WHA Advances Global Health Architecture Reform Amidst Questions About Where Process Will Really Lead

World Health Assembly 79 23/05/2026 • Felix Sassmannshausen

World Health Assembly delegates debate the newly adopted Global Health Architecture Reform in Committee B.

The 79th World Health Assembly adopted a widely anticipated Global Health Architecture Reform initiative. While WHO and many member states lauded it as a landmark move, the actual mandate is in fact highly restrictive. The process will not yield recommendations on “revisions to organizational mandates nor specific mergers or consolidations” in the often overlapping functions of multiple UN global health agencies. The process also must navigate sharp developed and developing world priorities, regarding equity. And the framework faces fierce backlash from civil society groups over their exclusion from the joint task force steering the initiaive.

The World Health Assembly on Friday endorsed a joint process for Global Health Architecture (GHA) Reform with the United Nations and other major, multilateral health agencies.

The process complementing the broader UN80 reform initiative, aims to yield recommendations that: a) enhance “alignment of the mandates and capacities” of global health actors with essential functions across global, regional and national levels; b) enhance “coordination and collaboration” and c) align financing, especially to “advance national self reliance and ensure sustainable and predictable support”. But the carefully curated mandate also precludes concrete recommendations for agency mergers or revisions to their mandates, leaving big questions about where the process will really lead.

Proponents have promoted the reform as a means of shifting power dynamics toward national authorities, aligning multilateral financing with sovereign priorities.

WHO Director-General Dr Tedros Adhanom Ghebreyesus emphasised that the overhaul must remain intrinsically bottom-up and mirror the agency’s own recent 16-month internal restructuring efforts. He explained that the Secretariat is identifying its absolute core mandates and will explicitly delegate non-core responsibilities to other global health partners based on their comparative advantages, thereby eliminating systemic duplication.

“All we do in the GHA should actually be bottom up, and we need to understand the needs of the countries we support,” said Dr Tedros.

Consolidating governance and the Lusaka agenda

Chef de Cabinet Razia Pendse reassures the Assembly that robust safeguards protect WHO’s constitutional mandate.

Leading the process is a 25-member task force, including 14 WHO member state representatives, including developed and developing nation co-chairs. The task force will also include up to four representatives of other UN health-related entities, as well as the World Bank and “a regional health organization.”

And the task force will include five representatives of the largest, non-UN global health organizations, including Gavi, the Vaccine Alliance; Global Fund to Fight AIDS, Tuberculosis and Malaria; the Coalition for Epidemic Preparedness Innovations; Unitaid; and the World Bank-hosted Pandemic Fund.

Governed by consensus, the body must hold regular Geneva-based consultations to ensure member states retain ultimate decision-making authority over international health policies. To synthesise its recommendations, the task force will engage with parallel reform efforts like the UN80 Initiative and the Lusaka agenda, a non-binding agreement launched in 2023 that aligns external financing with domestic health priorities.

Reassuring the Assembly, Chef de Cabinet Razia Pendse confirmed that the reform includes robust safeguards to protect the WHO’s constitutional mandate, noting that member states will ultimately review all proposed reform recommendations.

“WHO will approach this mandate with humility and with an inclusive spirit,” said Pendse.

Core mandate lacks ambition

Some member states, as well as a leading philanthropy, Wellcome Trust, criticised the lack of a real mandate to enact substantive structural changes in the way the UN agencies and its partners do business. These restrictive boundaries are explicitly defined in the proposal, stating:

“The process will propose neither revisions to organizational mandates nor specific mergers or consolidations, which fall within the authority of the relevant governing bodies, and will not address disease- or intervention-specific approaches.”

Currently, multiple United Nations entities – including UNICEF, UNFPA, UNITAID, UNAIDS and UN Women as well the UN Environment Programme and a range of UN humanitarian agencies, all engage in global health activities to some extent, with oft-overlapping activities as well as sometimes fierce competition for donor funds.

As for major non-UN agencies like Gavi, and the Global Fund, critics have suggested that the vertical, disease-focused nature of those programmes also reinforces that tendency at national level and thus countervenes the needed drive towards integration of health system services. For instance, The Global Fund manages a huge, and efficient mechanism for procurement supporting diagnostics and medicines access across dozens of low- and middle-income countries. But that mandate covers only the three major diseases. That leaves national governments scrambling to procure health products to address the soaring burden of noncommunicable diseases through other channels.

In light of all of that, a meaningful process must consider opportunities to streamline institutions through concrete recommendations regarding the merger and consolidation of global health organizations, argued Wellcome’s representative during the WHA debate.

This lack of practical objectives or outcomes to the reform process was also challenged by some member states. The delegate from Colombia expressed concern that the WHO Secretariat’s proposal focused heavily on methodology without clearly addressing the central, substantive issues of the reform. The Belgian delegate echoed the demand for a robust approach.

“We expect this reform to be ambitious and not just cosmetic,” he emphasised.

Civil society condemns exclusion

The Women Deliver representative demands civil society from the Global South be meaningful reform co-designers.

Meanwhile, non-state actors, led by the NCD Alliance, condemned their structural exclusion from the core, joint task force, noting that sidelining affected communities undermines meaningful governance and removes a critical force for accountability. To preserve the primarily intergovernmental nature of the reform, civil society groups other than the five named to the task force, would be relegated to peripheral consultations in “stakeholder constituency groups.”

“By excluding civil society and people living with NCDs from the joint task force set up to oversee this process, Member States are sidelining the voices of those most affected,” said NCD Alliance Policy and Advocacy Director Alison Cox in a statement to Health Policy Watch.

Pivoting to demands for direct representation, a coalition including the NCD Alliance, Save the Children and Wellcome argued, to no avail, for a modification of the process so that more civil society and frontline humanitarian expertise are embedded directly into the core task force body. They warned that ignoring these voices contradicts existing commitments to social participation and leaves the new architecture vulnerable to health-harming commercial interference.

“We urge member states to ensure that civil society, especially from the global south, are meaningful co-designers throughout all phases of this reform to truly leave no one behind,” said the Women Deliver representative during a continuation of the debate on Friday.

Complicating this push for inclusion, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) argued that the joint task force must also include private sector representation. The industry group further cautioned that the reform process should avoid encroaching upon intellectual property, licensing, and pricing decisions.

North-South frictions: demanding equity and sovereign control

The Cypriot delegate, representing nearly 50 nations, calls for urgent multilateral reform to stabilise the strained global system.

Despite civil society concerns, a broad coalition of member states unanimously supported the draft WHA decision on GHA Reform – describing it as a crucial response to declining official development assistance and escalating health emergencies.

Speaking on behalf of the European Union and nearly 50 aligned nations, Cyprus praised the resolution as a timely intervention for a highly strained multilateral system. The delegation noted that existing structures have reached their operational limits amid severe funding cuts, economic instability, and complex geopolitical conflicts.

“The time to act is now, and we should seize this opportunity,” said the Cypriot delegate during the debate.

Underlying frictions that emerged during the debate also revealed a divide between high-income countries focused on streamlining and stabilising the strained multilateral system and the Global South’s demands to shift more control to countries, including of finance for health systems, and protect vulnerable countries from financial shocks.

Representing the 47 member states of the WHO African Region, Zimbabwe underscored that while they support the process, the reform must actively reflect regional political priorities rather than merely streamlining at headquarters. The delegation demanded that the new design secure sustainable financing while protecting essential health functions and regional coordination capacities worldwide.

“The region calls for the provision of focused support to countries most affected by financial shocks, including WHO Africa member states, with a view to rationalising international health financing and strengthening regional coordination capacities,” said the Zimbabwean delegate.

Echoing these Global South concerns, Thailand, representing the South-East Asia Region, requested that the Secretariat translate multilateral decisions into practical country-level support. And Indonesia demanded robust equity safeguards to protect developing nations.

Pakistan demands ‘lean must not mean less’

The Pakistani delegate warns against organisational streamlining, insisting that a "lean" WHO must not mean less. — The Pakistani delegate warns against organisational streamlining, insisting that a “lean” WHO must not mean less.

Pakistan also warned against the unintended consequences of organisational streamlining.

“Lean must not become synonymous with less,” said the Pakistani delegate, who expressed concerns that agency consolidation seen as more efficient by donor nations also could weaken WHO’s country-level footprint. Taking issue with language in the document, he stressed that the task force should organize regular “consultations” rather than “information sessions” with other WHO member states to ensure their ongoing involvement in the process.

Addressing specific regional vulnerabilities, South Africa also stressed that sexual and reproductive health rights needs to be embedded within the new frameworks to prevent unintentionally reversing hard-won development gains in crisis contexts. Voicing the distinct concerns of Pacific Island states, Tonga demanded that the redesign preserve equitable pooled procurement mechanisms to reduce high transaction costs across their vast ocean distances.

“We want to be part of this conversation so that we can share our skills and explain our needs,” said the Tongan delegate.

Although the fine print of the text was not modified at the meeting, Chef de Cabinet Pendse and Director General Tedros reassured member states that their calls for equity and inclusion had been heard and would be “acted upon as we move the process forward.”

Reform must address economic weaponisation and power

KEI warns the health architecture reform remains incomplete without addressing economic sanctions.

While the Secretariat emphasised inclusive decision-making and internal institutional safeguards, experts warn that real change requires moving beyond procedural vocabulary to address the external structural dependencies that produce global inequity.

Highlighting the profound humanitarian consequences of geopolitical trade restrictions, Knowledge Ecology International (KEI) insisted that the GHA Reform would remain fundamentally incomplete without addressing trade sanctions and economic barriers that fragile states and marginalised populations face amidst increased geopolitical tensions.

“Medicine, medical equipment, and humanitarian goods should not be used as weapons of economic warfare,” said KEI representative Thirukumaran Balasubramaniam on Friday.

Ilona Kickbusch points out that global health reform is fundamentally a struggle over power.

Echoing this demand to tackle systemic barriers, Ilona Kickbusch, Co-Chair of the World Health Summit Council, cautioned that true institutional change requires confronting the political and financial interests of the states that dominate global governance.

“The current debate about reforming the global health architecture is, at its core, a debate about power – who holds it, who is losing it, and who intends to use this moment of rupture to consolidate it on new terms,” said Kickbusch ahead of this year’s World Health Assembly.

WHA reform success hinges on building consensus

While experts debate these broader power dynamics, the joint task force must focus on its operational mandate along a tight timeline. It will need to convene and begin synthesising evidence and proposals immediately, with the aim of submitting an interim report by late 2026 for review by the WHO Executive Board. The ambition is high. For instance, member states also expect the joint task force work to help align international funding with sovereign health strategies, ensuring greater readiness for emerging threats like the ongoing Ebola outbreak in the Democratic Republic of the Congo.

Ultimately, the success of the Global Health Architecture Reform will depend on whether the global community can navigate these competing priorities and translate them into a Geneva-based consensus for final approval at the Eightieth World Health Assembly.