Supervisory team
Nagasaki University
- Lead supervisor: Ryuichi Komatsu ([email protected])
- Supervisor: Miho Sato ([email protected])
LSHTM
- James Hargreaves ([email protected])
Project
Since January 2025, major donors have started to radically reduce their official development assistance for health, risking lives. 1 This situation has generated significant debates around reforming global health governance and architecture as well as health finance.2-5
The research project focuses on how global health governance and architecture shift in the first 2-3 years after the crisis, with a particular focus on whether and how these shifts affect the stated policy aims of global health institutions to strengthen health equity. This project will analyse and interpret the balance of equity and other principles and the drivers of change, and make predictions and recommendations for the future.
Research Questions
Question 1: Visions
By 2027, what visions for global health architecture reform have become dominant, and what new accountability frameworks are being proposed or adopted to underpin these shifts towards lower donor dependency and greater country ownership? What factors influence reform debate most and why? How is global health equity conceptualised and operationalised through the reform process?
Question 2: Structural Reform
What changes have happened to global health governance, architecture, and ecosystems and why? How have the roles and power balance of key actors, e.g, African Union and Africa CDCs, private sector, and civil society, changed and why? How have key global health organizations adjusted their organizations in response to the significant funding reductions in 2025? What are the likely effects of the changes on efforts to improve global health equity, and why?
Question 3: Effectiveness and equity
How have the reforms translated into effectiveness goals and, in particular, equity effects in global health? What have been the changes, and potential future changes, on country level programmes? What considerations have been influential for the reform and what measurements have been proposed to track effectiveness and equity?
Scope
The research will focus on the global health architecture and ecosystem as whole. Which exact organizations to be included in the study will be determined by mid-2027 depending on how the real changes are happening.
Proposed Methodology
Study Design: Mixed-methods
Qualitative analysis and data sources: Document analysis of reports, strategic plans, and policy papers of the selected organizations and beyond, from 2025-2027. consultations/interviews with key stakeholders and decision makers of the selected organizations: board members, program leads, government officials, and key civil society partners.
Quantitative analysis and data sources: Systematic analysis of available data published by WHO and other organizations, e.g., governments, recognizing outcome indicators are unlikely to reflect the changes in 2017. An online survey(s) to gather quantitative data from key stakeholders, such as ratings on various aspects of the reform following the agreed analytical framework.
References
1. For example, Cluver L, Makangila G, Hillis S, et al. Lancet 2025 May 10.
2. For example, Ooms G, Assefa Y, Charalambous S, et al. PLOS Glob Public Health 2025 May 14.
3. https://wellcome.org/insights/articles/global-health-shouldnt-rely-char…
4. Rasanathan, K., Cloete, K., Gitahi, G. et al. Nat Med 2025.
5. https://presidency.gov.gh/president-mahama-global-leaders-launch-the-ac…;
The role of LSHTM and NU in this collaborative project
Nagasaki University and Professor Komatsu, who coordinates global health governance courses and engages with the health diplomacy institutional network, will provide the overall guidance as the primary supervisor for this joint degree project and ensure to engage diverse stakeholders. Associate Professor Miho Sato will provide guidance on qualitative data collection/analysis.
LSHTM and Professor Hargreaves will ensure and provide overall guidance on evaluation methodology and equity measurement. Hargreaves is lead of a 5 year Wellcome Discovery Award – the Infectious Disease Equity Consortium – and the student would be invited to participate in and leverage the networks and partnerships within that group across a range of African settings.
At Nagasaki University and LSHTM, PhD students undertake a programme of transferable skills training, including in literature reviews, library and reference management software, project/PhD management, ethics etc. Students are members of the Doctoral College which run regular seminars on aspects of the PhD journey including upgrading, preparing his/her thesis and preparing for Viva.
Skills we expect a student to develop/acquire whilst pursuing this project
The student will learn substantive knowledge on political economy and policy analysis as well as global health governance processes and health systems. The student will be able to contribute to the global governance debates, while developing expert skills and knowledge about mixed-method evaluation methodology.
Particular prior educational requirements for a student undertaking this project
Practical experience in evaluation and broad exposure to public health programs in low- and middle- income country settings.