GFO Issue 463, Article Number: 1
ABSTRACT
In this new issue of GFO, we examine the widening gap between high-level global health commitments and the fragile realities confronting community-led responses on the ground. This issue highlights the consequences of funding delays, the marginalization of civil society in accelerated reprioritization processes, and the urgent need for inclusive governance, financial accountability, and health system leadership rooted in local contexts—particularly across Africa.
Dear subscribers,
There is a discordant undertone in this season’s global health discourse. While Brussels gathers the powerful to celebrate the promise of an immunized world, the communities on the frontlines of pandemics struggle to make themselves heard. Between spectacular fundraising drives, new financial instruments, and polished speeches about African vaccine manufacturing, the echoes from the periphery remain too often mere whispers. Yet it is precisely in the tension between diplomatic pageantry and the harshness of community realities that the credibility of global health governance is being tested.
Gavi’s recent summit, co-hosted with the European Union and the Gates Foundation, raised over $9 billion for its 2026–2030 strategy - a considerable achievement, albeit falling short of the $11.9 billion target . This shortfall, more symbolic than catastrophic, reminds us that resources are finite and trade-offs inevitable. More importantly, it underscores that health system resilience is not measured solely in billions raised, but in billions of invisible acts - often carried out in silence by community actors still relegated to the margins of decision-making.
This paradox is thrown into sharp relief by the Global Fund’s current “GC7 reprioritization” process. Triggered by delayed donor disbursements, the Fund is now compelled to revise country grants downward, deferring certain activities. While official guidance insists on safeguarding community-focused programs, the practical dynamics suggest a far more troubling risk: that the voices closest to epidemic realities will be sidelined. How can we speak of engagement when timelines, procedures, and reduced flexibility effectively exclude meaningful community participation?
This concern came to a head during the virtual civil society meeting on 20 May. The exchanges were marked by a mixture of worry and exasperation . Organizations decried the abrupt suspension of critical services for HIV, TB, and malaria - often without explanation or prior consultation. Behind acronyms and spreadsheets lie lives interrupted, medications missed, and support systems dismantled. The Global Fund has pledged to improve communication, but for many activists, words are no longer enough. What is needed is stability, transparency, and the full recognition of community actors as co-decision-makers.
This imperative was echoed in the powerful advocacy by African civil society around the newly approved Pandemic Agreement. These actors are not asking for a seat at the table - they are demanding co-ownership of pandemic preparedness, response, and financing. Trust, accountability, and the reach of health services are not built from Geneva or New York, but from the ground up. Communities are the connective tissue of health systems, especially when states falter or retreat. To exclude them is to undermine the entire edifice of global preparedness.
Africa is no longer content to be the execution ground for decisions made elsewhere. At the 78th World Health Assembly, African leaders declared their intention to build sustainable, self-financed health systems. The initiative led by Nigeria, in collaboration with the Global Fund, marks a notable inflection point: a transition from passive recipient to proactive architect. From Ethiopia’s experiences to Zimbabwe’s community health insurance schemes, and Dr. Donald Kaberuka’s calls for innovation - what emerges is a mosaic of ambition and agency that is no longer waiting for external validation.
But sovereignty demands more than rhetoric. It demands accountability. The Recoveries Report, submitted to the Global Fund’s 53rd Board meeting, serves as a sobering reminder. Far from a dry accounting exercise, it exposes the friction between fiduciary rigor and operational complexity. Recovering non-compliant expenditures in fragile contexts is not just a financial necessity - it can also mean the disruption of life-saving services. Hence the need for smarter, more context-sensitive risk management tools that balance transparency with operational flexibility.
In this complex environment, one issue may seem technical but is in fact deeply strategic: the Global Fund’s progress in securing privileges and immunities. These legal protections - highlighted in the P&I report presented in Geneva - enable the Fund to operate with fewer legal and administrative barriers. Far from bureaucratic formalities, they are essential shields for staff, assets, and programs in an increasingly unstable legal and political landscape.
What emerges from these developments is the portrait of a global health ecosystem at a crossroads. One that promises much but still struggles to align ambition with inclusion. One whose resilience cannot rest solely on the shoulders of major donors or global institutions but must be rooted in local agency, community intelligence, and sovereign leadership.
The task ahead is not merely to raise funds. It is to raise leverage - on inequality, on power dynamics, and on our collective imagination of a world where health is not a privilege to be negotiated, but a shared right to be realized.
And any thoughts about which aspect in the global health initiative sector you’d like to see covered in our newsletter are always welcome and we’d really appreciate suggestions on who can pen an article on it! Anyone who wishes to voluntarily contribute as a guest columnist and provide an incisive analysis or first-person account of what is happening at micro – or macro – levels in the field of global health interventions is also welcome. Any feedback and suggestions in French, Spanish, English can be sent to Ida Hakizinka ida.hakizinka@aidspan.org and/or christian.djoko@aidspan.org
If you like what you read, do spread the word around and ask others to subscribe!
Dear subscribers,
There is a discordant undertone in this season’s global health discourse. While Brussels gathers the powerful to celebrate the promise of an immunized world, the communities on the frontlines of pandemics struggle to make themselves heard. Between spectacular fundraising drives, new financial instruments, and polished speeches about African vaccine manufacturing, the echoes from the periphery remain too often mere whispers. Yet it is precisely in the tension between diplomatic pageantry and the harshness of community realities that the credibility of global health governance is being tested.
Gavi’s recent summit, co-hosted with the European Union and the Gates Foundation, raised over $9 billion for its 2026–2030 strategy - a considerable achievement, albeit falling short of the $11.9 billion target . This shortfall, more symbolic than catastrophic, reminds us that resources are finite and trade-offs inevitable. More importantly, it underscores that health system resilience is not measured solely in billions raised, but in billions of invisible acts - often carried out in silence by community actors still relegated to the margins of decision-making.
This paradox is thrown into sharp relief by the Global Fund’s current “GC7 reprioritization” process. Triggered by delayed donor disbursements, the Fund is now compelled to revise country grants downward, deferring certain activities. While official guidance insists on safeguarding community-focused programs, the practical dynamics suggest a far more troubling risk: that the voices closest to epidemic realities will be sidelined. How can we speak of engagement when timelines, procedures, and reduced flexibility effectively exclude meaningful community participation?
This concern came to a head during the virtual civil society meeting on 20 May. The exchanges were marked by a mixture of worry and exasperation . Organizations decried the abrupt suspension of critical services for HIV, TB, and malaria - often without explanation or prior consultation. Behind acronyms and spreadsheets lie lives interrupted, medications missed, and support systems dismantled. The Global Fund has pledged to improve communication, but for many activists, words are no longer enough. What is needed is stability, transparency, and the full recognition of community actors as co-decision-makers.
This imperative was echoed in the powerful advocacy by African civil society around the newly approved Pandemic Agreement. These actors are not asking for a seat at the table - they are demanding co-ownership of pandemic preparedness, response, and financing. Trust, accountability, and the reach of health services are not built from Geneva or New York, but from the ground up. Communities are the connective tissue of health systems, especially when states falter or retreat. To exclude them is to undermine the entire edifice of global preparedness.
Africa is no longer content to be the execution ground for decisions made elsewhere. At the 78th World Health Assembly, African leaders declared their intention to build sustainable, self-financed health systems. The initiative led by Nigeria, in collaboration with the Global Fund, marks a notable inflection point: a transition from passive recipient to proactive architect. From Ethiopia’s experiences to Zimbabwe’s community health insurance schemes, and Dr. Donald Kaberuka’s calls for innovation - what emerges is a mosaic of ambition and agency that is no longer waiting for external validation.
But sovereignty demands more than rhetoric. It demands accountability. The Recoveries Report, submitted to the Global Fund’s 53rd Board meeting, serves as a sobering reminder. Far from a dry accounting exercise, it exposes the friction between fiduciary rigor and operational complexity. Recovering non-compliant expenditures in fragile contexts is not just a financial necessity - it can also mean the disruption of life-saving services. Hence the need for smarter, more context-sensitive risk management tools that balance transparency with operational flexibility.
In this complex environment, one issue may seem technical but is in fact deeply strategic: the Global Fund’s progress in securing privileges and immunities. These legal protections - highlighted in the P&I report presented in Geneva - enable the Fund to operate with fewer legal and administrative barriers. Far from bureaucratic formalities, they are essential shields for staff, assets, and programs in an increasingly unstable legal and political landscape.
What emerges from these developments is the portrait of a global health ecosystem at a crossroads. One that promises much but still struggles to align ambition with inclusion. One whose resilience cannot rest solely on the shoulders of major donors or global institutions but must be rooted in local agency, community intelligence, and sovereign leadership.
The task ahead is not merely to raise funds. It is to raise leverage - on inequality, on power dynamics, and on our collective imagination of a world where health is not a privilege to be negotiated, but a shared right to be realized.
And any thoughts about which aspect in the global health initiative sector you’d like to see covered in our newsletter are always welcome and we’d really appreciate suggestions on who can pen an article on it! Anyone who wishes to voluntarily contribute as a guest columnist and provide an incisive analysis or first-person account of what is happening at micro – or macro – levels in the field of global health interventions is also welcome. Any feedback and suggestions in French, Spanish, English can be sent to Ida Hakizinka ida.hakizinka@aidspan.org and/or christian.djoko@aidspan.org
If you like what you read, do spread the word around and ask others to subscribe!
