We thank GFAN for their early October statement, which informed discussions at the 4-6 October FGHI Wilton Park dialogue. It has been a useful input into the broader FGHI process.

We welcome the involvement of GFAN in the process, and agree with the important points raised in their statement, points that have informed and been reflected in subsequent documents, including the Wilton Park report and the accompanying co-chairs’ technical note, which includes a set of principles that are guiding deliberations and discussions.

These principles can serve as a baseline for future discussions and actions on global health financing evolution and include:

  1. Commitment to existing targets – financing must be consistent with the progressive realisation of existing SDG 3 targets. Increased investments in health will be needed to ensure this.
  2. Equity – The range and coverage of health services must ensure no one is left behind, reaching marginalized groups and key populations.
  3. Impact – Resources meant for improving health must be invested in interventions and sectors that will generate the maximum amount of health, and support sustainable outcomes.
  4. Country leadership – The governments of recipient countries of GHIs must chart their own path of health development, ensuring inclusive engagement of civil society and communities, and external support must be provided in in line with this principle.
  5. Sustainability – The range and coverage of health services made available to a population must be consistent with the total funds (domestic and external) available to it and aligned with plans for a gradual transition towards domestic financing of integrated health services. The level of ambition of global and local priority setting and resource allocation mechanisms must be consistent with this principle.
  6. Accountability – Providers of development assistance for health should be accountable to countries – as well as their own electorates and civil society – for how they deliver their support, just as implementing countries are accountable to citizens, civil society and communities, and to funders and donors, for results generated on their path towards UHC and leaving no one behind.
  7. Adaptability – Systems for health resource allocation must anticipate the changing landscape of health needs and health determinants and adjust accordingly.
  8. Flexibility – Development assistance for health must respond to country needs and operate within country systems.

Global health initiatives (GHIs) have made, and are making, impressive contributions in terms of lives saved and infections and diseases averted through prevention and the introduction of new tools. We agree with GFAN that these contributions should be called out, while acknowledging that improvements can be made. The FGHI process is an open and informal one that is focused on how GHIs work and collaborate with each other and with countries. It is not about changing their mandates or scopes.

The independent Wellcome-commissioned report published in July was one of several inputs into the FGHI process, meant to stimulate discussion, debate and ideas. It is not an outcome of the process and as an independent report is not endorsed by us or the FGHI Steering Group.

The FGHI process is time-bound (through December 2023) and aspires to align around an outcomes document, a draft of which will be shared with Steering Group and Extended Commitments Task Team members and Wilton Park participants around 9 November for comments, with the goal of publication on UHC Day on 12 December. At that point the FGHI intends to hand over the baton to GHI boards to engage with the learnings from this process. The boards, including civil society and community constituencies, will decide how to drive implementation of the change agenda. It is our hope that the outcomes of the process will catalyze discussions on evolution of the wider global health financing ecosystem.

We thank GFAN and other civil society partners for bringing their views to our attention. We look forward to the opportunity to engage further at our 15 November CSO consultation (register here) and at the official side event we will convene, together with Africa CDC and Amref Health Africa, in Lusaka on 27 November (register here).

Dr John-Arne Røttingen and Dr Mercy Mwangangi
FGHI Co-Chairs