The challenge in global health? Spoiler: it's not just money

Jonny Barty is CEO at Acasus, a development consultancy that partners with governments to deliver bold health and education reforms that improve lives at scale.

As the 78th World Health Assembly gathers in Geneva this week, much of the conversation will focus on the need to mobilise more funding as aid budgets shrink worldwide.

But with economic pressures unlikely to ease in the near term, we must also ask a harder question - how do we deliver more from existing resources, or even less, without sacrificing ambition or diluting goals? 

Four principles can help answer this, even in the most resource-constrained environments. 

First, we need to build political commitment to deliver, sustain, and scale change. Lasting reform demands bold, committed leadership. It sets direction, maintains focus, and builds momentum — especially when things get tough.

But commitment isn’t guaranteed. It’s earned — through visible progress, quick wins, and hard-won results that build belief. When leaders see impact, their resolve tends to grow. Without this, reforms risk being sidelined or forgotten.

This was demonstrated in the Punjab Health Reforms Roadmap, led by now-Prime Minister Shehbaz Sharif.

As Chief Minister, early gains in primary health performance emboldened him to champion reforms that drove a 35 percentage point increase in immunisation coverage in three years.

Similar improvements are now also emerging in Khyber Pakhtunkhwa and Sindh provinces, with Pakistan setting new expectations for what’s possible in large countries.

Secondly, we need to focus on fewer, better data points and use them well. While most systems do not lack data, too often it is incomplete, unreliable, or too patchy to guide reform. Worse, regular, last-mile performance data — insights on the inputs and actions that drive real outcomes — are often missing entirely.

This poses a challenge — how can vaccine shortages be fixed if no one knows when they happen? How can labour room functionality improve if we don’t know which ones lack essential inputs, or whether they’re even open 24/7?

Rapid improvements are possible, though. In Nigeria’s Sokoto State, a 100-question digital tool is used to collect data from 92% of all primary health facilities each quarter — without any new funding. That data now fuels quarterly performance routines, driving the state’s first large-scale, data-led reform of primary care.

Thirdly, we need learning-led delivery. Reforms rarely fail because the strategy is wrong — they fail because implementation breaks down. Implementation is hard, especially in the places we care most about. It requires hundreds of small things to go right, every single day — not an easy task. 

That’s why we need to build capacity and courage in systems to launch, test, and adapt solutions through rapid cycles to quickly surface what works. This isn’t about experimenting for its own sake, but about acting quickly, learning (and failing) fast, and redirecting effort where it matters most.

We saw this in Sindh province in Pakistan, where under the leadership of Minister of Health Azra Fazal Pechuho, learning-led efforts to improve labour room functionality led to a 10 percentage point increase in institutional deliveries.

Increases were predominantly seen in public facilities, disproportionately targeting the least well-off.

Finally we need to make governance work. Reforms lose momentum without strong governance. Focus drifts. Solutions stall. Progress fades. What works? Simple, data-driven routines that keep systems moving and problems unblocked.

A quarterly stocktake with a prime minister on national priorities drives urgency and accountability. Monthly reviews at subnational levels keep managers focused and aligned. Add peer pressure, competition, and (non-financial) incentives, and performance will improve as much through governance as through new funding.

Yet in most systems, these routines are ad hoc, data-light, or too fragmented to drive change. Fixing this isn’t just about new processes — it’s a cultural shift. One that requires sleeves-up coaching and sustained support.

When done right though, the impact is real. In Democratic Republic of Congo, a coalition of partners worked with government to launch the Mashako Plan — aligning actors around clear priorities, targets, data, and delivery routines. 

Within two years, vaccination coverage in nine provinces rose by 26 percentage points, nearly doubling previous performance.

These four principles have helped drive improved health outcomes in some of the most complex, resource-constrained settings.

Adopting them takes courage. It’s not easy. But the evidence is clear - they can help deliver more with less. 

As the World Health Assembly gets underway, this is not a moment to pause. It’s a moment to double down — on bold political leadership, better data, smarter delivery, and strong governance.

The future of global health depends not just on what we fund — but on how well we deliver.