The High-Level Panel's agenda for reform of global health architecture and governance.
The report
The Accra Reset High-Level Panel on Reform of the Global Health Architecture and Governance sets out a practical reform agenda for a changing world. President John Dramani Mahama presents the report at Full Circle. Its organising principle is that cooperation should strengthen country-defined priorities and capabilities, rather than require countries to organise around separate institutions and funding streams.
A managed transition
The report does not call for the abrupt withdrawal of support. Essential services, humanitarian continuity and global public goods must be protected. Countries begin from different circumstances; international partners should support credible transitions while national and regional capability grows.
Five shifts in the operating model
- Practical sovereignty
- Countries control decisions, financing frameworks and data.
- Sovereign partnership
- Domestic resources underpin core national responsibilities.
- Collective regional power
- Countries jointly build functions best delivered together.
- Functions before institutions
- Test what each organisation uniquely contributes.
- Independent accountability
- Publish progress rather than rely on self-reporting.
From publication to implementation
The report proposes independent follow-up within six months and country-led compacts within twelve months. In the wider presidential agenda, HINGE is a proposed catalytic financing mechanism and RIO is the proposed Reform Interlock Observatory for mutual accountability. Both are to be co-created with partners as the implementation agenda develops.
One plan. One budget. One platform.
Ten recommendations
The report's practical pathways, presented here in summary.
01 One-stop country compact
Align partners behind a national health plan, a costed investment plan, the public budget and one country-led coordination platform. Target: within 12 months.
02 Sustainable financing transition
Build on equitable domestic resources, pooled financing and financial protection. External support should strengthen national priorities and protect essential services during transition.
03 Empower regional institutions
Delegate defined cross-border functions, backed by member-state financing and accountability. Establish or reinforce a regional pooled mechanism within 12-18 months.
04 Equitable health innovation
Support regionally led research, clinical trials and scientific capability, with access provisions and demand linked to national and regional priorities.
05 Regional health manufacturing
Coordinate production, technology transfer, regulation and investment. Initiate or reinforce a regionally led manufacturing pilot within 12-24 months.
06 Procurement and commodity security
Combine demand into reliably financed purchasing commitments and stronger supply systems. Establish or reinforce country-led coalitions within 18 months.
07 Global public goods
Define shared functions, costs, contributions, governance and equitable-access safeguards, with predictable collective financing. Proposed design horizon: 12-24 months.
08 Humanitarian continuity
Strengthen coordinated health emergency capability without diverting routine services or allocations. The report proposes country arrangements within 12 months.
09 Reform global health institutions
Apply the 4Cs: Commit, Collaborate, Consolidate and Close where appropriate. Preserve valuable functions and health gains through a managed transition.
10 Independent accountability
Establish independent follow-up within 6 months. Track governments and partners against agreed benchmarks and publish results that citizens can scrutinise.
These are the Panel's recommendations and proposed horizons, not a record of completed reforms. Underpinning the recommendations is a philosophy that asserts: No Ownership Without Control. Countries cannot “own” when the design rights are elsewhere.
