Within the framework of the Seville Action Platform (SAP), launched at the Fourth International Conference on Financing for Development (FFD4), the initiative ‘Towards a Renewed Global Health Ecosystem: Addressing the Challenges and Opportunities for Financing Inclusive, Resilient and Sustainable Health Systems’ was presented. Its objective is to reform the global health architecture to make it more cohesive, country-led and aligned with sustainable financing strategies.
The initiative, presented by President Sánchez together with the WHO, GAVI and the Global Fund, has a multi-year funding commitment from Spain of €315 million for the period 2025-2027. The main objectives are: (i) reform global health governance, (ii) align financing with national priorities, (iii) promote universal health coverage, and (iv) expand the mobilisation of domestic resources. More than fifteen countries, multilateral partners and civil society have joined this initiative to date, with the aim of having a tangible reform roadmap in place by mid-2026.
This is undoubtedly a substantial political commitment, underpinned by shared responsibility, which can help shape a reformed and more equitable global health architecture. The initiative, which is based on the Lusaka Agenda (2023), is structured around two key areas of action:
This is a highly relevant initiative that aims to build a strategic and inclusive approach to transforming global health governance, improving financial coherence, aligning international support with national priorities and supporting universal access to health. Its inclusive and sustainable approach would reduce access gaps, counteract health cuts and ensure resilient, equitable and quality systems. The initial financial commitment of $315 million would be a significant boost to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance (up to $188 million) and the WHO ($70.5 million).
The initiative's roadmap, which is still partly under development, will have to address challenges and critical issues such as long-term sustainability, as funding is projected until 2027, its implementation and impact on specific actions in each country, especially in fragile contexts or those with low institutional capacity, coordination between actors, and complementarity with initiatives such as the one in Lusaka, which partly inspired this initiative, which, incidentally, represents a historic opportunity to redefine global health from a more equitable and collaborative perspective.
The special event ‘Health Financing for a Secure and Sustainable Economy: Towards an Action Agenda for Health Financing’, held in Seville, was a first step towards addressing one of the most challenging issues: the financing of health systems and the reform of the global health architecture. The session emphasised the urgent need for sustainable investment in health to support economic resilience, equity and global health security, and laid the foundations for a collective commitment to this initiative, a commitment that has been endorsed by 14 countries (7 in Africa, 2 in Latin America, 2 in Asia, 2 in Europe and 1 in Oceania) as well as the European Commission, 9 regional and/or international bodies and 8 civil society organisations, including medicusmundi.
In addition to technical tools, the initiative requires political will and coordination for the structural change it proposes. As discussed at the Seville event, "health financing is deeply political and is determined by decisions about who pays, who benefits and who decides. A transformation must be based on solidarity over charity; cooperation over competition; and public leadership over market dependence.
Financing health for all is a moral imperative and a strategic necessity and building fair and sustainable systems requires bold collective action that cannot wait.