Global health. The current scenario and future perspectives

30 At the end of World War II, in the first half of the 20th century, and with the creation of the United Nations as a first global post-war action, a period of great progress for humanity, science, technology, health and education began. It was a time of transformation in politics, with the nation-state moving to public-private collaboration, and in international relations, with sovereign states becoming states that are also member of a network of alliances. This period saw the development of a multilateral architecture, initially and primarily centered around the United Nations. The United Nations system later diversified into regions, countries and specific issues, managed by specialized agencies, funds and programs. It became a true constellation of organizations, generally with their own administrations and funds, though coordinated by the UN Secretary- General. The General Assembly and predominantly state-driven governance bodies, such as the Economic and Social Council and the Human Rights Council, included many of these organizations as observers. An era of increasing proposals for global agreements and cooperation was thus inaugurated, which in the field of health had begun with great enthusiasm at the first Conference on Primary Health Care in Alma-Ata, Kazakhstan in 1978 (WHO, 1978). This conference established the universal commitment to basic health for all, a commitment maintained till today. Governance of the World Health Organization (WHO) and the global health system Following the framework of intergovernmental governance of the UN system, the World Health Organization (WHO) as the specialized agency with a generic mandate for global health, focuses its governance on member state participation at the World Health Assembly (WHA), which meets once a year and where each state has one vote. The WHA elects the Executive Board of 34 technically qualified members for a three-year term. Its main function is to implement decisions and policies of the WHA, provide advice and facilitate its work. Additionally, each UN agency with a health mandate, such as UNICEF or UNFPA, is managed by a specific secretariat that receives policy guidance and budget approval from a governing council or board of that agency consisting of all or some of its member states. Ultimately, all these agencies are accountable to the UN General Assembly, composed of all UN member states. This governance structure ensures the participation and voice of member states in shaping global health policies and programs. It allows for decision-