The Future of Global Health Initiatives (FGHI) was a time-bound, multi-stakeholder process involving representatives from governments, international and domestic financing partners, health organisations, civil society and the research and learning community. Focusing on global health initiatives (GHIs) as an entry point and catalyst for accelerating change in the broader global health financing ecosystem, the FGHI process sought to identify and support opportunities for these initiatives to be optimized to support national health priorities and countries’ progress toward universal health coverage (UHC).
The process has achieved what it set out to do. The Lusaka Agenda: Conclusions of the FGHI Process, published on 12 December 2023, UHC Day, is the culmination of the process and identifies five key shifts for the evolution of the global health financing ecosystem and near-term priorities and next steps to achieve these shifts.
Building from existing efforts, The Lusaka Agenda captures consensus around five key shifts for the long-term evolution of GHIs – and the wider health ecosystem – and highlights several near-term priorities and next steps to catalyse action towards the five shifts.
The Lusaka Agenda provides a foundation for coordinated action to support these shifts, and a path towards a joint long-term vision of domestically financed health systems and UHC that leaves no one behind. The realisation of the shifts requires united and collective effort across stakeholder groups, underpinned by mutual accountability.
The FGHI was an open and informal process that focused on how GHIs work and collaborate with each other and with countries. It is not about changing their mandates or scopes.
“Global Health Initiatives” is a term used to refer to organisations that integrate the efforts of stakeholders around the world to mobilise and disburse funds to address health challenges. They do so by supporting implementation of health programmes in low- and middle-income countries. GHIs play an important role in shaping global health, and these institutions invest billions in solutions and systems annually.
The FGHI process primarily focused on GHIs (i) whose governance is distinct from the core intergovernmental institutional arrangements of UN agencies and MDBs, (ii) with multi-stakeholder boards, (iii) replenishment models, and (iv) that provide grant funding to low- and middle-income countries (LMICs). It also extended to agencies that do market shaping for products that are procured/ financed by them.
The organisations in scope for this process were: the Global Fund to Fight AIDs, TB and Malaria; Gavi, the Vaccine Alliance; the Foundation for Innovative New Diagnostics (FIND); Unitaid; the Global Financing Facility (GFF); and the Coalition for Epidemic Preparedness Innovations (CEPI).
Of note, the process also considered the roles, responsibilities, and ways of working of other global health actors and their interface with GHIs, to foster better alignment and coherence of all external health finance (multilateral and bilateral) and technical assistance to countries.
There were two main phases of the process in 2023.
The first phase ran from January to mid-year and aimed to ensure the FGHI process was informed by lessons learnt from previous studies and alignment efforts, and centred around the experience and needs of implementing countries, as well as inputs from other global, regional, and national health stakeholders, including GHIs. The overarching aims of this research phase were:
- To articulate a clear vision of what the GHI ecosystem should seek to achieve over the next 15-20 years to most effectively, efficiently, and equitably strengthen health system capacities and deliver health impacts, based on an understanding of their comparative advantage;
- To analyse the extent to which GHIs’ current mandates and ways of working will need to evolve to enable them to deliver this vision effectively, efficiently, and equitably, and the contextual factors that would support or hinder such a shift; and
- To make recommendations on the changes needed to achieve this vision of success, and how and when they can be delivered.
This first phase culminated in an independent, Wellcome-commissioned research report, together with other analyses and inputs.
The second phase of the process ran from mid-year until December 2023. This included consultation with stakeholders on the research phase including at Wilton Park, UK (4-6 October) and Lusaka, Zambia (26 November).
The FGHI process of research and consultation has now ended. The Lusaka Agenda provides a foundation for coordinated action to support these shifts, and a path towards a joint long-term vision of domestically financed health systems and UHC that leaves no one behind. The realisation of the shifts requires united and collective effort across stakeholder groups, underpinned by mutual accountability.
A research consortium of five universities carried out a 6-month study (Feb – Jul 2023) entitled ‘Reimagining the Future of Global Health Initiatives’, to inform the FGHI process. The research was funded by Wellcome Trust and supported by the FGHI Research & Learning Task Team. The research consortium was comprised of academics from the University of Geneva (Switzerland), Queen Margaret University (Scotland), Stellenbosch University (South Africa), Aga Khan University (Pakistan), and Cheikh Anta Diop University, Dakar (Senegal).
The study involved multiple phases, including a desk review, key informant interviews at global and country-level, and virtual regional consultations. To gain closer insight into country-level perspectives, the research included three in-depth case studies (Senegal, South Africa, and Pakistan). Burden of disease analysis, including future projections, and health financing trends analysis informed these case studies, as well as the qualitative interviews. A cross-cutting political economy analysis was used to synthesize the findings. The aim of the study was to produce a vision of what the GHI ecosystem should look like in 15–20-years, and recommendations on the changes needed to make this vision a reality.
The research consortium’s final report was published on the FGHI website in mid-August. Webinars in late August and early September provided space for stakeholders to hear the consortium present its research findings and recommendations and discuss their implications for the next phase of the FGHI process. Written responses to the research report, were also received. The report was complemented by several other inputs that were considered as the Lusaka Agenda was developed.
The FGHI process was grounded in a foundation of independence of thought and did not start with a pre-determined view on the precise solutions needed. A Research & Learning Task Team supported and advised on the delivery of an action- and policy-oriented process of research and learning that identified opportunities for, and pathways towards, better alignment of the GHI landscape.
The FGHI process was centred on country leadership and voice, with governments and civil society driving the process, underpinned by rigorous evidence-based research, and with stakeholders using the tools at their disposal to catalyse change (for example through influence over financial, strategic, governance, and priority-setting decisions, and through adjustments to donor behaviours and expectations).
It took a targeted approach, focusing on GHIs outside the UN system where partners involved have the greatest capacity to bring about change. The process was collaborative and centred on a time-bound process of dialogue leading to collective action. The FGHI process was not a new initiative or organisation and concluded at the end of 2023.
The FGHI process was designed as an open, informal, time-bound process focused on how GHIs work and collaborate with each other and countries. While the timeline created the impetus for a valuable period of research, dialogue, and reflection, it had limitations, largely because of the tight timeframe and its informal nature. The research phase was carried out at a rapid pace as one of several inputs into the FGHI process. While this phase included consultations with over 200 experts at global, regional, and country level, and focused on implementing countries, it did not cover all stakeholder groups extensively. In addition, the focus of the process on the GHIs was deliberately narrow to concentrate on high impact institutions. it is hoped that this work serves as an entry point and catalyst for accelerating change in the broader global health financing ecosystem.
No. The FGHI was not designed to mobilise new financial pledges, establish new funds or mechanisms, or duplicate existing mechanisms for national level coordination like the Global Action Plan for Healthy Lives and Wellbeing for All.
The FGHI process was set up to ensure GHIs can do their work in the most effective, efficient, and equitable way as they support countries to strengthen health systems and build the capacities they need to respond to health challenges and drive towards Universal Health Coverage.
The FGHI process was always intended as a finite, time-bound process of consultation and research throughout 2023, culminating in the publication of the Lusaka Agenda.
The Lusaka Agenda has been shared with the boards of the GHIs to put the next steps into practice and to work together to catalyse action towards the five shifts outlined. From January 2024, an informal, interim working group will work together over 3-4 months to:
- help anchor the Lusaka Agenda on the agendas of the GHI boards and the African Union, and begin to drive its implementation; and
- engage with stakeholders, including GHIs, CSOs and a broader group of donor and implementing countries, to design the modalities of a global health financing alignment arrangement, to consider how to operationalize the key shifts also in the broader global health financing ecosystem.