Ahead of this week’s World Health Organization (WHO) Executive Board meeting, Dr Arush Lal (Visiting Fellow, LSE Health) argues for the adoption of a resolution to support coordination of fragmented global health architecture reforms at this year’s World Health Assembly.
The global health system is undergoing a period of profound instability. Climate change, disease outbreaks, humanitarian crises, and eroding multilateralism increasingly overlap, while sharp reductions in official development assistance and weakened replenishments have produced acute financing cliffs. Early estimates attribute hundreds of thousands of deaths to recent funding cuts, service disruptions, and stockouts – particularly in fragile settings. What began as a crisis of resources now risks becoming a crisis of direction and legitimacy for global health governance.
Multiple reform efforts have emerged in response. The Lusaka Agenda, the Accra Reset, Wellcome Trust’s regional proposals, and analyses from a range of institutions all point to insufficient country ownership and an architecture wholly unfit-for-purpose to address today’s challenges.
Yet these reform efforts themselves remain deeply fragmented. Without a legitimate mechanism to bring them together, the system risks drifting toward further institutional competition and incoherence.
The World Health Assembly (WHA) should therefore consider adopting a resolution on global health architecture reform at the May 2026 gathering. Building on the recent WHO Director-General report, Reform of the global health architecture and the UN80 Initiative, the aim of such a resolution should avoid mandating structural redesign. Rather, it would set out to establish a member state-led process to:
1) articulate shared principles for global health cooperation;
2) advance a ‘one country, one plan, one budget, one monitoring’ approach to align global health initiatives with national roadmaps; and
3) initiate a transparent and independent mapping of proposed reforms, functions, and comparative advantages across key actors, including member states, global health organizations, donors and philanthropic actors, and civil society partners.
Such a resolution calling for greater coordination across the global health architecture is not only timely, but also falls within the scope of the WHO to act as the “directing and coordinating authority” for international health work. Previous WHA resolutions serve as precedent for WHO’s normative authority, such as those calling for multisectoral action on antimicrobial resistance and system-wide coordination through the SDG3 Global Action Plan.
Politically, momentum for a WHA resolution would be most viable if it emphasizes coordination, as member states are unlikely to endorse any process that centralizes authority in WHO or diminishes the autonomy of independent global health institutions. Instead, a principles-based resolution – focusing on norms, shared expectations, and light-touch coordination – would align with the interests of both reform-minded donors and countries seeking greater efficiency and control in an era of shrinking global health assistance and increasing geopolitical uncertainty. Such a resolution could also begin examining related challenges, such as how preparedness and response financing can be systematically “twinned” with primary health care and routine service delivery, rather than treated as separate domains.
A WHA resolution could also encourage WHO, its member states and partners, to co-facilitate a time-bound process to identify options for improving coordination across available financing mechanisms and shifting power to regional bodies. This could create a politically salient reference point that donor governments – who also sit on the boards of global health and financing institutions – may be incentivized to reinforce. As donors themselves are increasingly confronted with political scrutiny and growing constraints, a member state-endorsed framework that improves coherence may reduce transaction costs and strengthen the legitimacy of future investments. Countries, meanwhile, have repeatedly called for harmonization of external support behind national plans and budgets, stronger public financial management, and simplified reporting. What they currently lack is a legitimate global process to convene and connect these fragmented or regional reform efforts.
Such a resolution would not, on its own, solve all global health’s structural problems. However, it would provide a credible locus for convergence and signal that member states and non-state actors alike are prepared to take joint responsibility for shaping the next phase of global health governance, rather than leaving this to ad hoc commissions or individual institutions. This could also lay the groundwork for a subsequently-linked UN General Assembly high-level meeting on global health architecture reform, further encouraging other UN agencies and sectors – climate, development, gender, humanitarian, security, finance, and human rights – to proactively address cross-cutting threats more coherently. This complementary process is needed to better link health issues to other sectors, while also pragmatically aligning with proposed UN80 reforms.
The choice is no longer between reform and stasis, but between deliberate coordination and unmanaged fragmentation. Ultimately, the WHA remains the primary global forum with the legitimacy to convene diverse actors and articulate a system-wide vision that others can voluntarily align behind. A WHA resolution would provide a credible, member state-mandated anchor for coherence at a moment when global health governance urgently requires clarity, stability, and collective action.
The views expressed in this post are those of the author and do not reflect those of Global Health at LSE, the London School of Economics and Political Science, or other author affiliations.
Featured image sourced from Pexels.
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