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.