Leaders of the international NGOs, Save the Children, Seed Global Health, AMREF, and LSE Health make five asks to member states attending next week’s 79th World Health Assembly, as they take the first steps to launch a joint UN process for reforming the global health architecture. 

As governments prepare for the 79th World Health Assembly (WHA79), the stakes could not be higher. On the table is a once-in-a-generation opportunity to reform the global health architecture (GHA) – triggered by the unprecedented cuts in foreign aid. But in the rush to redesign institutions and redirect funding flows, we risk losing the principle that should anchor every reform effort: universal health coverage (UHC), or the right of every person, everywhere, to access quality healthcare without financial hardship.

At the 158th WHO Executive Board, Member States requested the WHO to convene a joint process on global health architecture reform. The World Health Assembly remains uniquely positioned to convene Member States, civil society, donors, and multilaterals around a more coherent reform agenda.

The funding crisis is exposing deeper structural failures

Preliminary data from the Organisation for Economic Co-operation and Development (OECD) indicate that 2025 saw the largest annual decline in total official development assistance (ODA) on record, with a 23.1% reduction compared to 2024, bringing global aid back to levels seen in 2015 at the start of the 2030 Agenda for Sustainable Development.

A further 5.8% decrease is anticipated for 2026. These cuts risk leading to an additional 22.6 million deaths by 2030, including 5.4 million children under the age of five.

This downturn exposes structural weaknesses in systems that have long depended on external financing. For women, children, and adolescents, the health systems consequences are profound and immediate: disrupted maternal and newborn care, collapsing immunization and nutritional programmes, and reduced access to sexual and reproductive health services.

In humanitarian settings, conflict-affected and displaced populations may soon have no safety net at all.

Although it is said that “crises create opportunities,” the funding shock has exposed a long-recognized reality within global health: an architecture dependent on a small group of donors is inherently unstable and unable to deliver UHC.

Preventing future crises will require new foundations: domestic financing models insulated from geopolitical shifts, institutional mandates that endure beyond individual funders, external partners aligning behind national priorities, and a global health architecture in which UHC is structurally embedded rather than dependent on external support. Central to this is a well-trained and adequately financed health workforce, without which neither health systems nor universal health coverage (UHC) can be achieved.

UHC must guide global health reform

The 79th World Health Assembly will discuss several major issues separately: UHC (item 12.4) and primary health care (PHC) (item 12.5), implementation of the Pandemic Accord (item 13.3), the strategy on Economics of Health for All (item 15.5), and global health architecture (GHA) reform (item 20.1). While this reflects standard WHA procedures, the risk is that these discussions proceed in parallel rather than as part of a coherent reform agenda.

The appointment of Thailand and Andorra as co-facilitators for negotiations on the 2027 UN High-Level Meeting on UHC is politically significant. The 2027 UHC High Level Meeting (HLM) cannot become a separate process alongside GHA reform discussions. It should serve as one of the accountability mechanisms for reforms currently being debated in Geneva.

Five priorities for WHO Member States at WHA79

For WHA79 to make a real impact, Member States must ensure their decisions translate into practical improvements for the people most affected by systemic failure. In the lead-up to the 2027 UN High Level Meeting on UHC, we call for five key changes:

• Anchor GHA reform in UHC and country ownership
  Global health reform must align existing initiatives to avoid fragmentation. The WHO-led GHA reform process can help build that cohesion and should align mandates, structures, and incentives behind country-led priorities. Reform efforts need to address power imbalances, align behind country priorities, support global public goods, and strengthen mutual accountability. Country-led governance must be the foundation of any reformed architecture. To ensure commitments translate into action, Member States should establish clear, time-bound implementation milestones and accountability mechanisms, including civil society and affected communities. The 2027 UHC HLM should explicitly track and build on GHA reform commitments made in Geneva.
• Invest in PHC and sustainable financing
  Governments should increase domestic public spending on health – including an additional 1% of GDP for primary health care – while strengthening public financial management and institutionalizing health financing coordination through country-led platforms. However, many low-income countries face severe debt distress, limiting their ability to expand fiscal space for health without broader reforms to debt architecture and progressive domestic taxation. Meeting UHC targets will require progressive financial reforms and renewed attention to the Economics of Health for All agenda. Financing must be directed toward essential services, health workers, and financial protection for vulnerable populations.
• Strengthen the health workforce for UHC
  Health workers underpin resilient health systems, pandemic preparedness, and climate adaptation. Member States should expand fiscal space for the health workforce through sustained domestic financing, while aligning donor investments behind national workforce strategies and employment plans. This includes equitable recruitment, training, fair remuneration, and protection of frontline workers, including community health workers, particularly in underserved settings.  GHA reform and global financing mechanisms must support sustainable, country-led health systems rather than fragmented, short-term parallel programming.
• Institutionalize social participation and accountability
  Civil society engagement is critical to shaping policies that reflect the needs of affected populations. WHA77’s resolution on social participation should now be operationalized by embedding participation and transparency as core accountability mechanisms. WHO should establish regional and national consultative bodies bringing together Ministries of Health and Finance, donors, civil society, and affected communities to enable continuous dialogue and oversight. This should be supported by transparent reporting of health financing data, building on national health accounts and the Global Health Expenditure Database with open access to disaggregated data.
• Safeguard UHC in crisis and conflict settings
  GHA reform discussions cannot turn a blind eye to the humanitarian needs caused by conflicts and crises worldwide. Member States should mandate that GHA reform financing instruments – including the Pandemic Fund and IHR/Pandemic Agreement’s Coordinated Financing Mechanism – include ring-fenced allocations for essential health services in crisis-affected settings. In an era of rising polycrisis, protecting and advancing UHC reforms is not just morally necessary, but can also create momentum for health system reform.

WHA79 is a pivotal juncture. It will be remembered either as the moment governments anchored health reforms in equity and the needs of the people they serve, or as another missed opportunity clouded by consensus language and procedural paralysis.

Alhadi Khogali, is Senior Global Health Policy Advisor, Save the Children.

Renee de Jong is Senior Advocacy Advisor, Save the Children.

Marionka Pohl is Senior Director of Policy, Seed Global Health.

Rispah Walumbe is Health of Strategy & Policy, Amref Health Africa.

Arush Lal, is a Visiting Fellow at LSE Health, London School of Economics and Political Science.

Image Credits: WHO, OECD, WHO, Lisa Marie Theck/Unsplash.