In a context where funding is stagnating while needs are exploding, collaboration among the Global Fund, Gavi, and the Global Financing Facility (GFF) is no longer a slogan - it’s a condition for the aid system’s effectiveness. Gavi’s 2026–2030 replenishment secured a little over $9 billion, significantly below the $11.9 billion target - a budget reality that demands choices, discipline, and… credible synergies among institutions.

Why collaborate “more and better” now: structural and cyclical drivers

At the macro level, three forces are converging: (i) resources under pressure (donor fatigue, competing priorities, rising unit costs); (ii) risks of fragmentation at country level (multiple funding windows, parallel accountability demands, unaligned timelines); and (iii) a heightened demand for measurable impact from governing bodies and stakeholders, especially civil society.

On the “architecture” side, the GF/B51/21 document marks a shift from broad ambition to implementation organized around four workstreams: malaria, health systems strengthening (HSS), country engagement, and enabling functions. The Joint Committee Working Group has given way to a Taskforce co-chaired at CEO level, reporting directly to governing bodies - evidence of tighter strategic and operational integration.

In parallel, Gavi 6.0 (2026–2030) - approved by the Board in 2024 - bills itself as the Alliance’s “most ambitious” strategy to protect more people, against more diseases, faster, which requires a finer articulation with Global Fund financing and the GFF’s country instruments.

For its part, the GFF reiterates its country-driven model and alignment of partners behind integrated government priorities - a fertile ground for avoiding duplication across vertical programs and shoring up the sustainability of investments.

In short: financial constraints, an equity imperative, and an obligation to deliver results all argue for moving from a juxtaposition of programs to a disciplined joint portfolio governed by shared objectives, timelines, and metrics.

Concrete opportunities (and real tensions) in implementation

a) Malaria: a testbed for integration

Malaria is a case in point. Gavi and the Global Fund have aligned their guidance notes and recommend funding requests anchored in national strategies (for malaria and immunization), combining in-country the vaccines (RTS,S / R21) and other interventions according to context. Synchronized technical calendars are being tested to maximize leverage and avoid “gaps” between cycles.

On the budget side, Gavi’s exceptional co-financing approach for malaria vaccines (RTS,S and R21) clarifies country-level predictability and reduces friction between funders.

Tensions: balancing efficiency vs. equity (rapidly targeting where marginal returns are high vs. reaching remote areas and marginalized groups) remains tricky, and community organizations warn about crowding-out effects as budgets tighten.

b) HSS: coordinated investments with evidence behind them

Joint investments are advancing on supply chains, information systems (DHIS2), and workforce development. In “pathfinder” countries (Malawi, Mozambique, Chad, Ethiopia, Guinea), joint program management units, streamlined governance platforms, and harmonized grant cycles are being tested - “living laboratories” to inform scale-up.

Tensions: interoperability (data, processes, procurement), transaction costs (missions, reporting), and respect for government leadership. Without guardrails, there’s a risk of recreating parallel verticals within health systems themselves.

c) Enabling functions: mutualize to multiply

At the Global Health Campus, partners are exploring shared services (IT, procurement, translation, offshore back office) to capture recurring efficiency gains. These “back-office” advances can free up resources for last-mile delivery if - and only if - savings are reallocated to programmatic impact and equity tracking.

d) Governance and civil society: accountability as a compass

The current window demands robust accountability: shared indicators, regular public reporting, and independent evaluations, with meaningful participation of civil society and communities in decision-making. A Taskforce at the right hierarchical level will matter only if it institutionalizes a unified monitoring and evaluation framework and feedback loops that trigger course corrections.

On-the-ground warning: budget cuts of around ~30% are hitting community networks in multiple regions; closures of access points for key populations (e.g., Uganda) and reduced funding for community-led malaria interventions (e.g., Tanzania) are widening inequities. Hence the imperative to embed equity and community voice at the core of allocation and monitoring mechanisms.

Table 2. Collaboration workstreams & examples

Conditions for success: scaling without losing the mission

1) Align cycles and funding windows to country priorities. Generalize joint roadmaps and align GC8/Gavi 6.0 for malaria, building on fully costed national plans; secure the “right mix” of interventions (prevention / vaccines / case management) without an “tool-first” bias.

2) Harmonize co-financing requirements. Clarify and bring rules closer together (especially for new vaccines and HSS inputs) to avoid contradictory incentives for ministries of finance.

3) Mutualize where gains are clear, protect where social risk is high. Expand shared services (IT, procurement, translation) and institute a mechanism to reallocate savings to equity priorities (key populations, remote rural areas).

4) Unify accountability. Adopt a common indicator framework (coverage, health outcomes, efficiency), with quarterly country-level publication, disaggregated data (gender, poverty, geography), and joint independent evaluations. Recommendations must lead to action (time-bound plan, owners).

5) Institutionalize community voice. Make user/community representation mandatory on country steering committees, with dedicated budgets for capacity building and participation costs (travel, childcare, interpretation).

6) Document and learn fast. In pathfinder countries, formalize learning protocols (what works/fails, why) and replication mechanisms. The “living labs” (joint management units, streamlined governance, harmonized cycles) must produce ready-to-use specs for other contexts.

7) Clarify comparative advantage. Use GF/B51/21 to map who does what (e.g., Gavi: vaccine financing and immunization functions; Global Fund: malaria, HIV, TB, cross-cutting systems; GFF: country anchoring and catalysis via IDA/World Bank), then close the gray zones that create double funding and coordination costs.

8) Talk “total cost” and “value for money.” The relative resource shortfall (cf. ~$2.5B gap for Gavi) requires explicit trade-offs: prioritize interventions with strong cost-effectiveness and high equity potential (zero-dose catch-up, greener cold chains, digitized immunization data, integrated community-based delivery).

9) Synchronize technical doctrine. For malaria, maintain joint Gavi/Global Fund guidance, anchored in WHO recommendations and national strategic plans, to streamline applications and reduce friction in technical review.

10) Set public deadlines. The Taskforce should publish an integration timeline (milestones by workstream, country, and quarter), with named owners and an annual board review.

Conclusion: proof through results

The window of opportunity is narrow: less money, higher expectations, and health systems that must become more resilient to shocks (climate, epidemics, conflict). The three institutions have unlocked real advances - collaboration workstreams, malaria use cases, coordinated HSS investments, shared services - but the challenge is no longer to announce “pilots.” It is to deliver on the promise at country level, with verifiable, equitable results.

As stakeholders remind us, country ownership is non-negotiable, the voice of civil society must be protected, and transparency must guide every decision. Only under these conditions will the Gavi–GFF–Global Fund collaboration move from rhetoric to results - for people who do not have the luxury of waiting.