South and Southeast Asia in Global Health Governance: A Regional Perspective

Executive Summary

Global health governance (GHG) is undergoing a significant transformation. Over the past three decades, the institutional architecture underpinning global health has shifted from a predominantly intergovernmental model (for example, the World Health Organization [WHO]) to a dense and multi-layered web of actors including multilateral development banks (MDBs), global public–private partnerships (GPPPs), philanthropic organisations, regional institutions, and informal multistakeholder platforms. This proliferation of actors has brought about certain benefits, such as a significant mobilisation of health financing and resources, an expansion in technical cooperation, and initiatives to combat infectious diseases. However, this has simultaneously led to the production of a fragmented ecosystem of overlapping mandates, complex institutional relationships, skewed power dynamics, and blurred lines of accountability. This ever-evolving interplay of actors marked by evident power asymmetries has critical implications for equity, as agenda-setting, financing capacity, and decision-making power remain concentrated among a relatively small group of states, donors, and private actors. In turn, this limits the influence of lower- and middle-income countries (LMICs) despite their demographic significance.

Contemporary geopolitical and economic churnings have exacerbated these challenges. The recent COVID-19 pandemic exposed both strengths of and fractures in the current governance structure. Similarly, declining development assistance for health (DAH), the withdrawal of the United States (US) from the WHO, rising debt burdens faced by LMICs, and the emergence of polyalignments have called into question the future of GHG. Given this context, South and Southeast Asia—regions that collectively host a third of the world’s population—have high stakes in and the potential to shape the landscape of GHG (World Bank Group [WBG], 2025). [1] Yet, despite the growing manufacturing, pharmaceutical, and technical capacities coupled with the expanding geopolitical influence of countries within the regions, South and Southeast Asia’s representation in GHG discourse remains constrained by uneven institutional capacity. This study looks at how the major institutions of GHG engage with countries of the region (including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka, Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, Timor-Leste, and Vietnam) and explores pathways to strengthen its collective representation in GHG.

World Health Organization

The WHO is the central normative authority in global health, with a constitutional mandate to direct and coordinate international health. Its comparative advantage remains in its institutional legitimacy, standard-setting function, technical capacity, and ability to set internationally binding policy. However, there are serious concerns regarding its financing structure, marked by a heavy reliance on voluntary funding, and constrained accountability and independence. In Asia, the WHO’s regional functions are divided primarily between the two regional offices (ROs): the Western Pacific Regional Office (WPRO) and the South-East Asia Regional Office (SEARO). This bifurcation, which follows historical and political groupings rather than shared conditions,, does not necessarily match with current contextual realities or epidemiological profiles. This fragmentation is compounded by the fact that the ROs receive some of the most modest funding within WHO (despite serving a demographically significant population). Preserving the roles that make WHO a unique body with considerable legitimacy requires reforming the financing structure to maintain autonomy while clarifying its relationship to the broadening ecosystem of actors and partners.

Multilateral Development Banks

MDBs have become pivotal players in global health and have come to actively shape global governance systems. Beyond financing infrastructure projects, the MDBs have expanded their role in health systems strengthening, pandemic preparedness, digital health, and universal health coverage (UHC). By providing loans and stipulating policy conditionalities, institutions like the World Bank (WB) increasingly influence domestic health systems and the policy contexts in which they operate. Players like the Asian Development Bank (ADB) and the Asian Infrastructure Investment Bank (AIIB) have emerged as regional alternatives; however, they encounter their own set of challenges. This group of banks has clearly expanded health financing across South and Southeast Asia, but important questions remain about growing debt burdens, fragmented and vertical financing that favours vertical programmes over holistic health systems development, private sector investment, and balancing macroeconomic objectives and public health priorities. Countries in the region, particularly those with limited resources and capacity, would likely be in a stronger position to negotiate effectively with the MDBs if they focus on coordinating more closely with one another.

Global Public–Private Partnerships

The GPPPs for health refer to institutions such as the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). These serve as financing mechanisms to provide countries with support for health-related goals such as vaccination, and disease prevention and control. Over the past decades, GPPPs have emerged as influential transnational organisations that shape global health priorities, financing structures, and development priorities. With an increase in DAH, many GPPPs are undergoing internal reform processes that promote greater domestic ownership, co-financing mechanisms, and stronger integration between vertical programmes and broader health system needs. Some common critiques of the GPPPs include the influence of donors over strategic priorities, the expansion of GPPPs in areas that have historically been WHO’s mandate to lead, and the blurring of institutional roles and boundaries. Simultaneously, some LMICs in South and Southeast Asia are transitioning from aid recipients to contributors. Other middle-income countries (MICs) continue to receive support from the GPPPs and contribute modestly. These issues underscore the need for better coordination and stronger country ownership.

Regional Governance Organisations

Against this backdrop, the importance of regional health governance is even more evident. Regional institutions are well placed to coordinate country responses to shared health challenges, elevate country needs by consolidating collective bargaining capacity with global actors, and amplify a regional voice within the fragmented global governance landscape.

The current picture of regional health governance shows a stark divergence between South and Southeast Asia. The institutional infrastructure of the Association of Southeast Asian Nations (ASEAN) is more established than that of many other regional bodies, particularly in surveillance systems, emergency coordination mechanisms, and health security arrangements. However, ASEAN’s consensusbased decision-making slows down processes, and much of the organisation’s work is highly dependent on external funding. The South Asian Association for Regional Cooperation (SAARC), on the other hand, has been constrained by a high-level political stalemate, despite technical operations on health retaining some momentum. The Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC), an alternative to SAARC, has approached health from technological and innovation frameworks, but efforts remain uneven, and capacity limited. Across both subregions, formal governmental channels do not neatly overlap with the WHO ROs, and regional governance is fragmented, underresourced, and limited by the region’s ability to articulate collective positions on shared challenges in a common forum. Strengthening institutional coordination, political commitment, and regional ownership will be essential to building more effective regional health governance.

Non-Regional Platforms

Apart from the formal global and regional structures, broader geopolitical fora like the Group of 20 (G20), Group of 77 (G77), and Brazil, Russia, India, China, and South Africa (BRICS) and BRICS+ (an expansion of BRICS) have also been emerging as sites of GHG. While these lack the normative and decision-making authority of the WHO and the financing capacity of the MDBs and the GPPPs, they play a key role in catalysing political consensus, agenda-setting, health diplomacy, and setting priorities for development financing. For South and Southeast Asia, they play an important role in strengthening South–South cooperation, shaping multilateral reforms, and platforming countries like India and Indonesia as global health stewards.

Overall, the analysis concludes that South and Southeast Asia face both long-term structural vulnerabilities and notable gains from the current GHG architecture. GPPPs, regional cooperation mechanisms, and the growth of MDBs have mobilised previously unheard-of health resources, bolstered targeted disease control initiatives, increased pandemic preparedness, and allowed emerging economies to participate more actively in GHG. At the same time, the architecture has grown more dispersed due to a strong reliance on donors and enduring power disparities that continue to influence finance priorities and agenda-setting. As a result, the region becomes a crucial level of collaboration.

The region nevertheless possesses significant opportunities through countries’ growing technical expertise, manufacturing capacity, and diplomatic influence. Stronger regional coordination could amplify the collective voice of South and Southeast Asia in global decision-making.

These opportunities also carry risks. Commercial and economic interests are expected to weigh more heavily on global health priorities if WHO and regional health governance institutions are not strengthened. That would further dilute public health goals and reinforce existing disparities. Stronger regionalism will be necessary to protect public health interests and effectively bridge the gap between national priorities and global governance at a time when bilateralism is increasingly replacing multilateral collaboration.

While the growing capabilities and ownership of countries across South and Southeast Asia provide an opportunity to strengthen regional cooperation and exercise greater collective influence, realising this potential will depend upon navigating an increasingly complex geopolitical landscape marked by declining development assistance, shifting donor priorities, rising nationalism, and the growing influence of development finance institutions and private actors.

Pathways Forward

The analysis points to several areas through which South and Southeast Asian countries could strengthen their collective role in global health governance. Academics, civil society organisations (CSOs), and policymakers could further explore these pathways to assess their feasibility in improving regional coordination, ownership, and engagement with global institutions.

• Reaffirm WHO’s normative and coordinating role while strengthening its institutional independence. This includes reducing reliance on earmarked voluntary contributions and clarifying the separation between norm-setting and financing functions.
• Strengthen the region’s collective negotiating capacity to engage strategically with MDBs and GPPPs, ensuring that external financing better reflects regional priorities and does not dilute WHO’s normative leadership.
• Build a regional bridge across South and Southeast Asia by strengthening coordination across existing institutions and exploring flexible, consensus-based mechanisms that can provide a coherent regional voice in GHG.
• Strengthen regional governance around functions that require collective action, including cross-border health threats, pooled resources, expertise and procurement, regulatory cooperation, research and development (R&D), capacity building, and collective bargaining with global institutions.
• Expand regional cooperation beyond governments by leveraging academic, civil society, and professional networks to strengthen knowledge generation, implementation, accountability, and dialogue on the geopolitical dimensions of health.
• Position regionalism as a necessary complement to multilateralism, enabling South and Southeast Asia to safeguard public health priorities amidst growing bilateralism while becoming active architects of a more equitable and representative GHG system.