International before regional before national before local

Statement

We use internationally agreed solutions first, then regional, then national, then local ones. Each country remains sovereign over its own health system.

Rationale

Reusing solutions at the highest suitable level gives economies of scale, uniformity and cross-border compatibility. Under subsidiarity, decisions are still taken as close to the country as possible, and regional components are adopted by agreement.

Implications

• We inventory available international and regional components (e.g. from WHO, PAHO and PH4H) and assess their fit first.
• Regional components are agreed through regional governance and are not imposed.
• National systems connect through agreed interfaces and are not replaced.
• Where possible, we select and procure solutions jointly with other countries.

References: Sigra 2025; EC 2017; Ramirez et al. 2026; Nictiz & The Open Group 2023; Zorgring 2025.