with integrity and ambition.

Empowering lasting impact begins with the choices boards and executives make today. Let’s choose systems that endure.

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