On 4 – 6 October 2023, Future of Global Health Initiatives (FGHI) Co-Chairs Dr Mercy Mwangangi and Dr John-Arne Røttingen convened a group of global, regional, and national health stakeholders – from governments and international and domestic financing partners, civil society and health organizations – at and in collaboration with Wilton Park, UK, to reflect on how the global health financing ecosystem, including global health initiatives (GHIs), can be optimized to best support national health priorities and countries’ progress to universal health coverage (UHC).
Changes in demographics and disease burden, climate change, experiences of the COVID-19 pandemic, and political and economic shifts that present resource mobilization challenges are all converging on the need for change. This has created an urgency for action: the global health financing ecosystem must evolve to effectively meet the needs of tomorrow.
The dialogue was a key moment in the FGHI’s time-bound process of consultation, research and joint deliberations throughout 2023. Interventions from implementing partner countries during the meeting – including calls for country-led prioritization and planning and strengthened representation and voice on GHI boards – were clear and compelling.
Participants aligned on five strategic shifts for the evolution of the global health financing ecosystem to 2030 and beyond:
- Making a stronger contribution to primary health care (PHC)
- Mainstreaming sustainability across GHI portfolios
- Maintaining focus on achieving equity in outcomes
- Achieving strategic and operational coherence
- Coordinating approaches to products, R&D and regional manufacturing to address market and policy failures in global heath.
Dialogue participants made progress in identifying and prioritizing short-term actions to achieve these shifts, and supported further exploration of a proposal to establish a joint operational team of Global Fund/Gavi/Global Financing Facility, including also the World Bank and the World Health Organization, to drive implementation of changes in operations, with oversight by GHI governing bodies.
Broadly supported short-term priority actions for GHIs relate to:
- Improving the transparency of all external financial flows into countries
- Developing common metrics to demonstrate impact for primary health care and health systems strengthening, including on disease goals and service coverage
- Using government systems when possible and aligning to one plan, one budget, one monitoring and evaluation framework
- Coordination across GHIs of transition from GHI support to sustainable country financing and programming
- Supporting integrated service delivery for PHC impact
- Joint financing of country plans across all GHIs, multilateral and bilateral funders
- Identification of capacity gaps and coordinated financing and technical assistance to address gaps
- Establishing a vision for a more coordinated approach to R&D, manufacturing and market-shaping
There was broad agreement to identify a group of pathfinder countries to kickstart this work.
As one participant said, “This is a multi-lane highway. It is about all of us changing. We are calling for reduced duplication so that 1 plus 1 becomes 3.”
On the accountability front, there was concurrence on the central role of GHI boards in overseeing implementation of commitments and on the need for strengthened cross-board collaboration. There was support for linking to the African Leadership Meeting as a powerful regional mechanism with Head of State/Government engagement. And support too for a Friends of the FGHI arrangement to help drive implementation and accountability after the formal FGHI process wraps up at the end of 2023.
In the coming weeks, the FGHI Extended Commitments Task Team and Steering Group will carry this work forward, engaging with Wilton Park participants to finalize FGHI outcomes documents ahead of UHC Day on 12 December.
Dr Githinji Gitahi, CEO of Amref Health Africa, and Neil Briscoe, Head of Policy at Wilton Park expertly moderated the discussions.
The Wilton Park report which summarises the discussions that took place can be read here.
The FGHI Co-Chairs’ Technical Note can be read here. This note builds on the draft FGHI Commitments Paper – developed by the Commitments Task Team – which provided the foundation for the Wilton Park discussions.
Participants included:
- Susan Mochache, Africa Constituency Bureau for the Global Fund
- Desta Lakew, Amref Health Africa
- Kieran Daly, Bill and Melinda Gates Foundation (BMGF)
- Quintilla Wikeley, Brunswick Group
- Saul Walker, Coalition for Epidemic Preparedness Innovations (CEPI)
- Gabriella Fesus, Directorate-General, INTPA, European Commission
- Jens Busma, Federal Ministry for Economic Cooperation and Development, Germany
- Bill Rodriguez, FIND
- David Whineray, Foreign, Commonwealth and Development Office (FCDO), United Kingdom
- Beth Arthy, Foreign, Commonwealth and Development Office (FCDO), United Kingdom
- Joanna Scott-Nicholls, Foreign, Commonwealth and Development Office (FCDO), United Kingdom
- Anna Seymour, Foreign, Commonwealth and Development Office (FCDO), United Kingdom
- Linda Muller, Future of Global Health Initiatives
- David Marlow, GAVI The Vaccine Alliance
- Marie-Ange Saraka-Yao, GAVI The Vaccine Alliance
- Dr Patrick Kuma-Aboagye, Ghana Health Service, Ghana
- Kristen Chenier, Global Affairs Canada, Canada
- Luc Laviolette, Global Financing Facility (GFF)
- Prof Olive Shisana, Government of South Africa, South Africa
- Dr Roman Macaya, Independent
- Dr Anders Nordström, Independent
- Dr Jomkwan Yothasamut, International Health Policy Program Foundation, Thailand
- Prof Charlotte Watts, London School of Hygiene and Tropical Medicine (LSHTM)
- Magnus Lennartsson, Ministry for Foreign Affairs, Sweden
- Dr John-Arne Røttingen, Ministry of Foreign Affairs, Norway
- Dr Lynda Kurnia Wardhani, Ministry of Foreign Affairs, Indonesia
- Jin Hashimoto, Ministry of Foreign Affairs of Japan, Japan
- Dr Ruth Belachew, Ministry of Health, Ethiopia
- Dr Mercy Mwangangi, Ministry of Health, Kenya
- Dr Mohamed Jama, Ministry of Health and Human Services, Somalia
- Dr Gerald Manthalu, Ministry of Health and Population, Malawi
- Dr Polydor Mbongani Kabila, National Council on Universal Health Coverage (DRC)
- Prof Aamer Ikram, National Institutes of Health (NIH), Pakistan
- Oswaldo Adolfo Rada, Senderos Asociación Mutual
- Mike Podmore, Stopaids
- Peter Sands, The Global Fund to Fight AIDS, Tuberculosis and Malaria
- Dianne Stewart, The Global Fund to Fight AIDS, Tuberculosis and Malaria
- Dr Juan Pablo Uribe, The World Bank Group
- Tenu Avafia, UNITAID
- Dr Atul Gawande, United States Agency for International Development (USAID)
- Dr Mamadi Yilla, US Department of State, United States of America
- Clare Battle, Wellcome Trust
- Beck Smith, Wellcome Trust
- Dr Razia Pendse, World Health Organization
- Dr Githinji Gitahi, Amref Health Africa – Co-Facilitator
- Neil Briscoe, Wilton Park – Co-Facilitator
