Mapping of organisational mandates against future priority health functions
Comparative advantage in the multilateral health ecosystem
The global health architecture has expanded steadily over the past two decades. It now operates under acute pressure. Multiple reform processes are running in parallel, including the WHO-hosted Joint Process, the Accra Reset, the Lusaka Agenda, UN80, the EU-led Reflection Process, Wellcome Trust dialogues, and consultations convened by civil society coalitions, creating momentum towards structural change. Many of these processes have called for a structured comparative advantage analysis to inform concrete decisions about specific reforms.
This momentum is accelerating against a demanding fiscal backdrop. Global health financing is projected to fall by between 19 and 33% overall against 2023 levels, as governments redirect resources to other domestic and global priorities, including geopolitical realignments, debt management, and climate change. Within this overall trend, the composition of financing is also shifting. Across the window from 2020 to 2023, although total sovereign bilateral expenditure for global health declined, private foundation expenditure remained steady or even over the same period. In this context, as donors face simultaneous replenishment calls, decisions about how priorities in global health are determined have become more acute.
Despite this growing momentum, a critical gap remains: the absence of a rigorous, shared evidence base.
The purpose of this study is to provide evidence about global health mandate and practice across nine multilateral organisations as a basis for making concrete decisions on global health reform. The aim is to identify gaps, interdependencies, overlaps, and areas requiring clearer role delineation across the system.
