Last Updated on 22 Apr 2026

Rethinking the Future of Global Health: High-Level Dialogue on Global Health Architecture by Wellcome Trust, supported by IHPP Foundation

   Senior health policymakers, researchers, and global health leaders gathered in Bangkok on 9-10 April 2026 for a high-level dialogue titled Rethinking the Future of Global Health: High-Level Dialogue on Global Health Architecture. This global dialogue was hosted by the Wellcome Trust, with support from the International Health Policy Program (IHPP) Foundation.

The two-day dialogue brought together diverse voices from governments, international organisations, civil society, and academic institutions to discuss what a reformed global health system should look like, and how to get there. This dialogue represents the final culmination of months of sustained work hosted by the Wellcome Trust, which included commissioned papers by five thought leaders from across the world, followed by five regional dialogues.

Setting the Stage: Opening Remarks and Provocations

The dialogue opened with remarks by Dr John-Arne Røttingen, CEO of the Wellcome Trust, followed by Dr Viroj Tangcharoensathien. Dr Viroj called for three urgent actions: (1) reforming global health governance through nationally designed agendas, LMIC capacity strengthening, and the TAPIC (Transparency, Accountability, Participation, Integrity, and Capacity) principles of good governance; (2) strengthening WHO's core mandates of normative functions, global health security, and convening authority; and (3) reforming ODA and global health initiatives to prioritise the poorest countries and accelerate the transition from aid dependence to domestic financing. 

Click to expand: Detailed Statement from Dr. Viroj Tangcharoensathien

Thank you Wellcome Trust, John-Arne and your able team for convening this global dialogue.  

I. What is the current GH and GH Financing terrain?

  • Power imbalance in GH decision making, dominated by HIC
  • Very large accountability gaps
  • Inadequate domestic financing for health, lack of capacity and leadership, and deteriorating Corruption Perception Index in most LMICS
  • Studies show DAH are incoherence with country priorities, donors’ driven agenda does not adhere to Paris declaration on aids effectiveness, and further fragmented by many priorities driven by GHIs and bilateral
    • Although every dollar per capita increase in ODA is associated with a 0.035 decrease in U5MR, DAH tends to achieve stronger and more sustainable results when delivered through government systems and aligned with aid effectiveness. Studies show that DAH impact is highly heterogeneous, with greater effects in countries with stronger governance and health infrastructure.
  • By April this year, 29 countries signed bilateral MOU with US GOvernmetn, US contributes 12.8b country co investment 7.5B 

II. What actions are required today?

  1. Reforming GH governance
  • Nationally designed health agenda and implementation,
    • LMIC capacity strengthening,
      • HPSR informed national health policy and implementation capacity, GH diplomacy, leadership,
    • Framed good governance characterized by TAPIC which stands for Transparency, Accountability, Participation, Integrity and capacity in policy implementation
  • Regionally coordinated with mutual support within region
  • Aligned with global agendas

It is easy to say regional coordinated, challenges remain on 

  • Heterogeneity within a geographical region, sub-region should be a feasible solution
  • Trust, border conflicts, competition within region
  • Existing regional / sub-regional structure: variation in capacity
  1. Strengthening Role of WHO
  • As specialized agency, directing and coordinating authority on international health, three key mandates should be sustained and strengthened
    • normative functions,
    • global health security,

Both functions can be achieved through convening experts,

  1. Reforming ODA and GHI
  • Prioritize LIC n=26, strengthen efficiency of ODA/ DAH, country priority,
  • Implementing Accra Reset Initiation, despite its potential and leadership, Africa is faced with challenges of political instability, corruption, energy crises, soaring public debt, and other problems that might hinder the progress of ARI.
  • For Lower middle-income countries (n=54): concrete transition from ODA dependent to domestic funding.

In closing, from five decades of Thai health systems development since 1970s, times and again, evidence confirms that health systems capacity, nation-wide distribution of PHC, committed health workforce through rural retention strategies and adequate funding through leadership and political commitment, not verbal but financial commitment; all of which lead to UHC and equitable health of the population.

Thailand UHC has proved a “great equalizer”. It nullifies rich poor provinces U5MR.

Finally, please enjoy the deliberations today and tomorrow.


Before the first breakout group discussions, Dr Suwit Wibulpolprasert offered a provocation, remarking the rising tide of global health reform efforts currently underway. He noted that the challenge facing global health is not a shortage of discussions, ideas, or reform proposals, it is the persistent failure to translate those ideas into meaningful, lasting change. His remarks challenged participants to move beyond diagnosis and towards action.      

Day One: Breakout Discussions on Architecture and Coherence

The first day featured two breakout discussions in small groups, facilitated by Dr Angkana Lekagul with support from Ms Tashi Chozom and Ms Divya Lakhotia. Participants explored two themes:
1.    Enabling regional health architecture to take on functions in a way that effectively aligns with country needs 
2.    Streamlining the global ecosystem to improve coherence and efficiency
The discussions were rich and candid. Participants demonstrated a strong sense of urgency and a genuine appetite for change, reflecting a shared recognition that the current system is no longer fit for purpose.

Day Two: Deep Dives into Operational Reform

The second day shifted from diagnosis to design, with focused deep-dive sessions on the following:
1.    Pooled procurement – exploring how collective purchasing power can be harnessed to improve access to medicines, vaccines, and health commodities.
2.    Operationalising one plan, one budget, one monitoring and evaluation framework – examining how to translate the principle of alignment into practice, reducing the burden of parallel planning processes on national health systems.
3.    Mandate refinement at global and regional levels – interrogating the roles, functions, and boundaries of global and regional health institutions, and identifying where clarity and consolidation are most needed.
Conclusion
The global dialogue added a timely, grounded, and action-oriented voice to the global conversation. The depth of engagement across both days reflected not only the complexity of the challenge, but also the determination of those gathered to shape a global health system that is more equitable, more coordinated, and genuinely fit for purpose.