Four collective priorities developed through a year-long consultation process were presented to WHO leadership and Member States during a World Health Assembly side event attended by more than 120 participants from governments, civil society, academia and WHO.
Nearly 300 civil society voices have called on WHO leadership and Member States to strengthen domestic health financing, presenting four collective asks at an official side event of the Seventy-ninth World Health Assembly.
The asks, developed through a year-long consultation process convened under the WHO Civil Society Commission in partnership with Save the Children, were presented during "Domestic Leadership in Health Financing: A Dialogue with the WHO Director-General" on 19 May 2026. Co-hosted by the WHO Civil Society Commission, Save the Children, the Republic of South Africa, World Vision and Medicus Mundi, the event brought together more than 120 participants from WHO, governments, civil society and academia.
The dialogue marked the culmination of a three-part series grounded in the Economics of Health for All approach, which promotes viewing health not as a cost, but as an investment in economic resilience, social well-being and sustainable development. Over the course of the series, participants explored how countries can respond to growing financing pressures while advancing universal health coverage.
Dr Kalipso Chalkidou, Director of Health Financing and Economics, World Health Organization, representing the WHO Director-General, highlighted the scale of the challenge. Development assistance for health has fallen by an estimated 23–30%, with low-income countries facing the greatest impact, even as they continue to rely heavily on out-of-pocket spending. Her message to civil society was direct: "We really rely on you to drive this message."
Professor Mariana Mazzucato, Professor of Innovation and Public Value at University College London (UCL), reinforced a central theme of the series. "Health is not a sector that supports the economy. Health is an objective, the economy must be designed to deliver," she said, pointing to the human and economic costs of underinvestment in health.
Country experiences demonstrated what domestic leadership can look like in practice. Following abrupt reductions in USAID and PEPFAR funding, South Africa moved quickly to protect essential services. Dr Aquina Thulare, Technical Specialist: Health Economics, National Health Insurance, South Africa, shared South Africa's response to reductions in external health financing.
"We immediately engaged with our fiscal space and started having earnest conversations with our Ministry of Finance," said Dr Aquina Thulare.
WHO Representative to South Africa, Shenaaz El-Halabi, noted that emergency funding helped address critical workforce gaps and maintain essential health services, underscoring the importance of domestic leadership in health financing.
Thailand offered a longer-term perspective. Dr Suwit Wibulpolprasert, Vice Chair of the Thailand Elderly Council Association and Member of the Governing Body of Thai UHC, highlighted how sustained investment in health and social protection helped build one of the developing world's strongest universal health coverage systems, reminding participants that "action without declaration is much better than declaration without action."
The importance of long-term thinking was echoed by Dr Angela M. Seiler Torres of the WHO Youth Council, who called for young people to be included in health financing decisions and highlighted the need for greater intergenerational accountability.
Civil society's four asks
On behalf of the Commission and its partners, Nidda Yusuf, Senior Health Financing Advisor at Save the Children, presented four collective asks developed through consultations with civil society organizations worldwide.
The asks called for:
- Protection of life-saving essential health services and investment in primary health care, including a commitment of an additional 1% of GDP to primary health care, explicit protection for sexual and reproductive health, non-communicable disease and mental health services, and equity floors so investment reaches the most vulnerable first.
- Stronger domestic health financing: setting, publishing and tracking country-defined health spending targets, backed by progressive taxation and health taxes, action on illicit financial flows and debt resolution, and improved public financial management so resources reach frontline services.
- Institutionalize civil society participation in health governance and decision-making processes, including formal representation in decision-making bodies and dedicated funding for grassroots and marginalized organizations to participate effectively.
- Greater transparency and accountability in health financing data ahead of the 2027 United Nations High-Level Meeting on Universal Health Coverage, including WHO publication of data disaggregated by gender, disability, geography, age and socioeconomic status, and Member State submission of national health accounts within 12 months of the reference year.
"Sustainable health financing must be built on three mutually reinforcing elements: strong country leadership, a more coherent and efficient global health financing architecture, and a genuine partnership with communities and civil society," said Ambassador Patricia McCullagh, Deputy Permanent Representative of Canada to the United Nations organizations in Geneva.
The following day, the Commission and Save the Children presented the asks at the Global Parliamentary Forum, bringing civil society priorities directly into discussions with Member State parliamentarians.
With preparations underway for the 2027 United Nations High-Level Meeting on Universal Health Coverage, the Commission and its partners will continue working to advance the priorities identified through the dialogue process.
