GLOBAL health leaders meeting in Geneva have intensified calls for a shift from donor-driven health funding and programming towards country-led financing and delivery systems.
The push dominated the Accra Reset High-Level Dialogue on Global Health Architecture, held on the margins of the 79th World Health Assembly (WHA79), where more than 250 heads of state, ministers, and global health leaders gathered to debate the future of global health governance.
A statement released after the event on Monday, May 25, said discussions focused strongly on the Accra Reset initiative, launched in 2025 by Ghana’s President John Dramani Mahama, which aims to reshape global health around country sovereignty, domestic resource mobilisation, and stronger national control of priorities and implementation.
Mahama told participants at the event that global health reform must move beyond fragmented donor coordination towards systems where countries define and execute their own health agendas.
He described health as “the vanguard, the proof of concept, and the moral imperative” for broader development reform.
The initiative, according to the statement, proposes new mechanisms, including a Reform Observatory and a financing gateway platform, aimed at channeling investment into country-designed programmes rather than externally structured interventions.
“If the Accra Reset can move health commitments into working programmes, it can do so for any sector,” said President Mahama. “Health is the vanguard, the proof of concept, and the moral imperative.”
The statement noted that several Ministers from Indonesia, Brazil, Kenya, and Ghana backed the proposal, arguing that sovereignty must translate into real control over health financing and delivery rather than symbolic policy shifts.
Indonesia’s Health Minister, Budi Sadikin, said financing pathways remained a key constraint, urging stronger alignment between health ministries, finance ministries, and international financial institutions.
“The money is there,” said Sadikin, adding that “As an Accra Reset Co-Chair, my proposal is to help all countries develop proper health care financing pathways, so health ministers can convince their finance ministers and the big banks to invest in health.”
Also, the Brazil’s Health Minister, Alexandre Padilha, noted that sovereignty must be backed by stronger national systems and sustainable financing, warning against treating it as a rhetorical aspiration.
On his part, Kenya’s Health Minister, Aden Duale, said African countries were already increasing domestic funding for universal health coverage,
He also noted that it signalled what he described as a gradual reduction in dependency on external support.
“Kenya and Ghana are leading in terms of creating a practical health sovereignty. How do we do that? By making sure that we take charge of the health systems and health financing in our country,” said Duale. “In 18 months, we have mobilized domestically to fund our health care and universal health coverage.”
According to the statement, major global health financing institutions, including the Global Fund, Gavi, and the Pandemic Fund, present at the meeting also expressed support for the reform agenda while acknowledging the difficulty of transitioning from long-standing donor-dependent systems.
Meanwhile, Nigeria’s National Health Insurance Authority highlighted ongoing efforts to consolidate fragmented health programmes into a single national framework, with the Director-General, Kelechi Ohiri, a doctor, saying the “one plan, one national dialogue” approach was improving coordination and reducing duplication.
“[In Nigeria], the Health Sector Blueprint became the foundation and the platform for coordinating activities across the entire country and our relationship with partners…the whole principle of having one plan, one national dialogue was put in place,” Ohiri said.
“With the Global Fund, we began to pilot the integration of [HIV, TB, and malaria] vertical programmes, not just in the health system broadly, but also in health insurance,” he added.
Despite broad consensus on the need for reform, participants warned that the global health space risks further fragmentation due to overlapping initiatives and the absence of a unified implementation roadmap.
World Health Organization Regional Director for Africa, Mohamed Yakub Janabi, urged that reforms be judged by their impact on populations rather than institutional redesigns.
He further said the sector must move “from promises to progress and from commitment to impact.”
Mustapha Usman is an investigative journalist with the International Centre for Investigative Reporting. You can easily reach him via: musman@icirnigeria.com. He tweets @UsmanMustapha_M