GFO Issue 466, Article Number: 1
ABSTRACT
In this new issue of GFO, the editorial examines the financial strains challenging global health and the Global Fund, while highlighting the rise of health sovereignty exemplified by Nigeria’s ambitious reform. It calls for a renewed focus on coherence, justice, and sustainability, so that health becomes a truly shared and nationally owned public good.
Dear subscribers,
It is one of the paradoxes of our time: never has global health saved so many lives or produced so much evidence, while at the same time appearing to falter under its own financial and moral weight. The Global Fund’s latest report cites 70 million lives saved since its inception and major advances against HIV, tuberculosis, and malaria. Yet as we approach the symbolic milestone of 2030, budget lines are thinning, allocations are shrinking, and the “last mile” - where inequalities sharpen and systems strain - is proving to be the longest of all.
The turn toward austerity: a Global Fund under constraint
The Office of the Inspector General’s (OIG) 2025 rapid assurance review of reduced Grant Cycle 7 allocations exposes this tension with surgical precision. Faced with an unexpected funding shortfall, the Global Fund acted swiftly but strategically to protect its core mission. Cuts were applied like a controlled tourniquet - preventing hemorrhage, preserving vital functions. This operation avoided paralysis, but it also revealed a structural fragility: a model still too dependent on the fluctuations of international aid. The Global Fund has weathered the storm, but not without raising a question that can no longer be ignored: how can global health remain sustainable without relying on a financial current that is ebbing away?
The African pivot: the rise of health sovereignty
Some countries are beginning to provide concrete answers. Nigeria, in particular, has launched one of the most ambitious health financing reforms on the continent. At the National Health Financing Dialogue, the country outlined a new social contract - one in which health is financed by national means. Health insurance is now mandatory for federal employees, new taxes have been introduced on tobacco, alcohol, and sugary drinks, and the diaspora is being called upon to contribute. The Health Minister, Dr. Muhammad Ali Pate, has set an ambitious goal: to insure 44 million Nigerians by 2030. Finance Minister Wale Edun explicitly links economic reform to health transformation. Together, they embody a shift in perspective: health is no longer a cost to absorb, but a productive infrastructure - a driver of growth and social cohesion.
If successful, this reform could inspire a new continental vision - one of an Africa that, instead of pleading for resources, builds its own instruments of protection and equity. Sustainability will not come only from pledging conferences in Geneva, but from countries’ capacity to reform taxation, mobilize markets, and engage citizens in co-owning their health futures.
The blind spots of progress: the forgotten children of HIV
Meanwhile, as attention focuses on macro-financial reforms, another, quieter tragedy persists: that of children left behind in the HIV response, particularly in Francophone Africa. Forty years after the virus’s discovery, the progress achieved for adults has not extended to children. In West and Central Africa, the prevention–testing–treatment chain remains fragile: delayed diagnoses, supply shortages, fragmented governance. These weaknesses expose a health architecture that, despite billions invested, still struggles to link maternal and child health with HIV care.
Yet the science exists. Optimized pediatric treatments (pALD), prevention of mother-to-child transmission, and community-based follow-up are proven tools. What is missing is the integration of services, predictable financing, and firm political will. Without these, “ending AIDS in children by 2030” will remain a hollow promise.
The test of truth: the upcoming Replenishment
As the Global Fund prepares for its Eighth Replenishment, the entire system faces a moment of truth. The goal is no longer to secure more promises, but to preserve their real value. As the Fund’s report emphasizes, future success will depend less on new tools than on targeted investment in system functions - supply chains, laboratories, data systems, community infrastructure. This is where the “last mile” must be won: the space where the marginal return on investment is greatest, but the path is most difficult.
L’Initiative and justice as a compass
Amid this landscape of recalibration and reform, L’Initiative’s 2024 activity report stands out as a moral compass. Where others see constraints, it acts with coherence. Its interventions in the most vulnerable countries reflect a rare conviction: that health is not a technical sector, but a vehicle for social justice. By embedding equity, sustainability, and rights within its operational logic, L’Initiative reminds us that effectiveness is not merely a question of efficiency - it is about the alignment between values and means.
Coherence as resistance
This moment calls for ethical and strategic clarity. We must learn to do less, but better; to govern through evidence, not posture; to treat coherence as a form of resistance in a fragmented world. If global health is to survive its own success, it must reconcile itself with its founding principles: enlightened solidarity, shared responsibility, and the courage to act where need is most acute.
Only by binding rigor to justice, and restraint to ambition, can this system not only endure - but endure with purpose.
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,
It is one of the paradoxes of our time: never has global health saved so many lives or produced so much evidence, while at the same time appearing to falter under its own financial and moral weight. The Global Fund’s latest report cites 70 million lives saved since its inception and major advances against HIV, tuberculosis, and malaria. Yet as we approach the symbolic milestone of 2030, budget lines are thinning, allocations are shrinking, and the “last mile” - where inequalities sharpen and systems strain - is proving to be the longest of all.
The turn toward austerity: a Global Fund under constraint
The Office of the Inspector General’s (OIG) 2025 rapid assurance review of reduced Grant Cycle 7 allocations exposes this tension with surgical precision. Faced with an unexpected funding shortfall, the Global Fund acted swiftly but strategically to protect its core mission. Cuts were applied like a controlled tourniquet - preventing hemorrhage, preserving vital functions. This operation avoided paralysis, but it also revealed a structural fragility: a model still too dependent on the fluctuations of international aid. The Global Fund has weathered the storm, but not without raising a question that can no longer be ignored: how can global health remain sustainable without relying on a financial current that is ebbing away?
The African pivot: the rise of health sovereignty
Some countries are beginning to provide concrete answers. Nigeria, in particular, has launched one of the most ambitious health financing reforms on the continent. At the National Health Financing Dialogue, the country outlined a new social contract - one in which health is financed by national means. Health insurance is now mandatory for federal employees, new taxes have been introduced on tobacco, alcohol, and sugary drinks, and the diaspora is being called upon to contribute. The Health Minister, Dr. Muhammad Ali Pate, has set an ambitious goal: to insure 44 million Nigerians by 2030. Finance Minister Wale Edun explicitly links economic reform to health transformation. Together, they embody a shift in perspective: health is no longer a cost to absorb, but a productive infrastructure - a driver of growth and social cohesion.
If successful, this reform could inspire a new continental vision - one of an Africa that, instead of pleading for resources, builds its own instruments of protection and equity. Sustainability will not come only from pledging conferences in Geneva, but from countries’ capacity to reform taxation, mobilize markets, and engage citizens in co-owning their health futures.
The blind spots of progress: the forgotten children of HIV
Meanwhile, as attention focuses on macro-financial reforms, another, quieter tragedy persists: that of children left behind in the HIV response, particularly in Francophone Africa. Forty years after the virus’s discovery, the progress achieved for adults has not extended to children. In West and Central Africa, the prevention–testing–treatment chain remains fragile: delayed diagnoses, supply shortages, fragmented governance. These weaknesses expose a health architecture that, despite billions invested, still struggles to link maternal and child health with HIV care.
Yet the science exists. Optimized pediatric treatments (pALD), prevention of mother-to-child transmission, and community-based follow-up are proven tools. What is missing is the integration of services, predictable financing, and firm political will. Without these, “ending AIDS in children by 2030” will remain a hollow promise.
The test of truth: the upcoming Replenishment
As the Global Fund prepares for its Eighth Replenishment, the entire system faces a moment of truth. The goal is no longer to secure more promises, but to preserve their real value. As the Fund’s report emphasizes, future success will depend less on new tools than on targeted investment in system functions - supply chains, laboratories, data systems, community infrastructure. This is where the “last mile” must be won: the space where the marginal return on investment is greatest, but the path is most difficult.
L’Initiative and justice as a compass
Amid this landscape of recalibration and reform, L’Initiative’s 2024 activity report stands out as a moral compass. Where others see constraints, it acts with coherence. Its interventions in the most vulnerable countries reflect a rare conviction: that health is not a technical sector, but a vehicle for social justice. By embedding equity, sustainability, and rights within its operational logic, L’Initiative reminds us that effectiveness is not merely a question of efficiency - it is about the alignment between values and means.
Coherence as resistance
This moment calls for ethical and strategic clarity. We must learn to do less, but better; to govern through evidence, not posture; to treat coherence as a form of resistance in a fragmented world. If global health is to survive its own success, it must reconcile itself with its founding principles: enlightened solidarity, shared responsibility, and the courage to act where need is most acute.
Only by binding rigor to justice, and restraint to ambition, can this system not only endure - but endure with purpose.
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!
