For the first time, the G20 Leaders’ Declaration explicitly references the Lusaka Agenda  – a significant milestone for developing countries that have long called for a fairer global health architecture. This acknowledgement gives political weight to an agenda that places integrated health systems, universal health coverage, and national leadership at the center of global health reform.

But a reference alone is not enough. Commitments must translate into action. With donor funding in decline and health needs growing more complex, G20 countries – and other nations – must deliver on the Lusaka Agenda: strengthen primary health care, secure sustainable domestic financing, and build resilient systems that protect the most vulnerable. Health is not a cost – it is the smartest investment. G20 countries have both the responsibility and the capacity to act together.

We stand at a pivotal moment in global health. The era of fragmented, disease-specific programs has shown its limitations. People live with multiple conditions, and health needs are increasingly interconnected.

Most low- and middle-income countries are ready and capable of taking greater responsibility for their populations’ health. But fragile states and those affected by conflict face unique challenges that demand global solidarity. These countries must remain a priority in efforts to strengthen health systems and ensure access for all.

We cannot afford to repeat the mistakes of the past. Fragmentation has left millions underserved. Today,  countries must act together to protect the most vulnerable and champion integration over division.

The Lusaka Agenda: A blueprint for change

The Lusaka Agenda is the result of a country-led process initiated in Africa and endorsed globally. It was developed through consultations with governments, regional bodies such as the African Union and Africa CDC, and global health partners, and was formally launched at the Conference on Public Health in Africa (CPHIA) in Lusaka in November 2023. Since then, it has been recognized by WHO, supported by Gavi and the Global Fund, and now referenced in the G20 Leaders’ Declaration—a milestone that gives it political weight and global legitimacy.

The Agenda calls for a fundamental shift in how global health is organized. 

First, it urges countries and partners to prioritize primary health care as the foundation of health systems, ensuring that essential services are accessible to all and integrated across disease areas. 

Second, it emphasizes the need to strengthen resilient and integrated health systems, moving away from fragmented, vertical programs toward approaches that respond to people’s real needs rather than donor-driven priorities. 

Third, it calls for sustainable domestic financing, encouraging countries to increase public health spending and embed health as a core investment in national budgets. 

Finally, it seeks to foster coherence across global health initiatives, reducing duplication and aligning efforts under a unified vision for universal health coverage.

At its core, the Lusaka Agenda is a call for equity, self-reliance in the production of medical products, and nationally led health systems—both in Africa and globally. Countries in the Global South are already leading this transformation, supported by regional institutions like the African Union and Africa CDC. 

They bring ownership, political will, and a young, dynamic population ready for change. But leadership must be matched with investment.

Examples from around the world show this is possible: the Philippines funds universal health coverage through health taxes on tobacco and alcohol; Rwanda has embedded cancer screening into primary care; and Jordan integrates non-communicable disease care with infectious disease treatment for refugees. These points demonstrate that integration works – and that reform cannot wait.

Why reform cannot wait

Global health has achieved extraordinary gains. Child mortality has halved since 2000. Millions of lives have been saved through vaccines, infectious disease treatment, and stronger health systems. Norway has been proud to contribute, through Gavi, the Global Fund, the Global Financing Facility, and other funds and initiatives.

But success has come at a cost. Vertical programs have created fragmentation. While HIV, TB, and malaria patients often receive quality care, millions with chronic diseases die undiagnosed. Every year, hundreds of thousands of children die from preventable conditions like asthma, pneumonia, diarrhoea and diabetes. 

Air pollution alone claims eight million deaths annually, more than half a million of them children. These are not inevitable tragedies; they are failures of access. The treatments exist. They are affordable. Yet they do not reach those who need them most. This is not inefficiency – it is injustice.

Shared leadership: Norway and South Africa

South Africa, through its G20 Presidency under the theme “Solidarity, Equality, Sustainability”, has elevated priorities that matter: universal health coverage, primary health care, and non-communicable diseases. 

Norway, as a G20 guest country this year, stands firmly alongside South Africa in these efforts. Both nations share a commitment to sexual and reproductive health and rights (SRHR), a cornerstone of equity and resilience. Together, we champion integrated health systems that protect the most vulnerable and deliver care for all.

South Africa’s leadership also extends to health sovereignty. The Johannesburg Process – supported by Norway, the World Health Organization (WHO), Gavi, and others – is strengthening local production of vaccines and medicines, including the mRNA technology transfer hub in Cape Town. 

For Norway, this is about more than technology; it is about resilience, preparedness, fairness and economic growth. By investing in regional manufacturing capacity, we help ensure that lifesaving tools reach those who need them most, when they need them. Investment in production creates jobs and revenues for States to build their own sustainable societies.

Driving reform and building resilience

Norway contributed to building the global health system we have today, investing billions in vaccines, disease control, and maternal and child health. But we also helped shape a system that became too vertical and fragmented. Now it’s time to reform this system towards the future. 

As Minister of International Development Åsmund Aukrust stated at the Oslo seminar in September: “Norway will continue delivering on our promise of 1% of GNI to official development assistance. Public health and strengthening health systems remain a priority. We will work to ensure universal health coverage in low-income countries, where we protect the vulnerable and marginalized—especially children and youth.”

Norway’s leadership is not only financial. It is political and strategic. We will champion integration and equity, support WHO’s coordination role, fund country-led priorities, and ensure that children and vulnerable populations come first.

As the world moves from negotiation to implementation of the Pandemic Agreement, Norway is proud to have helped secure this landmark deal. Together with partners, we are now focused on turning commitments into action, strengthening preparedness, building surge capacity, and ensuring equitable access to countermeasures. 

The Pandemic Fund, which came out of G20 and Norway supports, is a critical instrument for financing readiness and response. These efforts are not separate from health systems. They are part of making them stronger, more resilient, and better able to protect future generations.

 Smarter, fairer health financing

We need systems that make smarter, transparent and evidence-based decisions about resource allocation. It is unsustainable to overspend on one disease while ignoring others that kill just as many – or more. Inequality in spending must be addressed. Children and youth must come first. The most vulnerable must be shielded, not only from illness but from financial ruin caused by health costs. Universal Health Coverage (UHC) is not just a moral imperative. It is an economic one.

For many countries, the costs of strengthening health systems are rising as chronic, non-communicable diseases become more prevalent. These illnesses not only strain health budgets but also impose heavy social and economic burdens: parents unable to work because they care for chronically ill children, and adults sidelined from the workforce due to long-term conditions. This is a drag on productivity and national development.

Strengthening domestic resource mobilization, through good budgeting practices, improved tax systems and a broader tax base, is essential for sustainable health financing. 

Fiscal measures such as taxes on tobacco, alcohol, sugary drinks, and pollution are powerful tools to fund health and promote healthier societies. At the same time, initiatives like the Johannesburg Process contribute directly to strengthening local production and pandemic preparedness. These are investments in sovereignty and resilience.

WHO should coordinate

The WHO is uniquely positioned to play a central coordinating role in this transformation. As the only global health body with a constitutional mandate to coordinate international health work, WHO should guide the implementation of the Lusaka Agenda. 

This includes helping align global health initiatives with country priorities, developing practical tools for integration, and supporting national systems to deliver care based on real needs. WHO should act as a convener and facilitator—championing equity, integration, and country ownership across all levels of the global health architecture.

Call to action

The G20 has a unique role in shaping global health priorities and mobilizing resources. Its collective influence can drive reforms and keep health at the center of sustainable development.

However, words alone are not enough. At the G20 Health Ministers’ meeting in Polokwane earlier this month, a joint declaration could not be agreed on because two countries opposed the text. 

Yet all other G20 members and invited countries supported it—a strong indication of consensus and momentum. Now, that momentum must translate into action.

As the Norwegian Minister of Health and Care Services stated in Polokwane: “We need bold action: we must move from a Lusaka Agenda to Lusaka Deliverables, Lusaka Timeline, Lusaka KPIs—and most important: Lusaka Results.”

Acting together is essential. We must put the health of the most vulnerable first. The tools exist. Resources exist. What is needed now is political will—and the courage to act.

Stine Håheim is Norway’s State Secretary for International Development. She has also served as Deputy Minister in the Ministry of Foreign Affairs, and as a Member of Parliament (2013-2017). She trained as a teacher.

Usman Mushtaq is Norway’s State Secretary for Health and Care Services. A medical doctor by training, Mushtaq was preciously the Vice Mayor for Labour, Integration, and Social Services in Oslo.