Post-COVID donor retrenchment, drastic cuts to global health financing, and the restructuring of major philanthropic and multilateral actors are colliding with longstanding structural weaknesses, including underinvestment in global health systems. The question facing the sector is no longer whether the architecture will change, but who gets to shape that change and on what terms.
On July 28, 2026, Kinaura Partners hosted a 60-minute webinar exploring this transition through the lens of a five-actor framework structuring the global health system today. Anchored by Kinaura’s forthcoming paper on navigating the global health architecture shift, the session brought an esteemed panel of practitioners into moderated conversation, testing the paper’s analysis against firsthand experience rather than presenting it as settled conclusion. The discussion centered on the trends reshaping the system through 2035, including shifting donor funding and the recalibration of major philanthropic actors, and on what a deliberate transition looks like in practice, with particular emphasis on African and continent-based voices and country ownership.
Speaker Bios
Edwige Fortier, Deputy Director, Global Health Multilateral Ecosystems I Gates Foundation
Edwige Fortier is Deputy Director, Global Health Multilateral Ecosystems at the Gates Foundation, where she leads integrated advocacy, communications, and resource mobilization strategies across major global health institutions, including the Global Fund, Gavi, the Global Polio Eradication Initiative, and the Global Financing Facility. She established and leads a cross-functional team that brings together advocacy, communications, and financing efforts to strengthen alignment across the global health multilateral ecosystem. In 2025, she helped mobilize $24 billion in financing for global health impact and continues to advance partnerships, policy change, and ecosystem reform to improve the effectiveness and sustainability of global health investments.
Brian Li Han Wong, Senior Coordinator & Strategic Advisor I Accra Reset Initiative
Brian Li Han Wong is a global public health expert, entrepreneur, and interdisciplinary researcher focused on digital health, global health diplomacy and governance, health financing, primary health care, workforce development, and pandemic preparedness and response. He is Senior Coordinator and Strategic Advisor with the Accra Reset Initiative, a consultant with PMNCH and the PHAS project at Peking University, a UNICEF global thought leadership fellow, an advisor for Baraka Impact Finance, and an advisor to health technology start-ups. He founded LonWHO, the UK’s first ModelWHO simulation, and UK Model WHO to expand youth engagement in global health policy, advocacy, and diplomacy.
Rosemary Mburu, Executive Director I WACI Health
Rosemary Mburu is Executive Director of WACI Health and a global development expert advancing equitable, resilient, and people-centered health systems across Africa and globally. Her work spans global health architecture reform, health financing, governance, community leadership, and strategic partnerships. She co-leads the HEAR CSO Consortium on Global Health Architecture Reform and is a member of the Health Works Leaders Coalition, contributing to efforts to strengthen primary health care, health financing, workforce resilience, and regulatory systems. She has served on international advisory bodies and national steering committees in Kenya and was recently appointed to the National Task Force on Ebola Preparedness and Response, linking global policy to national implementation. In 2026, TIME100 Health recognized her for advancing African leadership and global health equity.
Megan Fotheringham, Global Health and Infectious Disease Senior Advisor
Megan Fotheringham, MPP, MPH, is a senior global health leader with more than 20 years of experience advancing infectious disease, malaria, health systems, and global health security programs. She most recently served as Deputy Director of USAID’s Bureau for Global Health, Office of Infectious Disease, where she helped oversee USAID’s malaria and infectious disease portfolios, shaped strategy for an approximately $2 billion annual portfolio, and represented the Agency in National Security Council–convened forums on global health security and outbreak response. Her work bridges policy, financing, evidence translation, and implementation across donor, multilateral, and country program settings.
Alex Harris (Moderator), Director, Global Health Advisor
Alex Harris is a global public health advisor with more than 20 years’ experience shaping strategy, policy, advocacy, and partnerships across government, non-profit, private-sector, and philanthropic organisations. He formerly led the diplomacy and partnerships functions, as well as the European office, at Wellcome, where he oversaw a global team responsible for building the external knowledge, networks, and partnerships needed to ensure health research delivers benefits for people around the world. His work has advanced global health priorities including climate and health, infectious disease, mental health, and pandemic preparedness and response, with a focus on strengthening engagement with governments, multilateral agencies, the private sector, and civil society. During the Covid-19 pandemic, he played a leadership role in Wellcome’s response, including its contribution to the Access to Covid-19 Tools (ACT) Accelerator and efforts to promote equitable access for low- and middle-income countries. He has also contributed to the Global Action Plan for Sustainable Development Goal 3, helped found the Future of Global Health Initiatives project, and continues to support organisations in developing the strategies, policies, and partnerships needed to improve health worldwide.
Resources
The Present and Future of the Global Health Architecture: Navigating a System in Transition: Kinaura Partners Report
HEAR CSO Global Health Architecture consultation reports: https://hearcso.org/
Key Takeaways
Kinaura Kinaura Partners convened four practitioners and a moderator for a candid hour on where the global health architecture transition currently stands and its future. The panel brought perspectives from African-led reform initiatives, philanthropic financing, bilateral donor programming, and civil society advocacy.
These takeaways synthesize perspectives and ideas raised by panelists during the webinar. They are intended to capture the themes that emerged from the discussion and do not necessarily represent the views of every participant or of Kinaura Partners. The common thread the discussion kept returning to was the tension between preventing further fragmentation and accepting that the current system cannot be held in place. Below are key takeaways from the conversation:
The debate has shifted from whether to reform to how fast, and in what sequence. Two or three years ago, the sector had no broad agreement that the architecture needed to change. That agreement is now universal, and the discussion has moved inside the transition itself: how much of the current system to hold in place while its replacement is designed, and whether those two tasks can run in parallel or only in sequence. One perspective from panelists was that greater country leadership does not require severing ties with the global architecture, and the solidarity that produced three decades of gains remains necessary in a redesigned form.
Survival pressure is fragmenting delivery systems now.
Eighteen months of funding shocks have pushed institutions into survival behavior, competing for a shrinking resource pool, protecting mandates and staff, and replacing durable delivery systems with shorter and narrower projects. Some useful innovation will come out of that scramble, alongside duplication and a drift away from the coordinated delivery that produced the gains now at risk. Protecting the functions and delivery capacity that still matter, without freezing the system in place, is the practical problem of the next two years.
The transition should be judged on equity and impact, not institutional alignment alone.
Much of the reform conversation concentrates on coordination, alignment, and changes to operating models, treated as though those were the destination. Panelists challenged the sector to apply a harder test: are reforms sustaining or improving outcomes for people? They noted that a reform process can demonstrate institutional progress while access or coverage deteriorates in particular populations.
The financing gap is partly a pipeline problem.
Panelists discussed that there is a perception that the money has disappeared. However, the discussion included on how sovereign donors are making choices to move resources away from overseas development and away from health, and health has taken the steepest of those cuts. Roughly two to three trillion dollars in programmatic financing is available on the African continent, held back by a limited pipeline able to absorb and execute it. The conversation emerged with a three-part approach: hold traditional donors to their commitments rather than treating the cuts as settled, build out private and blended capital while accepting its high transaction costs, and treat domestic resource mobilization as the channel with the most room to grow, on a horizon of fifteen to twenty years.
Reform has added voices without moving decision rights.
Every reform round so far has widened the conversation while authority stayed in place, and three tests came out of the discussion for whether this round is different. Priorities are set through country institutions before financing is committed, so that countries stop responding to a menu of what funders will earmark. Accountability runs toward countries as well as from them, covering whether funders show up on time and drop last-minute conditions. Communities, civil society, and parliamentarians hold a resourced role in that accountability, because country leadership does not mean government leadership alone. Country leadership carries more weight now than it did five years ago because the multilateral platforms that guaranteed civil society a voice are being displaced by government-to-government agreements with no equivalent guarantee, which puts the burden on domestic frameworks, including social contracting, to fund those roles from public budgets.
