GFO Issue 468, Article Number: 1
ABSTRACT
This new issue of the GFO shows how, in a context of declining funding, global health is oscillating between budgetary realism and strategic renewal. Between the Global Fund’s defensive refocusing, the uncertainties surrounding PEPFAR, the ethical tensions highlighted in Geneva, and WHO’s initiatives to strengthen community engagement and the One Health approach, this issue underscores that 2025 may well be the year in which the sector - forced to ‘do more with less’- has learned to reinvent itself from the ground up without abandoning its essential ambitions.
Dear subscribers,
The 2025 edition of the Bill & Melinda Gates Foundation’s Goalkeepers offered a revealing snapshot of a sector at a crossroads. Beneath the celebration and the optimism, a more sober tone emerged: child survival - once a symbol of inexorable progress- has returned as an indicator of urgent concern. “Doing more with less” is no longer a slogan but a necessity. By honouring Spain for its financial commitment, the Foundation sent a clear political message about the importance of pragmatic multilateralism: refocus, prioritize, rationalize. This form of realism is deliberately assertive, yet it also reflects a deeper unease - an acknowledgment that the world, in scaling back its ambitions to fit shrinking budgets, risks losing sight of its original promise: to save lives, broadly and without compromise.
It is within this same tension that the Global Fund’s mid-term review of Grant Cycle 7 takes shape. Confronted with tightening financial flows, the Fund has adopted the posture of a custodian of essentials: safeguarding continuity of HIV, tuberculosis, and malaria services, protecting community systems, and postponing secondary activities. Such prioritization is not a retreat but an attempt at rebuilding. Under pressure, the institution is reshaping its operating logic -integration, cost-effectiveness, equity, sustainability - four pillars of a sober reconstruction in which community participation is both a moral imperative and a condition for survival.
In parallel, transparency and accountability reassert themselves as indispensable counterweights. The annual report of the Sanctions Panel, presented in Geneva, is a reminder that institutional legitimacy depends not only on financial efficiency but also on steady ethical rigor. In an ecosystem under strain, trust becomes the most valuable non-financial resource.
Yet while major donors tighten their budgets, other shifts are redrawing the landscape of solidarity. In the United States, the Bridge Plan signals a turbulent period for PEPFAR. Budget cuts, recentralized decision-making, and diminished community input point to a model under stress. Civil society organizations warn that it is not only a program at risk but the underlying philosophy of the HIV response - rooted in participation and local accountability - that is being eroded.
Against these setbacks, the World Health Organization appears to be charting a quiet but significant counter-movement. Its new ten-step plan for formal engagement of civil society acknowledges a lesson etched by the pandemic: communities are not auxiliary actors but strategic partners. Meanwhile, the National Bridging Workshops translate the promise of “One Health” into practice, bridging human, animal, and environmental health sectors. In more than sixty countries, these workshops turn diagnostics into action plans, replacing silos with shared operational blueprints.
A productive paradox thus emerges: as financing contracts, the architecture of cooperation becomes sharper; as global health appears to retreat, it simultaneously reinvents itself from the ground up. Between budgetary realism and systemic renewal, 2025 may be the year when global health stops waiting for promised resources and instead learns to rebuild - with clarity, restraint, and one remaining certainty: the collective resolve not to give up.
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,
The 2025 edition of the Bill & Melinda Gates Foundation’s Goalkeepers offered a revealing snapshot of a sector at a crossroads. Beneath the celebration and the optimism, a more sober tone emerged: child survival - once a symbol of inexorable progress- has returned as an indicator of urgent concern. “Doing more with less” is no longer a slogan but a necessity. By honouring Spain for its financial commitment, the Foundation sent a clear political message about the importance of pragmatic multilateralism: refocus, prioritize, rationalize. This form of realism is deliberately assertive, yet it also reflects a deeper unease - an acknowledgment that the world, in scaling back its ambitions to fit shrinking budgets, risks losing sight of its original promise: to save lives, broadly and without compromise.
It is within this same tension that the Global Fund’s mid-term review of Grant Cycle 7 takes shape. Confronted with tightening financial flows, the Fund has adopted the posture of a custodian of essentials: safeguarding continuity of HIV, tuberculosis, and malaria services, protecting community systems, and postponing secondary activities. Such prioritization is not a retreat but an attempt at rebuilding. Under pressure, the institution is reshaping its operating logic -integration, cost-effectiveness, equity, sustainability - four pillars of a sober reconstruction in which community participation is both a moral imperative and a condition for survival.
In parallel, transparency and accountability reassert themselves as indispensable counterweights. The annual report of the Sanctions Panel, presented in Geneva, is a reminder that institutional legitimacy depends not only on financial efficiency but also on steady ethical rigor. In an ecosystem under strain, trust becomes the most valuable non-financial resource.
Yet while major donors tighten their budgets, other shifts are redrawing the landscape of solidarity. In the United States, the Bridge Plan signals a turbulent period for PEPFAR. Budget cuts, recentralized decision-making, and diminished community input point to a model under stress. Civil society organizations warn that it is not only a program at risk but the underlying philosophy of the HIV response - rooted in participation and local accountability - that is being eroded.
Against these setbacks, the World Health Organization appears to be charting a quiet but significant counter-movement. Its new ten-step plan for formal engagement of civil society acknowledges a lesson etched by the pandemic: communities are not auxiliary actors but strategic partners. Meanwhile, the National Bridging Workshops translate the promise of “One Health” into practice, bridging human, animal, and environmental health sectors. In more than sixty countries, these workshops turn diagnostics into action plans, replacing silos with shared operational blueprints.
A productive paradox thus emerges: as financing contracts, the architecture of cooperation becomes sharper; as global health appears to retreat, it simultaneously reinvents itself from the ground up. Between budgetary realism and systemic renewal, 2025 may be the year when global health stops waiting for promised resources and instead learns to rebuild - with clarity, restraint, and one remaining certainty: the collective resolve not to give up.
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!
