There Is a Solution to the Global Health Care Crisis

In eastern Uganda, Khadijah Kantono, a mother of nine, began bleeding heavily while in labor last year. Rushed to a health center, midwife Irene Koote quickly recognized the danger signs, stabilized her, and immediately alerted the attending doctor for urgent intervention. Following the delivery, the doctor performed emergency surgery with the support of the midwife, removing Kantono’s torn uterus and ultimately saving her life.

Kantono survived because the system had a skilled health worker present and able to act. In many places around the world, that is not the case.

In eastern Uganda, Khadijah Kantono, a mother of nine, began bleeding heavily while in labor last year. Rushed to a health center, midwife Irene Koote quickly recognized the danger signs, stabilized her, and immediately alerted the attending doctor for urgent intervention. Following the delivery, the doctor performed emergency surgery with the support of the midwife, removing Kantono’s torn uterus and ultimately saving her life.

Kantono survived because the system had a skilled health worker present and able to act. In many places around the world, that is not the case.

Today, health systems everywhere are strained. In 2025, the dismantling of the U.S. Agency for International Development and wider aid cuts by donor governments triggered immediate consequences. Clinics shut down, medicines and health workers disappeared, and the number of preventable deaths rose.

The global contraction in foreign assistance exposed a much deeper problem: the fragility of a global health model that had been too reliant on short-term and fragmented donor-driven projects.

The world knows how to fix this. Health care improves when countries are supported to lead and strengthen their own health systems, with external partners aligned behind national health strategies. Today’s moment of disruption offers an opportunity to ensure more mothers like Kantono survive.

The stakes could not be higher. The rapid withdrawal of aid is projected to cause 22.6 million  additional deaths by 2030, including 5.4 million children under five. Global health financing has fallen by 21 percent in a single year, from $49.6 billion in 2024 to $39.1 billion in 2025, with further declines expected over the next five years.

Despite growing consensus that global health systems must change, there is little clarity on what comes next. Governments, multilateral organizations, philanthropies, and institutions are advancing reforms, but it is often through separate and overlapping agendas with no shared roadmap for implementation. With at least 11 competing if well-intentioned reform agendas—including the Accra Reset, Lusaka Agenda, and the U.S. government’s global health compacts—the world has reached a reckoning.

To better understand this rapidly changing landscape, colleagues at Seed Global Health and the Harvard School of Public Health led the first comprehensive mapping of today’s major global health reforms to get a better sense of where they align, where tensions remain, and what this means for the future. We found:

1. Consensus exists. The good news is that the global health community has reached a consensus on the need and direction of reform. Broadly, that includes countries taking ownership of their national strategies, institutional alignment on those plans, longer-term sustainable funding, and a move toward greater domestic resource mobilization. But in each of those areas, challenges remain.
2. Fragmentation is accelerating. The reforms themselves are reproducing the fragmentation that countries and organizations are trying to solve. They are emerging independently, using different frameworks, and creating overlapping requirements.
3. Power still shapes priorities. Despite growing consensus around country sovereignty, financing decisions are heavily shaped by the geopolitical, economic, and security interests of donors who are accountable to their own political realities. The flow of dollars will continue to shape priorities and decision-making.

4. The biggest bottleneck is implementation. Reform initiatives focus on financing and efficiency at the expense of institutional capacity, operational systems, and the workforce, leading to a mismatch between ambitions and a country’s capacity to deliver.
5. We stand to lose progress. A failure to align implementation, funding, and milestones will undermine hard-won gains in global health across HIV, tuberculosis, malaria, and women’s health.

There is no coherent global reform process—yet. Recognizing these gaps and parallel processes is essential to reconciling differences. The World Health Organization-facilitated process, which will launch at the World Health Assembly in Geneva this week, will be an important start to bring member states, multilateral organizations, philanthropies, and civil society around one table to agree on the way ahead.

So, what is the path forward?

First, stakeholders in global health must move from mere principles and talking points to actual implementation. Collectively, we need to determine a common roadmap: how various reform efforts align, what platforms drive implementation, who leads what, and how to support countries through transition.

Second, reform processes must reduce fragmentation, not further it. Countries should not have to navigate multiple and overlapping initiatives. We need agreement on coordinated financing—and greater amounts of it—as well as a single delivery platform to reduce administrative burdens and ultimately strengthen national systems. This also includes the capacity for countries to push back on agreements or conditions not in line with their respective national priorities.

Third, capacities must be addressed. The success of any reforms depends on whether countries have the institutions, governance and operational systems, and workforce needed to deliver it.

Finally, the financing transition must be realistic. Many countries are heavily dependent on external financing, particularly while more than half of African countries spend more servicing debt than on health care. Domestic resource mobilization is essential, but reform efforts must create credible pathways for financial independence rather than shifting risks onto countries too quickly.

The case for domestic investment in health should start with the economic reality. Investing in health will help drive countries’ economic growth, productivity, and stability.

Examples exist. In Uganda, the government created an approach centered on country ownership, inviting partners to fund national plans for long-term investment in the health system, upgrading health facilities, and expanding the health workforce. This has been backed by a commitment to increase health spending from 5.6 percent of the national budget to 9 percent by 2030.

At Mbale Regional Referral Hospital, near where Kantono lives, a partnership between the Ministry of Health and Seed Global Health saw maternal mortality reduced by 47 percent last year alone, despite the deep foreign aid cuts and strain across the health system. The benefits for citizens are increasingly clear, and potentially a model for other countries to follow.

These gains were driven by Uganda’s leadership to align sustained domestic and external funding behind clear country priorities, a strategy to increase access to emergency and quality care, a commitment to training and retaining its workforce, and codifying health as a pillar of economic and national resilience. Kantono survived because investment in system capacity meant she was able to get the care she needed at exactly the right moment.

The global health community faces a choice: continue pursuing fragmented reforms or build a system capable of delivering quality health care for millions around the world.