From fragmentation to integration: regional health governance in southeast Asia

Southeast Asia's regional health governance has evolved into a dense but weakly integrated system of overlapping institutions. This Health Policy paper maps the regional health governance of the Association of Southeast Asian Nations (ASEAN) as an evolving health regime complex, tracing the historical origins of regional health governance to the early 20th century and examining developments from 1980 to 2024. The study also identifies two structural features: functional specialisation along with persistent fragmentation and structural asymmetry, in which external actors dominate technical and agenda-setting roles while ASEAN retains coordination authority. Although recent reforms under the ASEAN Post-2015 Health Development Agenda have improved institutional alignment, system-wide coherence remains poor. Strengthening regional health governance will require institutional rationalisation to reduce duplication and strengthen underdeveloped functions, alongside a rebalancing of external engagement to restore regional ownership of policy priorities. The analytical approach developed in this Health Policy paper offers a transferable framework for other regions facing institutional proliferation. Policy efforts should shift from expanding arrangements towards managing complexity through coordination, functional differentiation, and clearer authority structures.