Transforming the Global Health Ecosystem

Executive Summary

The Global Health Ecosystem is entering a period of structural transition. Over the past 25 years, major gains were achieved, including a significant reduction in child mortality and infectious disease burden. However, global health institutions are now facing a crisis of relevance driven by declining funding and shifting geopolitical priorities.

Development Assistance for Health has dropped sharply, falling from $49.6 billion in 2024 to $39.1 billion in 2025. At the same time, over half of African countries are at high risk of debt distress. This signals the end of a donor-dependent model and the need for a more resilient and self-sustaining Global Health Ecosystem.

A strategic reset is required. Health must be repositioned as a core economic and infrastructure priority rather than a social cost. The future Global Health Ecosystem should shift from externally driven programs to nationally owned and regionally coordinated systems. This includes adopting Beyond Aid strategies, strengthening Public Financial Management systems, and integrating donor flows into domestic budgeting frameworks.

Key Takeaways

• Health as Economic Infrastructure: Governments must treat health systems as foundational infrastructure, financed through domestic revenue and long-term investment mechanisms.
• Declining Donor Dependence: External health funding is expected to continue falling, requiring proactive domestic financing strategies.
• System Efficiency: The Global Health Ecosystem must reduce fragmentation and improve efficiency through institutional consolidation and clearer mandates.
• Regional Leadership: Regional bodies should play a central role in defining priorities and coordinating responses within the Global Health Ecosystem.
• Market Strengthening: Investment in local manufacturing and supply chains is critical to improving resilience and reducing external dependency.
• Focus on Global Public Goods: International funding should prioritize research, data systems, and pandemic preparedness, with related examples in health financing innovations across the continent.
• Accountability and ROI: Investments must be tied to measurable outcomes, including system performance, affordability, and long-term sustainability.