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As traditional aid models strain under political and economic pressure, countries are at risk of shrinking development goals to match shrinking budgets. But doing so would miss the moment entirely. The real crisis in global health may not be funding — it may be a crisis of imagination.
Ministers of health find themselves facing a period of exceptional complexity. Funding is diminishing, health needs are increasing and trust in institutions is being tested. The challenge ahead is not solely financial; it is fundamentally a matter of leadership.
Our council brings together former heads of state, ministers, and leaders from various sectors. We established this group not to debate the importance of leadership and management, but to take action on it. If we want stronger, more resilient systems, we must invest in the people who lead and manage them.
But leadership is more than just a skill set. It is a political and structural matter, deeply connected to questions of sovereignty, power and priority. The path to sustainable development starts with national leadership, vision, and systems that function effectively.
Reclaiming sovereignty in a changing aid environment
As traditional aid models shift dramatically, clarity of national leadership has become more important, not less. While countries have always borne responsibility for their development, periods of external financing have often blurred lines of authority and accountability.
Today’s environment demands a reset. National governments must be recognised not as implementers of externally defined programmes, but as the architects of their own development agendas. This shift requires partnerships that align behind nationally determined priorities, longer planning horizons, and global actors that support effective and impactful country leadership.
Don’t start with scarcity — start with ambition
Too often, health systems are built around the money available. We call for a different approach. Start instead with the question: What do people truly need, and what kind of system will serve them best?
Let us work backwards from the desired outcome: quality integrated health services that put people at the centre. What structures, financing mechanisms and capabilities are necessary to turn that vision into reality and ensure its sustainability?
During moments of crisis, it is tempting to scale down our ambitions and accept minimal progress or even damage limitation. Yet it is precisely under fiscal constraint that clarity of ambition matters most: without it, scarce resources are fragmented, short-term decisions crowd out reform, and systems drift further from what people actually need.
History teaches us that what drives transformation is elevating our aspirations — with clarity of purpose, long-term dedication, and courageous public and private leadership.
Institutions require more than just inputs
Infrastructure and commodities may be visible signs of investment, but they are not the whole picture. Systems are only as strong as the people who operate them. This means leadership and management are not just soft skills. They are vital capabilities, especially during times of change and upheaval.
Sustainable systems change also depends on aligned leadership across the wider ecosystem — within government, across public institutions, and in partnership with communities, the private sector and other societal actors — anchored by a clear public mandate and shared national purpose. We must challenge the common belief that these skills can be gained passively or learned on the job. They demand dedicated investment, coaching, mentorship and a culture that values long-term learning and behaviour change over short-term results.
A window for redesign
Recent events, including significant funding withdrawals and shifting donor priorities, have put many national public health programmes at risk. However, this moment also offers an opportunity to rethink and redesign. Governments can seize this inflection point to develop systems that are people-centred, integrated, and prepared for the future.
The Nigerian Health Sector Renewal Investment Initiative, unveiled by the president in 2023, with its whole-of-government compact, multi-stakeholder partnerships, and increasing domestic financing in a sector-wide approach, represents an example of necessary shifts in health development
In another example, the minister of health of Senegal has outlined a clear, three-part strategy for health transformation: strengthening institutions and governance to unblock delivery bottlenecks, leveraging digital tools to expand access, and diversifying funding through domestic resource mobilisation.
What sets these approaches apart is not the components themselves — many countries are pursuing similar goals — but the clarity of ownership. These are sovereign visions, shaped by local priorities, delivered by national teams and framed around the long-term health of their people.
In many contexts, these plans will also require governments to deliberately shape how private capital contributes to national goals and priorities, aligning markets, regulation and incentives.
What comes next?
The coming years will challenge the resilience of our institutions and the strength of our commitments. However, they also offer the possibility of a new era of public sector transformation — one driven not by crisis response, but by ambition.
To facilitate this transition, we urge all stakeholders in global development to:
- Invest in public sector leadership and management as essential foundations, not optional extras;
- Transition from siloed, approaches to integrated, country-designed systems; and
- Support long-term capacity, not just short-term results
As a council, we remain steadfast in our belief: strong systems are created by strong leaders. The most effective way to promote equity, resilience and results is to invest in institutions — and the people who lead them — for the long term.
Let 2026 be the year we stop asking what can be done with what is left. Rather, let it be the year we start building what is needed with the leadership we already have. DM
The High-Level Council on Leadership & Management for Development is a global collective of former heads of state, ministers and global leaders committed to elevating leadership and management as core pillars of sustainable development. Council members include Barbara Bush, Helen Clark, Julio Frenk, Dan Glickman, Wendy Kopp, Robert Newman, Muhammad Pate, Manuel Pulgar-Vidal, Jaime Saavedra and Ellen Johnson Sirleaf. For more information on the council, click here.
Facts Only
The High-Level Council on Leadership & Management for Development is a global collective of former heads of state, ministers, and leaders.
The council includes members such as Barbara Bush, Helen Clark, Julio Frenk, Dan Glickman, Wendy Kopp, Robert Newman, Muhammad Pate, Manuel Pulgar-Vidal, Jaime Saavedra, and Ellen Johnson Sirleaf.
Traditional aid models are under strain due to political and economic pressures.
Health ministers face increasing complexity, diminishing funding, and eroding trust in institutions.
The council advocates for investing in leadership and management as core pillars of sustainable development.
National governments are urged to reclaim sovereignty and design their own development agendas.
The Nigerian Health Sector Renewal Investment Initiative was unveiled in 2023, featuring a whole-of-government approach and multi-stakeholder partnerships.
Senegal’s health minister has outlined a three-part strategy: strengthening governance, leveraging digital tools, and diversifying funding.
The council calls for long-term capacity building over short-term results.
The article was published in 2024, referencing events and initiatives up to 2023.
Executive Summary
Global health systems face a critical juncture as traditional aid models decline and funding pressures mount. The High-Level Council on Leadership & Management for Development argues that the core challenge is not financial scarcity but a crisis of leadership and imagination. National governments must reclaim sovereignty over their health agendas, moving beyond donor-driven programs to design systems aligned with local priorities. Examples like Nigeria’s Health Sector Renewal Investment Initiative and Senegal’s three-part health transformation strategy demonstrate how countries can prioritize long-term, people-centered reforms. The council emphasizes that sustainable development requires investing in leadership capabilities, integrated systems, and domestic resource mobilization rather than relying on short-term fixes. While fiscal constraints may tempt policymakers to scale back ambitions, the council advocates for bold, visionary planning to ensure health systems meet actual needs. The call to action includes shifting from siloed approaches to country-led solutions and supporting long-term institutional capacity over immediate results.
The narrative highlights a tension between external aid dependencies and national ownership, framing leadership as the linchpin for resilient health systems. However, the feasibility of these reforms remains uncertain, particularly in contexts with weak governance or competing political priorities. The council’s perspective reflects a broader debate about the future of global health financing and the role of sovereignty in development.
Full Take
The strongest version of this narrative is its call for a paradigm shift in global health—from donor dependency to sovereign leadership. The council rightly identifies that funding alone cannot solve systemic challenges; leadership, vision, and institutional capacity are equally critical. The examples of Nigeria and Senegal provide concrete models of how countries can take ownership of their health systems, even amid fiscal constraints. This is a refreshing counterpoint to the prevailing doom-and-gloom discourse around shrinking aid budgets.
However, the narrative risks oversimplifying the structural barriers to sovereignty. While the call for "ambition over scarcity" is inspiring, it assumes that national governments have the political will and administrative capacity to execute such reforms—a premise that may not hold in fragile states or where corruption and patronage networks dominate. The emphasis on leadership as a panacea could also inadvertently shift blame onto individual leaders rather than addressing systemic inequities in global health financing. Additionally, the council’s focus on "long-term learning" and "behavior change" may clash with the short-term electoral cycles that drive many policymakers.
Root cause: This narrative echoes the broader neoliberal turn in development discourse, where sovereignty and self-reliance are framed as solutions to external dependency. Yet it sidesteps the question of how power asymmetries—between donors and recipients, or between elites and citizens—shape whose "ambition" gets prioritized. The assumption that national leadership alone can overcome these dynamics may underestimate the role of global economic structures in constraining agency.
Implications: If adopted, this approach could empower countries to design more responsive health systems. But without addressing the political economy of aid—such as how donor conditions often undermine sovereignty—it risks becoming another well-intentioned but toothless reform agenda. The second-order consequence could be a further retreat of international solidarity, as wealthy nations use the rhetoric of "national ownership" to justify cutting aid.
Bridge questions:
How can countries with weak governance or high corruption ensure that "sovereign leadership" translates into equitable outcomes rather than elite capture?
What mechanisms could hold global actors accountable for aligning with national priorities, rather than imposing their own agendas?
If leadership is the solution, what happens when leaders fail—or when their priorities diverge from public needs?
Counterstrike scan: A bad actor pushing this narrative might use it to justify aid cuts under the guise of "empowering sovereignty," while ignoring the material support still needed in low-income countries. However, the council’s explicit call for *investment* in leadership and long-term capacity—rather than austerity—distinguishes it from such cynical framing. The content does not align with a predatory playbook; it genuinely advocates for systemic reform.
Patterns detected: none
Sentinel — Human
The article exhibits strong human signals—nuanced argumentation, concrete examples, and stylistic idiosyncrasies—with minimal indicators of synthetic generation.