A public health physician, Dr Ebere Okereke, has warned that global progress toward Universal Health Coverage (UHC) is stalling as out-of-pocket health spending continues to rise, deepening financial hardship worldwide.
Okereke, speaking to reporters on Wednesday in Abuja, said the slowdown underscores an urgent need to shift from crisis-driven health interventions to resilient, country-led health systems strengthening.
Crisis model weakened national systems
The physician, Chief Programme Officer at the Mohamed bin Zayed Foundation for Humanity, explained that the prevailing global health financing model has been largely built around emergency responses to HIV, Ebola, malaria, and COVID-19.
She noted that while this approach saved millions of lives, it weakened national health systems over time by creating parallel structures and limiting long-term domestic capacity building.
Okereke described global health as now standing at an inflection point, citing her peer-reviewed article published in PLOS Medicine on March 3.
“We built crisis machinery that saved millions of lives, then kept running it as if every year were an emergency,” she said.
“That choice carries costs: weakened national institutions, parallel delivery systems, and progress dependent on external actors arriving on time,” she warned.
Country Control Must Become Default
In the paper titled “From Crisis Response to Country Control: Restoring Agency and Sustainability in Global Health,” she argued that durable health gains require country control as the default approach.
She referenced recent global health monitoring showing that UHC progress has plateaued in many low- and middle-income countries, while financial hardship from healthcare payments continues to rise.
Okereke said heavy reliance on external financing, vertical disease programmes, and parallel reporting structures has limited governments’ ability to sustainably integrate services into national budgets and systems.
“When financing tightens or global priorities shift, countries are left exposed,” she said, urging policymakers to institutionalize country ownership in health reforms.
Predictable funding and citizen accountability needed
She stressed that lasting health gains require building country control into systems by default, rather than treating national ownership as optional.
Okereke emphasized that reforming the global health architecture demands predictable financing streams that strengthen core health systems and reinforce national institutional capacity.
She also called for reduced dependence on parallel donor-driven platforms and greater accountability to citizens rather than allowing external funders to dominate domestic health priorities.
Avoid short-term fixes that create fragility
Okereke cautioned that efficiency-driven workarounds may deliver short-term results but risk entrenching long-term systemic fragility in national health structures.
“Build agency into the system from the start,” she advised, highlighting the importance of embedding sovereignty in global health design.
While recognizing the lifesaving impact of emergency responses over the past three decades, she said the next phase of global health must prioritize sovereignty, institutional strength, and fiscal resilience.
