Background <p>Reform of the global health architecture has emerged as a central policy priority, yet regionally grounded perspectives that translate critical analysis into actionable directions remain limited. This gap is particularly evident in the Middle East and Central Asia (MECA), a region characterized by diverse political and economic contexts, fragile and emergency-prone settings, and wide variation in health system capacity and governance. This study aimed to assess MECA stakeholders’ perspectives on the strengths and weaknesses of the current global health architecture, articulate a shared regional vision for future governance, and identify and prioritize reform directions relevant to the MECA context.</p> Methods <p>A mixed-methods, multi-phase deliberative policy dialogue approach was employed. Data were collected through semi-structured interviews with 47 key informants, an online survey of 248 stakeholders from 17 MECA countries, and a two-day regional dialogue involving 49 senior leaders from 14 countries. The exercise culminated in a structured prioritization completed by 34 participants. Qualitative data were analyzed thematically using a hybrid inductive–deductive approach, quantitative data were summarized descriptively, and findings were triangulated across phases.</p> Results <p>Findings were synthesized into five priority reform directions reflecting shared concerns around governance imbalances, fragmented financing, and limited regional agency. Aligning global health financing and technical support with nationally defined priorities emerged as the top priority, selected by over 90% of participants in the prioritization exercise. Strengthening regional leadership and enhancing regional collaboration mechanisms were each prioritized by approximately 70% of participants. Strengthening regional data and digital systems as shared public goods was prioritized by 69%, while reinforcing national leadership for integrated, primary health care (PHC)–centered systems was prioritized by 63%. Across reform areas, participants emphasized strengthening and connecting existing institutions rather than creating new structures and highlighted the importance of clear implementation frameworks, accountability mechanisms, and measurable progress indicators.</p> Conclusions <p>From a MECA perspective, effective global health reform requires a shift away from fragmented, externally driven models toward more regionally anchored, country-led, and integrated systems grounded in shared accountability. This includes rebalancing decision-making power, improving coherence across governance and financing mechanisms, and strengthening national and regional ownership of health priorities. These findings provide an empirically grounded regional perspective to inform ongoing global discussions on building more equitable, resilient, and responsive health systems.</p>