The reform of the global health architecture (GHA) discussed in the last WHO Executive Board (E.B.) in February 2026, is a matter of strategic importance for the future of the global health system (GHS) and its functions and for the shaping of the GHA itself.

The E.B. approved a Decision requesting that the Director General of WHO:

(1) designs a proposal for an inclusive, transparent, time-bound, resource effective and efficient process, hosted by WHO, led by Member States, to support the transformation of the current GHA;

(2) convenes relevant global health actors in the design of the proposal, considering ongoing global health reform initiatives;

(3) submits a proposal on the process for the consideration of the Seventy-ninth World Health Assembly (WHA).

This is happening when there is a proliferation of initiatives undertaken by different actors to consider possible reforms to the GHS, the GHA, the WHO, the U.N.  System and the development cooperation ecosystem in the field of health (DCH).

It is important that the process that WHO proposes in May 2026 is credible, useful, objective, participatory, representative, with the appropriate legitimacy of the actors involved, meaningful, impartial and binding, and leading to a roadmap for change to bring about a more efficient and more effective architecture arising from a multilateral consensus.

A departure point in the reflection on the need for reforming the GHA is a comprehensive analysis and definition of the functions needed in the current GHS, with the participation of all Member States.

The discussion should not oversimplify the role of WHO as a purely normative and standard setting agency. It should remember the different functions of the WHO stipulated in its Constitution, especially its role as international directing and coordinating health authority.

Another issue that must be thoroughly analyzed is the current atomization of the GHA. Reducing the balkanization of the GHA is one of the fundamental challenges: streamlining the multitude of multi-stakeholder partnerships that often duplicate existing multilateral mechanisms; optimizing and rationalizing transaction costs; enhancing the synergies; merging platforms and flows of resources and technical cooperation. No reform will be useful or meaningful if we do not overcome this fragmentation that generates redundancies, duplications and competing governance structures.

There is also a confusion about global public goods on health (GPGH), thinking that they should be financed through ODA and seeing them primarily as the object of the efforts of development partners. GPGH imply mechanisms, products and services that should have collective ownership and financing as well as multilateral governance. They should therefore be funded as direct contributions from national health authorities to common regional or global platforms, not through ODA budgets.

Finally, the implications of recent events and trends need to be addressed: the withdrawal of the United States from the WHO, the major U.S. ODA cuts, and the US bilateral health agreements with individual countries outside the multilateral framework of the WHO, the IHR, and the Pandemic Treaty.

Having said that, these are some possible ways of advancing the agenda of reform of the GHA:

1) The WHO process must be a well-defined one, building a clear framework of reference for multilaterally agreeing on the essential functions of the GHS, which must be the prerequisite of any approach to reform the GHA.

2) An objective mapping of the global health initiatives (GHI) must be carried out, in relation to the essential functions of the GHS that must be undertaken in the future.

3) An inventory of the myriads of existing structures that make up this GHA is not enough. It is necessary to build a powerful analysis of the relevance, redundancy, efficiency and effectiveness of the current GHA.

4) The process should not be a lengthy one. A document written by the WHO Secretariat alone is not enough. Neither is the creation of an intergovernmental working group which would embark on endless discussions. A process must be created with participation of the Member States, with legitimacy and representativeness and with the appropriate expertise to carry out the task.

5) The most effective mechanism would be to create an independent panel of experts, with a small secretariat, convened jointly by the Secretary-General of the U.N. and the Director-General of the WHO, to produce a thorough and action-oriented report to be discussed by the 160th E.B. and the subsequent WHA in 2027.

6) A special effort should be made to foster convergence of the several initiatives on reforms of the GHS and the GHA that are underway. It is not a question of  merging them but rather of ensuring that they do not become parallel and contradictory processes that end up undermining the process or bypassing the multilateral nature of the exercise.