Comparative Advantage in the Multilateral Health Ecosystem

The purpose of the study is to collate, synthesise and analyse evidence and recommendations to support decisive reform within and across nine multilateral organisations in the global health ecosystem. The study is undertaken to contribute to wider global health reform processes.

The objective of the study is to assess the comparative advantage of key multilateral organisations (MOs) in delivering priority functions of a future global health architecture, interdependencies, and the implications of this for future division of labour, ways of working and collaboration. It will also identify realistic and sustainable pathways for reform, taking account of the incentives shaping current behaviour.

The audience of the study are MOPAN members engaged in ongoing reform efforts, multilateral health organisations, country governments (especially ministries of health) and other Global Health actors aligned closely with the WHO hosted Joint Process to support dialogue and decision-making on reform options.

Global health cooperation is at a turning point

Multilateral health organisations, including the World Health Organization (WHO) and other global health institutions, have saved lives and expanded access to healthcare, particularly for the most vulnerable. But today’s global health architecture operates in a more constrained and politically contested environment.

Over time, the global health system has become increasingly fragmented. Multiple health financing channels, parallel processes, and overlapping mandates across international health organisations have created inefficiencies and heavy administrative burdens for countries. At the same time, geopolitical shifts and declining official development assistance (ODA) for health are reshaping global health priorities, with funding more often linked to foreign policy interests.

While international health financing will remain important, current trends are unlikely to reverse. Incentives that prioritise visibility and direct service delivery have weakened support for core health system functions and country-led priorities. This has widened the gap between vertical, disease-specific programmes and the growing need for strong, demand-driven primary health care and health systems strengthening.

The global health architecture must adapt

Global health governance needs to evolve.

Multilateral organisations must protect essential global health functions, better align their efforts, and reduce duplication across the system. At the same time, countries need greater leadership and ownership of their health priorities, supported by stronger domestic health financing and more sustainable health systems.

A future-ready global health architecture must reflect changing health needs, political realities, and resource constraints. This includes strengthening global health governance, increasing domestic resource mobilisation, and supporting greater health sovereignty and country ownership.

This study builds on performance evidence from MOPAN assessments of multilateral organisations, in line with other MOPAN Insights. Its findings will inform future assessments of global health organisations, with particular relevance for analysing the enabling environment for organisational effectiveness—a key focus of the new MOPAN 4 methodology.

Despite numerous reform proposals, there remains limited evidence on how global health actors, organisations and delivery pathways should be optimally configured. Drawing on MOPAN’s existing assessments, this study helps address that gap by examining how nine multilateral organisations function within the broader global health architecture. Rather than assessing organisations in isolation, it focuses on collaboration, interdependencies and the system’s collective ability to deliver results efficiently in a complex and resource‑constrained geopolitical environment. The analysis also considers the links between the global health architecture and development assistance for health, with a primary focus on the development dimensions of the system.

Consultations and the literature review highlight strong demand from global health stakeholders for actionable insights on how public health needs and global public goods can be met more effectively. Stakeholders also emphasised the importance of building on existing reform initiatives and aligning with the WHO‑hosted Joint Process.

The findings will be presented to support ongoing reform dialogue—helping preserve institutional strengths, reduce duplication and improve alignment. The analysis will also reflect the principle of subsidiarity, recognising the growing role of regional approaches. Where possible, it will highlight how global, regional and country‑level functions interact to support more effective delivery across diverse contexts.