The last two decades have witnessed unprecedented progress in global health: tens of millions of lives saved, mortality rates slashed, and life expectancy extended even in the poorest nations. However, the landscape is shifting. Donor budgets are shrinking, recipient countries demand greater autonomy, and communities seek more control over their health outcomes. The existing model, while successful, is no longer sustainable.
To maintain momentum, global health must undergo a fundamental transformation: becoming more efficient, more responsive to national priorities, and more integrated and innovative. The Global Fund, a pivotal force in this progress, must lead the charge.
Maximizing Impact: Squeezing Every Dollar
The first priority is ensuring maximum value from every dollar invested. This means accelerating access to life-saving innovations, exemplified by the rapid rollout of lenacapavir, a highly effective HIV prevention tool, in both low- and middle-income countries simultaneously. Similarly, next-generation mosquito nets, 45% more effective for a marginal cost increase, and AI-enabled digital X-rays for advanced TB screening are being deployed rapidly.
Time is critical. Delays cost lives. Scale equals impact. Bureaucratic pilot programs and slow rollouts are unacceptable. But innovation alone is insufficient. Affordability, weak health systems, stigma, and discrimination remain formidable barriers. Reaching those most at risk is not merely an ethical imperative; it’s an epidemiological and economic necessity.
Maximizing impact also requires breaking down silos between disease programs and integrating health services. A holistic approach that addresses infectious diseases alongside non-communicable conditions and mental health delivers better outcomes and cost savings. Continuous efficiency improvements are essential. The Global Fund, already operating with 6% overhead, is leveraging technology, including AI, to reduce costs by another 20% while streamlining processes.
Accelerating Self-Reliance: A Phased Transition
With donor funding under pressure, countries must accelerate their path to self-reliance. This is not an abrupt switch but a phased transition. Too hasty a withdrawal will derail progress and cost lives. The Global Fund will partner with countries to develop tailored transition plans, incentivizing self-sufficiency while ensuring continuity.
For some nations, this means a three-year grant cycle as their last. Others may require two cycles. For all but the most fragile states, robust transition plans are essential. Support includes strengthening public financial management, unlocking new funding sources, and facilitating debt-for-health swaps.
Countries can sustain access to affordable medicines by leveraging the Global Fund’s pooled procurement mechanism. By offering pre-financing and collaborating with regional platforms, nations gain greater control over costs. Even in conflict-ridden or economically distressed states, building sustainable systems remains paramount.
Transforming the Global Health Ecosystem
The Global Fund was born from disruption: a recognition that the status quo was too slow and bureaucratic. That same restless energy is needed now. The current global health architecture is fragmented, duplicative, and inefficient. Rationalization is essential. Merging or closing redundant agencies, clarifying roles, and streamlining collaboration are non-negotiable.
The Global Fund, as the largest multilateral funder, must leverage its strengths: market-shaping capabilities, global procurement, and community systems strengthening. However, its evolution must align with a broader vision, encompassing the WHO, Gavi, UNAIDS, product development partnerships, and development banks.
Bilateral approaches will only exacerbate complexity. Strengthening the multilateral system is the only viable path. Tough choices are inevitable. Resource constraints demand rigorous prioritization. The transformation must be driven by national leadership and regional bodies, not dictated from Geneva or New York.
The choice is stark: adapt or erode. The progress of the past two decades proves what is possible when the world acts together. But the existing model is no longer sustainable. The next 20 years will test whether we can reinvent the system with the same boldness that created it. The future of global health depends on it
