BOLD, ACTIONABLE CIVIL SOCIETY-OWNED VISIONS FOR THE FUTURE OF
GLOBAL HEALTH ARCHITECTURE
by Dr. Uzodinma Adirieje
Chief Executive Officer, Afrihealth Optonet Association (AHOA)
Abstract
The future of global health must be owned and shaped by the people
it serves. Civil society organizations (CSOs) have long been instrumental in
advancing equity, accountability, and inclusion, yet remain marginalized in
decision-making within the dominant global health architecture. This paper
articulates nine bold, actionable, civil society–owned visions that seek to
decolonize financing, democratize data, empower communities, and integrate
planetary health. These proposals call for a radical reimagining of governance,
where communities are equal partners, rights replace charity, and justice
replaces dependency. Civil society must no longer be implementers of external
agendas but architects of a new, people-centered global health order.
1. Introduction
The global health architecture as we know it today is inadequate for
the challenges of our century. It remains largely donor-driven,
state-dominated, and disconnected from the daily realities of the communities
it claims to serve. Health priorities are too often determined in northern
boardrooms rather than local communities. Civil society organizations — the
voices of the people — are frequently relegated to implementers,
subcontractors, or observers, rather than being recognized as co-owners of the
system. The time has come to redefine global health governance from the ground
up. We must establish an architecture that is equitable, inclusive,
accountable, and owned by civil society. What follows are bold, actionable
visions for this transformation.
Vision 1: Civil
Society as Equal Partners
Civil society must be treated as equal partners, not implementers.
This requires institutional reforms to ensure mandatory civil society
representation — with voting power — in the governing boards of international
health organizations such as WHO, GAVI, and the Global Fund. We must establish
Global Civil Society Health Councils at global, regional, and national levels
to co-create and review health policies. Moreover, funding mechanisms must flow
directly to local and community-based organizations (CBOs), not merely through
governments or large international NGOs. This is the foundation of shared
ownership and true partnership.
Vision 2:
Decolonizing Global Health Financing
Global health remains entangled in dependency — where low- and
middle-income countries rely heavily on donor priorities that may not align
with their national needs. We propose a Global Equity Health Fund, jointly
managed by coalitions of Southern CSOs, governments, and social entrepreneurs.
High-income countries should contribute a fair share based on GDP and
historical responsibility for global inequities, including climate and health
burdens. We must also foster community financing innovations — such as diaspora
bonds, cooperative health funds, and digital micro-contributions — to empower
communities to invest directly in their own health systems.
Vision 3:
People-Powered Health Systems
Communities must not only be beneficiaries of health interventions
but active shapers of health policy, planning, and accountability. This can be
achieved by institutionalizing Community Health Parliaments, where citizens
debate and review local health budgets and outcomes. Tools like citizen
scorecards, social audits, and community health insurance cooperatives can
strengthen transparency, trust, and shared responsibility. When communities
govern, ownership thrives — and so does health.
Vision 4: Data
Democracy and Open Health Intelligence
Health data must be treated as a public good rather than a private
asset. We must adopt a Global People’s Health Data Charter to guarantee open
access, transparency, and ethical data governance. Civil society–owned digital
observatories should collect and analyze data on service access, health equity,
and budget performance. Data justice ensures that information empowers rather
than exploits the people it represents.
Vision 5: Health
as a Human Right, Not a Commodity
Health is a right, not a privilege. Our fifth vision proposes a
Global Treaty on Health Equity — a binding international instrument compelling
states and corporations to uphold universal access to essential health
services. Civil society networks must organize health equity litigation
coalitions to challenge unjust patent laws, discriminatory insurance systems,
and privatization of public health goods. Every trade agreement, climate
policy, and investment framework should undergo health equity audits to ensure
they advance, not undermine, the right to health.
Vision 6:
Integrating Planetary and Human Health
Human health cannot thrive on a dying planet. Civil society must
champion a Coalition on Planetary Health Governance, integrating health
advocacy into climate and biodiversity negotiations. Governments should
redirect fossil fuel subsidies toward resilient, green health infrastructure,
while CSOs lead community-based adaptation programs addressing climate-related
health risks. Planetary health must be embedded in all public health planning.
Vision 7:
Feminist and Youth Leadership
Global health governance must reflect the diversity of humanity. We
call for 50 percent representation of women and youth in decision-making bodies
at all levels. Funding should prioritize grassroots feminist and youth-led
networks that innovate, organize, and advocate for health equity. Mentorship
and succession programs should link emerging youth voices with experienced
civil society leaders to ensure sustained leadership transformation.
Vision 8:
Accountability and Technology for Equity
We propose the creation of a Global Civil Society Accountability
Index, which annually rates governments, donors, and institutions on
commitments and outcomes. All health programs should adopt open contracting and
expenditure tracking systems accessible to the public. Technology must be
harnessed ethically — promoting open-source digital health solutions and
ensuring that AI-driven health innovations respect equity, privacy, and human
rights.
Vision 9: A
People’s Global Health Architecture
The final vision envisions a People’s Global Health Architecture — a
civil society–led ecosystem grounded in justice, solidarity, and shared
knowledge. This includes establishing a Global People’s Health Assembly,
building cross-sectoral alliances across climate, labor, and migration
movements, and creating a Permanent Civil Society Observatory on Global Health
Governance to monitor and influence global health reform.
Conclusion
The global health architecture of the future must be owned by the
people it serves. Civil society is not a passive partner; it is the lifeblood
of accountability, innovation, and justice. We must move from consultation to
co-creation, from charity to solidarity, and from top-down models to
people-driven systems. Let us unite to build a just, inclusive, and resilient
global health system — one that reflects our shared humanity and collective
determination that no one shall be left behind.
About the Author
Dr. Uzodinma Adirieje is an environmental health researcher with
Afrihealth Optonet Association (AHOA), focused on linking ecosystem health and
human well-being in Nigeria. He is a global health practitioner, development expert,
and civil society leader whose work sits at the critical nexus of biodiversity,
health, and climate change. He serves as the Chief Executive Officer of AHOA, a
pan-African civil society network advancing sustainable development through
advocacy, policy dialogue, and grassroots interventions. With over two decades
of experience, Dr. Adirieje has championed the understanding that biodiversity
is essential for human health - supporting food security, disease regulation,
clean water, and resilient livelihoods. His leadership promotes integrated
approaches that address environmental degradation, climate change, and poverty
simultaneously. Through AHOA, he leads multi-country initiatives on climate
change, ecosystem restoration, renewable energy, universal health coverage, and
climate-smart agriculture, while advocating for stronger governance and
inclusive community participation. At national, regional, and global levels,
Dr. Adirieje engages with governments, international organizations, and civil
society to drive policies linking health and environment. His work underscores
that safeguarding biodiversity is not only an ecological necessity but also a
cornerstone of global health and sustainable development in Africa and the
Global South.
Dr. Uzodinma Adirieje.
CEO/PD,
Afrihealth Optonet Association
(AHOA) – CSOs Network
& Think-tank
<https://afrihealthcsos.blogspot.com/2024/03/about-afrihealth-optonet-association_15.html>
Phone/WhatsApp: +2348034725905
Email: afrepton@gmail.com
Website: http://www.afrihealthcsos.org
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