Recent decisions by the US Government signal a need for major changes to the way global health is organised. As the contribution of development assistance to financing health services falls, there is a need to ensure that national strategies are respected and that countries have access to affordable drugs and a variety of health-related technologies.
Leaders of aid-recipient countries, the traditional donors and large middle-income countries will need to take joint responsibility for making this possible. Despite a context of global competition and contestation, there is a lot of agreement on key global health objectives, so that it could be an important arena for establishing more inclusive governance. This will involve changes to current institutional arrangements. These changes are likely to take place in a piecemeal manner, whereby new approaches for tackling a problem will be tested at a relatively small scale before agreements are reached for more ambitious reforms and the capacity to implement them is built. The transition that is needed will be difficult and will take time. However, it is important that it succeed, in order to make effective responses to major health threats possible and to ensure progress towards universal access to effective health care.
