Developing and Validating a Global Governance Framework for Health: A Delphi Consensus Study

Area of Science:

• Global Health Governance
• International Health Law
• Public Health Policy

Background:

• COVID-19 pandemic highlighted weaknesses in global health governance, including fragmented authority and inequitable resource distribution.
• The WHO Pandemic Agreement (2025) aims to address these gaps but faces operational and institutional challenges.
• Existing frameworks require strengthening in leadership, financing, equity, and legal accountability.

Purpose of the Study:

• To develop and empirically validate a Global Governance for Health (GGFH) Framework.
• To strengthen global, regional, and national health governance structures.
• To enhance pandemic preparedness and response mechanisms.

Main Methods:

• A three-round Delphi study involving 31 experts from diverse sectors.
• Evaluation of 32 structured governance statements across seven domains using a 7-point Likert scale.
• Consensus determination (median ≥ 6; SD ≤ 1.35; ≥75% agreement) and thematic analysis of comments.
• Mapping statements to WHO Pandemic Agreement articles to identify gaps.

Main Results:

• Consensus achieved across all seven governance domains by Round 3.
• Strong agreement on enhancing WHO leadership, sustainable/equitable financing, LMIC representation, legal preparedness, and accountability tools.
• Governance goals identified as an integrated system, with financing, equity, and legal frameworks as key enablers for treaty implementation.

Conclusions:

• The Delphi process validated a comprehensive and operational Global Governance for Health (GGFH) Framework.
• The GGFH complements the WHO Pandemic Agreement by addressing limitations in governance, financing, and equity.
• The framework provides a roadmap for global pandemic preparedness and treaty implementation.