What would the global health funding ecosystem look like if solidarity were not just a value — but a practice embedded in decision-making, governance, and accountability?
This question anchored two intensive days of conversation in Johannesburg, convened by EthicsLab at the University of Cape Town as part of the Global Health Solidarity Project.
The gathering brought together a diverse group of researchers, policymakers, funders, practitioners, and civil society leaders, united by a shared recognition: despite its growing prominence in discourse, solidarity has rarely been built into the structures that actually determine how global health operates. Not into funding flows. Not into governance arrangements. Not into the accountability systems that shape who holds power — and who does not.
From the outset, participants chose candour over comfort. The conversation did not begin with aspirations; it began with an honest appraisal of where the field currently stands. As Prof. Caesar Atuire, Principal Investigator of the Global Health Solidarity Project, framed it at the opening:
"We've been talking about solidarity for years. What feels different now is that we are asking what it would take to make it real."
That shift from solidarity as rhetoric to solidarity as requirement set the tone for everything that followed. Participants worked from a unifying premise: global health does not function as a collection of separate institutions, each managing their own commitments in isolation. It functions as an interconnected ecosystem. If solidarity is to have genuine meaning, it must shape how that ecosystem is designed and governed as a whole. The workshop's task, then, was to develop a shared framework that is grounded in practice, analytically robust, and open to challenge.
The most generative moments came when participants spoke from experience rather than principle. Funders were candid about the structural barriers that undermine their own solidaristic aspirations. One funder reflected on the persistent challenge of reach and representation:
"It's been a bit of a struggle because sometimes when you have responses to a call, we notice that it's from the same people and countries. We have examined the way we structure calls and still recognise things haven't changed. Then, we developed a model where one organisation leads as a hub — this helps with leadership around the shared financial systems and administration." — Salome Wawire, Science for Africa Foundation
These kinds of reflections kept the conversation from drifting into abstraction. What many participants suggested is missing in the field is not goodwill, but clarity: clarity about what solidarity actually requires, from which actors, under what conditions, and with what consequences when those obligations go unmet. As one participant put it,
"There is clear appetite across the field for this conversation. What is missing is not commitment in principle, but clarity on what solidarity demands in practice."
A significant portion of the workshop was devoted to examining twelve draft propositions developed through a synthesis of project data, qualitative interviews, and regional consultations. These propositions distilled emerging themes about what solidarity is — and what it should demand or achieve — within global health. Crucially, no single proposition was sufficient on its own. Only when considered together did they begin to form a coherent picture of what an ecosystem oriented around solidarity might look like.
The exercise was as much about tension as it was about consensus. Participants tested where the propositions cohered and where they contradicted one another. The deeper question throughout the discussions was: how do you translate these propositions into a language that changes the game? The ambition was to ask what it would mean to design funding mechanisms, governance structures, partnerships, and institutional cultures in ways that make solidarity an organisational obligation.
At the same time, there was recognition throughout that technical fixes alone will not be enough. Several participants described the effort as a structural intervention as much as a policy exercise — a contribution to a broader cultural shift in how global health understands collective responsibility. In a field still grappling with deep structural inequalities and the legacies of colonialism, institutionalising solidarity requires more than procedural adjustment. It requires rethinking norms, incentives, and power relations. It requires patience with process.
As Peter Kiroy of the Wellcome Trust observed:
"Solidarity in global health is a process. Rather than waiting for perfection, we are working on the process."
Prof Ntobeko Ntusi, South African Medical Research Council added:
“Funding is not just a technical exercise but a reflection of values.”
The later sessions shifted toward practical pathways forward. Conversations explored the development of institutional self-assessment tools, governance frameworks that embed solidaristic commitments, and accountability mechanisms capable of making solidarity visible without reducing it to a simplistic checklist. The intention is not to instrumentalise solidarity, but to give it institutional traction.
What Comes Next
The propositions refined in Johannesburg will now move into a broader phase of consultation. Regional feedback webinars and stakeholder engagements across geographies and sectors will further test and strengthen the framework. The emerging document is not intended as a final word. It is explicitly an invitation: to debate, to refine, and to co-create. The process itself reflects the principle at stake: solidarity cannot be imposed; it must be collectively shaped.
In the months ahead, the conversation will continue — across regions, institutions, and sectors. Look out for upcoming feedback webinars in your region and join us in shaping this work.
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