Sources: thelancet.com
by A Nordström
Struck by substantial funding cuts throughout 2025, the global health community stands at a crossroads. Notwithstanding the grave consequences of decreased international financing, this crisis offers an unprecedented chance to address the well known flaws in the current system. Although the notion that we should first stabilise and later transform the global health landscape has gained traction, it fails to recognise that the present sense of urgency is precisely what makes systemic change possible, and that those two processes should therefore happen in tandem. Immediate responses cannot be siloed from the long-term outlook. Many global health reform discussions are already well underway, but they remain dispersed, without shared vision and legitimate leadership. For these diverse perspectives to come together, a common framing and understanding of prevailing issues and current opportunities is needed
Panel
Discourse so far: fragmented reforms for a fragmented system?
Various perspectives on global health reforms have been articulated, contributing to a continuously evolving landscape. As of now, the most prominent voices have come from Africa and Europe. The overarching sentiment has been that the current financing crisis should be viewed as an opportunity for positive change in global health. Leaders in Africa have acknowledged the need for continued international finance, but have underscored preference for partnerships built on co-creation rather than on a donor–recipient basis, stressing that each country should gradually take on a larger share of its own health financing. By contrast, a handful of traditional development partners have spoken of stepping up and taking responsibility for global health, with less emphasis on rethinking the partnership model. However, such pledges, along with the persistent use of language grounded in the aid framework, risk reinforcing the very system leaders in Africa are attempting to reset.
The insufficient co-ordination and amount of common objectives could stall the reform progress and threaten its success. Importantly, coordination restricted to like-minded groups will not suffice, and alignment across actors is needed, especially given the uneven distribution of resources, influence, and legitimacy shaping the current discourse. Additionally, amid the pressure to adapt to the current austerity environment, there is a risk that organisations will prioritise short-term cost-containment strategies over strategic restructuring.
