Accra Reset, One Year On: Global South Leaders Move from Declarations to Delivery

At a packed UNGA side event in New York, Ghana’s President John Dramani Mahama launched “A Sovereign Future for Health,” a report with 10 recommendations, as leaders from Africa, Latin America, the Caribbean and Europe debated what an equitable global partnership should look like.

Watch the recorded event:

A year after the Accra Reset was launched on the sidelines of the UN General Assembly, the initiative returned to New York with a larger coalition and a more concrete agenda. Organizers had expected about 350 people. More than 600 came, and President Mahama said the turnout showed the idea was “catching fire.”

The evening was moderated by journalist Zeinab Badawi. It brought together sitting and former heads of state, the leaders of the world’s major global health institutions, ministers from France and the United Kingdom, and some of Africa’s most prominent business figures. The message running through the speeches was clear. The Global South is no longer asking for a better aid system. It wants the authority, capability and financing to direct its own development, and it is inviting the Global North into a different kind of partnership.

“No ownership without control”

The Accra Reset was launched in September 2025 in response to a shrinking and fragmenting aid landscape. It identified three linked burdens on the Global South. The first is geostrategic marginalization, where others write the rules. The second is geopolitical vulnerability, where decisions made far away can undo national plans overnight. The third is donor dependence.

In his keynote, President Mahama argued that decades of development rhetoric had given countries ownership in name only. He pointed to the 2005 Paris Declaration, which made country ownership a guiding principle. “We were handed a broken cauldron where we were asked to own a soup that was cooked entirely in someone else’s kitchen,” he said.

He was equally direct with his peers. Moving power from Geneva or Washington to an unaccountable ministry in Accra or Abuja, he said, would not create sovereignty on its own. “No ownership without control. Yes. But no control without absolute accountability to our people. This is the bedrock of our new global bargain.”

Mahama tied the global agenda to his government’s “Resetting Ghana” program, which covers fiscal discipline, anti-corruption efforts, local pharmaceutical manufacturing backed by guaranteed state purchasing, and the 24-hour economy initiative. “A national reset without a global reset leaves us building on shifting sands,” he said. “Likewise, a global reset without domestic discipline is unfeasible.”

A report written for the citizen, not the diplomat

The centerpiece of the evening was the launch of A Sovereign Future for Health. The report was produced by the Accra Reset’s High-Level Panel on the reform of global health architecture and governance, co-chaired by Peter Piot, Elhadj As Sy, Priscila Ferraz Soares and Indonesia’s Health Minister Budi Gunadi Sadikin, with Michel Sidibé as special adviser. It sets out 10 practical recommendations.

Minister Sadikin linked the report to the 1955 Bandung Conference, held in the Indonesian city where he studied. The conference affirmed the political sovereignty of newly independent Asian and African nations. “More than seventy years later,” he said, “the same spirit is being carried forward from political sovereignty to health sovereignty.”

The report’s core argument is about sovereignty in decision-making, health financing, local manufacturing and health data. It proposes moving from disease-specific silos toward people-centered systems, and from donor-led programs toward a single country-led national health plan. External support should “complement national priorities, not direct them.” Regional and global bodies still have a role in areas such as pooled procurement, regulatory approval, research and cross-border disease surveillance, but with a clear mandate from countries.

Sadikin said the panel had been told to write with ordinary people in mind: a mother in Tamale or Tambacounda “may never read this report, but she should be able to feel its impact.”

Mahama said Ghana and the Accra Reset’s Presidential Council will now convene governments, global health bodies, development finance institutions, philanthropies and the private sector to turn the recommendations into country-level compacts. He also said Ghana would carry the agenda into the African Union when it assumes the AU chair in 2027.

A year of building

Speakers and a highlights video described what the initiative has done in its first twelve months:

• The Sankoré Institute of Global Negotiators opened in Kigali to train and credential sovereign negotiators, in partnership with the African School of Governance and the G7’s CONNEX initiative.
• An extraordinary AU summit on health was held in Accra, where a new vision and roadmap for maternal and child health was unveiled.
• The AU adopted a roadmap to 2030 in July.
• Master Key, a digital skills mobility platform, was designed under President William Ruto’s leadership.
• A framework for maximizing Africa’s G20 seat was adopted at the 2025 G20.

UN Deputy Secretary-General Amina J. Mohammed spoke on behalf of Secretary-General António Guterres. She said the conversation had begun with health but “very quickly became a much bigger conversation about sovereignty,” meaning the room countries have to make their own choices. She placed the Reset in a longer line of commitments, including the Paris Declaration, the Lusaka Agenda and the Sevilla financing conference. She stressed that lasting change depends on money: “Public finance has to remain at the center, but public finance has to grow.”

The Accra Reset’s guardians opened the evening. Former Nigerian President Olusegun Obasanjo used a Yoruba image to describe the moment: “If the drum beating is changing, the dancing steps must also change.” Former Costa Rican President Laura Chinchilla, speaking for the Club de Madrid, said she envied Africa’s ability to organize collectively. She argued that the old framework of “donors and recipients” no longer fits a Global South that offers capital, innovation, young populations and critical minerals.

Financing that matches the life of the asset

Barbados Prime Minister Mia Mottley gave one of the evening’s most substantive interventions. She described how conversations that started at last year’s launch led to the Vulnerability to Viability Compact. The compact was signed in Vienna in June with multilateral development banks and the OPEC Fund. It commits to longer-term, affordable financing for the V20 group of climate-vulnerable countries, which now numbers 77.

Her central point was about maturity mismatch. “No school is gonna last only ten years. No water main is gonna last fifteen years. No clinic is only going to last fifteen years.” Short-term, high-interest borrowing, she said, forces governments into impossible trade-offs. She compared it to having six children, helping two, telling two to watch, and telling the other two they have no chance.

Mottley said Barbados expects to complete a debt-for-health swap by year-end. Under the deal, the World Bank, Inter-American Development Bank, Caribbean Development Bank and CAF will work together to repurchase $600 million of Barbadian debt and free up $150 million in savings for health care. She also asked a pointed question: if countries must reform to engage with the world, “how do international financial institutions not reform themselves to do the same thing?”

WHO Director-General Dr. Tedros Adhanom Ghebreyesus made a similar case for financial self-reliance. He said Africa loses about $80 billion a year to illicit financial flows and pays around $90 billion in debt service, while receiving roughly $60 billion in aid. “Do the math,” he said. He confirmed WHO’s full support for the initiative. He also said the report’s recommendations would feed into the member-state-led global health architecture reform process that the World Health Assembly established in May, where Africa CDC holds a seat.

Global health institutions: support, with caveats

Leaders of the major global health funds welcomed the report and described changes already underway. They also offered cautions that show where the debate is still open.

Peter Sands, Executive Director of the Global Fund, described new explicit transition timetables, collaborative procurement and stronger co-financing requirements. He warned that faster progress toward health sovereignty “should not be equated to a retreat from global solidarity. This is a new form of partnership. It’s not an exit ramp for donors.” He noted that countries affected by conflict and instability face a much longer path.

Dr. Sania Nishtar, CEO of Gavi, said the report validates Gavi’s own reform agenda, which includes devolved decision-making, simpler processes and investment in the African Vaccine Manufacturing Accelerator. She urged the panel to go further in its next phase. She asked it to identify clearly which functions must remain global, address resource leakage in health systems, fill capability gaps such as AI-enabled bioterrorism, and confront “the elephant in the room, which is reform of the World Health Organization.”

Priya Basu, Executive Head of the Pandemic Fund, said every dollar the Fund has awarded in Africa has unlocked more than three times as much in domestic financing.

The North responds

Former UK Prime Minister Gordon Brown has championed the initiative from the start. He said the Global South “is leading the Global North.” He presented polling of 100,000 people across 34 countries. By 57% to 17%, respondents said they would accept some compromise of national interest in exchange for effective international cooperation. He announced a declaration signed by 100 former leaders calling for new principles of cooperation. He argued that the UN Charter must be updated to address climate change, AI, global public goods, gender equality, and equal partnership between North and South.

Speaking on behalf of President Emmanuel Macron, French Minister Eléonore Caroit said France endorses the Accra Reset. She cited the 73% fall in AIDS-related deaths as proof that global health investment works when decisions are made at the right level. She noted that her title is “partnerships minister,” not development minister, and said: “Now is the time to pivot from a legacy of aid to an era of partnership.”

Ed Miliband, the United Kingdom’s Secretary of State for Foreign and Commonwealth Affairs, said Britain is moving “from donor to investor.” He pledged support for multilateral development bank reform, smarter use of guarantees, and action on debt and illicit finance. He added that the UK comes to the conversation “not with a finished answer, but with a clear commitment to listen.”

OECD Deputy Secretary-General František Ružička focused on domestic resource mobilization. He said the joint OECD–UN Tax Inspectors Without Borders program has generated $2.72 billion in additional tax revenue so far, with a further $7.67 billion assessed. He estimated that illicit flows in commodity trade, especially in the extractive industries, cost the continent $30 billion to $52 billion a year. He also pointed to the African Virtual Investment Platform, now running with 12 countries in cooperation with the African Union, which aims to strengthen investor confidence in African economies. He noted that at the last AU summit, he heard the phrase “development assistance” zero times and “partnership” hundreds of times. He closed with a proverb: “When the spiders unite, they can tie up the lion.”

Former Colombian President Juan Manuel Santos, who chairs The Elders, warned of the drift toward a “might is right” world order. He called for a much stronger partnership between Latin America and Africa.

Egyptian Prime Minister Mostafa Madbouly, speaking for President Abdel Fattah El-Sisi, supported a common Global South negotiating framework on health. He stressed that the Reset should complement the African Union and regional economic communities rather than duplicate them.

Mothers, babies and talent

Maternal and child health has been chosen as the first real test of the new approach. Mahama noted that nearly seven in ten maternal deaths worldwide occur in sub-Saharan Africa, and that Ghana remains three times above the SDG target for maternal mortality.

Tanzanian Foreign Minister Mahmoud Thabit Kombo delivered remarks on behalf of President Samia Suluhu Hassan, the AU champion for maternal and child health, who was unable to attend following the death of her husband. “We do not face a crisis of knowledge,” her message said. “We face a crisis of delivery.” She announced plans for a global action plan under African leadership. The plan will work alongside the Mother Africa initiative and BUMBY (Business United for Mothers, Babies and Youth), the Reset’s private-sector arm for maternal and child health.

President Ruto announced that Master Key is moving from design to delivery, with Kenya leading the first national implementation. The platform will let people hold and share verified records of their skills, qualifications and work experience across borders. Citizens will control what they share, and countries will keep sovereignty over their data. It will not award jobs or visas. Ruto set a practical benchmark for next year: “Was a trusted record issued in one African country recognized and used in another?”

The private sector’s turn

A closing panel turned to trade and investment.

AfCFTA Secretary-General Wamkele Mene said 50 countries are now implementing the agreement. Intra-African trade reached $220 billion in 2024, with a growing share in manufactured goods. He argued that official figures undercount informal cross-border trade. Visa restrictions, however, remain a major obstacle: more than 90% of Africans need a visa to visit another African country.

Aliko Dangote took up that point. “Nobody will come and develop our continent but us,” he said. He asked why Europeans often travel more easily within Africa than Africans do. He said the Dangote Group plans to invest about $46 billion across Africa between now and 2030.

IFC Managing Director Makhtar Diop gave a concrete example of blended finance: a logistics corridor linking Ghana’s rail and river network to Burkina Faso. Mahama later announced that the IFC had committed $200 million to open the corridor to the Sahelian states. Diop also described IFC’s work to channel long-term, local-currency capital from African pension funds and institutional investors into infrastructure.

Equity Group CEO James Mwangi said his bank directs 30% of its lending to agriculture. He called private capital “the only way to scale and sustain the transformation.”

What comes next

In brief closing remarks, Mahama described the Accra Reset as “like a river that is flowing,” open to any partner working on health reform who wants to join. He reaffirmed Ghana’s goal that anyone holding an African passport should be able to travel anywhere on the continent.

Former Liberian President Ellen Johnson Sirleaf gave the final word as a guardian of the initiative. She reflected on how far the idea has come since it was first discussed in Accra little more than a year ago. “Sovereignty is the number one issue,” she said, alongside self-reliance, African leadership, and partnership. She pointed to two efforts that together represent Africa’s message to the world. The first is the Accra Reset, which is about Africa planning and taking charge of its own future. The second is the African Renaissance initiative, which she said recognizes that the work can only succeed through “a global partnership in which we are equals. We all take responsibility and we all benefit.”

The test ahead is the one speakers kept returning to: whether the report’s 10 recommendations become country compacts, whether new financing terms reach clinics and classrooms, and whether a mother giving birth tonight is any safer for it. As Mahama put it: “We’ve come full circle, but let us not go around in circles.”