Title:Reshaping the future of global health

Countries put the focus on achieving health sovereignty through communities of practice

Today we are witnessing vast upheaval in the global health field, particularly in the area of development assistance organizations and structures. Last year’s abrupt dismantling of the U.S. Agency for International Development (USAID) and the U.S. withdrawal from the World Health Organization (WHO) sent shockwaves through the global community dedicated to this life-giving work.

“We’re seeing an acceleration of questions that were already emerging about sustainability, country ownership, and the future architecture of global health,” notes Norman J. Beauchamp Jr., executive vice president for health sciences at Georgetown University Medical Center and executive dean of the School of Medicine.

Amid this changing landscape, Georgetown students, staff, faculty, and alumni are helping shape a new vision of health sovereignty, with a grounding in the Jesuit values of cura personalis or care for the whole person, service to others, and expanding the common good.

“At Georgetown, global health is not simply work done across borders. It’s a reflection of the university’s commitment to human dignity, partnership, justice, and the common good,” Beauchamp adds. “The university’s role is not to substitute its judgment for that of countries and communities, but to help convene partners, generate evidence, support implementation, and learn from innovations emerging around the world.”

Reimagining the global health architecture

While the dismantling of long-standing institutions has created uncertainty, it has also prompted a critical opportunity for evaluating whether the old systems were meeting the needs of today.

Looking at the past three decades of his work in global health, Ambassador Mark Dybul (C’85, M’92) recognizes the ongoing need for deep systemic change in the field to match the ambitions set out at the turn of the millennium.

“To be honest, it hasn’t shifted enough,” says Dybul, professor in the Department of Medicine at Georgetown University School of Medicine and a senior advisor at Georgetown’s Center for Global Health Practice and Impact (CGHPI). “We were stuck in old values and systems that were created 25 years ago and are not built for the current time.”

Early in his career, Dybul led the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR), a global health initiative established in 2003 by President George W. Bush. Dybul later served as executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, returning to Georgetown in 2017 to help lead a new global health center.

“I helped start and run two massive international health organizations, but we have not kept the promise that we made in 2000 to support countries by building the capacities so that they could fully own and run their own health systems.”

He points out that the old model of paternalistic aid delivered from wealthy, powerful countries to high-need countries can create unhealthy relationships and dependencies.

“They still do need financial support, but we need to be supporting them to own and lead the response in their countries, their health systems. And they’ll do it in an extraordinary way that we can then learn from, and use to improve our own health system. It can be a beautiful virtuous circle rather than what it’s been, which is unidirectional: ‘Here’s our money, here’s our expertise, do it this way.’ Often they have better ways and can teach us.”

“That idea of bidirectional learning is central to Georgetown’s approach,” says Beauchamp. “The future of global health is not charity moving in one direction. It is partnership, humility, and shared learning across countries, systems, and communities.”

In 2019, Dybul co-founded CGHPI with Deus Bazira, associate professor of medicine and leader of Georgetown’s Global Health Institute. Understanding and implementing this kind of major health system overhaul fits into the vision of CGHPI, which works to sustainably improve health outcomes through the generation and translation of scientific evidence into policy and practice. And the conditions today are ideal for change.

Although the current U.S. administration’s actions have put a spotlight on reduced financial support for global health, foreign aid funding from developed countries has been in steady decline for the last decade, apart from a short time during the COVID-19 pandemic.

“This is not just in the last six months, eight months,” explains Dybul. “Now there’s an acceleration to it, but linked to that acceleration is that vision of country ownership, country sovereignty, treating people as equals. And we have not been doing that enough.”

Health sovereignty and the Accra Reset

“In the last decades, countries that have historically benefited from the generosity of development aid started thinking long term about how to sustainably fund their own health agendas,” says Bazira.

He notes that when COVID hit, economies stagnated and many African countries borrowed heavily, leading to a debt crisis. The setback meant some countries were now paying more in debt servicing than they were spending on education and health combined.

In 2023–2024 Bazira and Dybul joined other leaders outside of Georgetown in conversations around supporting new approaches to foreign aid and global health. In 2025, these exploratory conversations became more urgent.

“We asked, how can the world respond to protect the gains around global health, but also work with global development institutions and countries to have an orderly transition into a sustainable future, where countries do more for themselves and achieve full health sovereignty?

Countries making the decisions, identifying their priorities, driving the health agenda in their countries, and ultimately financing more of their own health care,” explains Bazira. “Traditionally, others were paying for certain things and dictated their agenda, oftentimes bypassing national government systems.”

If global trade policies were more equitable, developing countries would need less financial assistance from others, Bazira says, leading to more just and sustainable systems.

“If they got more out of their own resources, if they added more value to their natural wealth, whether it’s minerals or agriculture, and could produce and trade more finished products, they would be getting more money into their economies and wouldn’t need assistance.”

African leaders including Ghana’s President John Mahama, former Nigerian President Olusegun Obasanjo, and former Liberian President Ellen Johnson Sirleaf were already thinking along similar lines about the future of health sovereignty in Africa. Their conversations helped shape what became known as the Accra Reset, an African-led effort to reimagine global health governance through greater country ownership and regional collaboration.

To broaden the coalition, the group convened leaders during the October 2025 U.N. General Assembly—including presidents, prime ministers, and representatives from the World Health Organization and the World Bank—and presented this concept of the Accra Reset. It was well received, and has since expanded through a heads-of-state council and a high-level panel focused on the future of global health governance and architecture that includes Dybul among its members.

“They signed onto the idea of re-imagining global development architecture using health as an entry point,” says Bazira, who notes that health was chosen because “it is vulnerable and dependent on a lot of overseas development assistance, and stands to lose the most with some of these sudden changes that are happening.”

Establishing communities of practice

As a trusted academic institution on the global stage, Georgetown University is an important part of the Accra Reset initiative, supporting the countries’ agenda, helping find funding, and partnering to develop a structured approach for the program’s success.

Beauchamp notes that “Georgetown brings a distinctive set of assets to this work: deep global health experience, implementation science, policy translation, law, diplomacy, ethics, and a Jesuit commitment to accompanying communities rather than directing them.”

“We started shopping this idea around, and several foundations agreed to the vision as it aligns with what they’re trying to do,” says Bazira. Some of the supporters were also new partners to the university.

The next step was to put this new model of health sovereignty into action. Rather than working with countries one by one, Georgetown helped implement the communities of practice approach, facilitating the creation of a group of countries who work together and form a support network for idea sharing and solidarity. A dozen African countries were identified based on factors like similar health systems and governance structures, as well as historical relationships.

In March 2026, teams from eight countries—made up of senior representatives from ministries of health and finance—came together in Kampala, Uganda, to explore how health and economic flourishing go hand-in-hand. “Rather than just a social good that you do when money is available, health is also foundational for prosperity and economic development,” Bazira explains, because investment in health creates jobs and helps sustain a productive workforce.

The Kampala group coalesced and Georgetown’s CGHPI helped them develop scaffolding for success, with each country working on different elements contributing to health sovereignty, staying in touch over the intervals and meeting quarterly to exchange ideas, successes, and challenges. Georgetown is intentional about not leading but rather assisting with convening, coordinating, and connecting the different countries’ health and finance ministries, as well as providing on-demand technical support to individual countries and at the community of practice level to enhance best practices sharing, wider dissemination, and benchmarking efforts.

“The goal is to help countries turn good ideas into executable plans, while ensuring that ownership remains where it belongs: with the countries and communities themselves,” explains Beauchamp.

“We’ll work with countries to write policy papers and publish their learnings in peer-reviewed journals, so other countries who are not even part of the community of practice can learn from the progress being made,” says Bazira. “Hopefully, that will lead to more countries joining the community of practice.”

As the coalition continues to develop, they hope to learn from countries beyond the African continent, such as South Korea, Indonesia, Singapore, and Brazil, who successfully moved away from dependency on foreign aid and can share lessons from their experiences.

“Dr. Bazira and Dr. Dybul are exemplars for GUMC’s pillar, global health, with an emphasis on in-country capacity building,” says Beauchamp. “The future of global health cannot be built on dependency. It must be built on dignity, sovereignty, shared learning, and the humility to recognize that innovation emerges from communities around the world. Georgetown has an important role to play as a trusted convener and implementation partner.”

The legal side

To overhaul a system as massive and complex as global health financing, experts are approaching it from many angles.

“That interdisciplinary approach is a natural fit for Georgetown,” says Beauchamp. “Health, law, diplomacy, public policy, ethics, and human rights are brought together in service of durable systems change.”

From a legal perspective, for example, Botswana has a new government that set up structures for delivering reforms in five strategic areas including health, and took the plans to parliament to pass a law that institutionalized the new structures, so that they will outlive any specific government. Other countries in the community of practice took note, says Bazira.

Siona Sharma (SFS’20, L’26) just co-authored a paper on the legality of the U.S. withdrawal from WHO and believes health is a human right that requires legal protection. Determined to serve others in the field of global health, she graduated from the School of Foreign Service’s Science, Technology, and International Affairs (STIA) program during the pandemic, and joined an organization working mostly with American agencies and foundations.

“Graduating into COVID, a lot of people were thinking about global health,” says Sharma. With an interest in East Africa, she moved to Ethiopia to gain an in-country perspective on receiving financial assistance, and importantly, she notes, to learn from local community leaders who know their needs best. “If I’m serving a community that is not my own, it feels important to by led by those who understand their own needs.”

While there she worked on the continental COVID response, seeing how countries like Rwanda and Morocco successfully addressed the pandemic with far fewer resources than places like the U.S. To learn more about the donor perspective, she moved to Geneva and worked for the Global Fund.

“I began to understand what donors ask for and what that machinery looks like when they funnel money to people on the continent,” Sharma explains. She then entered Georgetown Law with the hope of helping individuals in marginalized communities, and in a broader sense, to help reform systems and structures at institutions to support public health as a fundamental human right.

She chose to return to Georgetown for its expertise in global health law, and spent her first summer interning in Malawi helping people living with HIV. The experience was profound.

“The women I worked with were sex workers, who are legally protected in Malawi, but they were often arbitrarily arrested and harassed by police, who would expose their health status—for example, by requiring them to take their daily antiretroviral medications in front of others. One of the best ways to protect vulnerable groups is to aid them in legal empowerment and organizing. The lead women of such organizations, created to protect sex workers, had been trained by local lawyers to serve as paralegals, advising other workers about their rights while facing the police. It was motivating.”

And then she connected the dots.

“I realized that one of the groups received funding from the human rights division of the Global Fund where I had been working. They are doing work over the years to not only help people win their lawsuits, but also to ensure that people are legally empowered and able to address their health needs. When the legal system was attempting to limit people’s rights, we reached out to the Global Fund to conduct high- level advocacy on behalf of the vulnerable populations we were working with in Malawi.

“I carry that seminal experience with me now. People are going to need lawyers and medical professionals to help them regardless of how the global health structure changes. People are benefiting from our advocacy, and I hope to keep being part of that effort.”

Entering the field today

With so much upheaval in the global health field, Dybul believes it’s a good time for the next generation of leaders to introduce new solutions.

“When things are changing in a dramatic way, young people have a chance to contribute and to direct, to be involved in the change, to think of the ideas for how that will change. And the access to technology and connectivity with people accelerates that ability.”

For Anya Hirschfeld (G’25), earning her master’s in Health and the Public Interest opened the door to her current role in global health for the Council on Foreign Relations, where she did her capstone project. After graduating and before her new position started, she reached out to her mentor John Monahan, senior advisor to Georgetown’s Global Health Institute, who connected her with Georgetown Global Health Nigeria, a program supported by CGHPI.

“I wanted to do something that would supplement my policy engagements from Washington, to keep adding that central ingredient of what’s really happening on the ground,” Hirschfeld notes.

Within two weeks, she was on her way to Abuja for an experience that would change her approach to her work. There for a month, she traveled to a clinic in the northern state of Kano to observe mothers of children experiencing severe and acute malnutrition.

“In the global health policy world, you look at malnutrition rates and trends. But being there and seeing mothers on cots with their babies, and seeing all of these intersecting issues—all of these cultural foundations and religious, gender, economic implications that brought them to this state of complete and total emergency—was really shocking to me.”

As she saw mothers and children being readmitted, she began thinking about how they could be supported in a more holistic way. How is their home life and how are they able to care for their families?

“There’s a very high birth rate and they come back with other children who are also on the brink of death.”

She started a project proposal to interview and screen mothers “for anxiety and depression, and check in on their relationships at home with their husbands. And while they’re admitted for that, on average for a week, see what kinds of interventions might be possible to support them.

The in-person encounter was life-changing for her. Despite all the changes in global health financing, structures, and policies, as someone relatively new to the field, she is hopeful and inspired by the many people she’s already met, particularly those in the countries who are working to achieve full health sovereignty.

“I have a lot to learn and a lot to experience. But I’ve met amazing people who are working on the ground in global health, locals working on the implementing partner side. They have expertise about what worked and didn’t work with older systems. If they are properly incorporated into the new system, it will have a huge value add.”

With the growing population of young people in low and middle-income countries, Dybul sees their innovation as key going forward.

“There’s no reason for there to be any poverty, for people not to have health care anywhere in the world,” says Dybul. ”Now is the time to be bold, to come forward with big ideas. It’s a huge opportunity for young people to have a disproportionate impact that is rare in history.”

Along with developing innovative solutions, Bazira underscores the importance of putting the ideas into practice and how Georgetown can help, by collecting and disseminating important lessons and models for how to make it happen.

“For most countries, it’s not a lack of good ideas, it’s how you translate those ideas into action. The execution, the implementation piece is where the community of practice and Georgetown’s technical role is going to be prominent, translating good plans and policies into action.”