Global Public Health Funding Is at Risk

Since 2002, the United States has been the largest funder of the Global Fund, a multilateral public health organization dedicated to fighting AIDS, malaria, and tuberculosis. The United States contributed 14.53% of the total World Health Organization (WHO) budget in 2024 and 12.2% of GAVI’s total funding between 2020 and 2025. In addition to essential financial support, the United States has provided expertise and leadership. That's why the U.S. funding freeze and the loss of these resources—both financial and human—has forced organizations to rethink budgets and strategies. 

Yet while U.S. funding loss represents the largest cut, other long-term global health donors are also reducing their budgets. Leading contributors such as Germany and the UK, along with several other European nations, have experienced sharp declines in Official Development Assistance (ODA)—both in terms of their overall budget share and in dollar amounts. This broader trend adds further strain to international development and global health financing. In the face of funding loss, multilateral organizations must adapt quickly to protect global health.

Making the most of the (potential) buffer period

Although rapid short-term response is necessary to avoid disruption of public health programs related to immunization, pandemic preparedness, and more—which would jeopardize health outcomes for the most vulnerable—the full impact of funding loss will take time to materialize. The United States must provide a one-year notice before officially withdrawing from the WHO, meaning funding commitments and obligations should, in theory, continue for at least a year before withdrawal is complete. But even after giving notice, the United States is required to pay WHO’s assessed contributions until the end of the WHO fiscal year. 

While the legal process behind the withdrawal might suggest a window of opportunity for leaders to plan, adapt, and reinforce their strategies, the reality is that every day without sufficient global health funding intensifies the need to rethink and adapt. Whether a clear time frame exists or not—and even if the United States does not fully comply—the need to reexamine and transform our approach has long been overdue. 

In this era of shrinking budgets and competing global priorities, we offer a 3-step approach to help multilaterals obtain—and use—funding to maximize health outcomes for people around the world.

Step 1: Drive Fund Replenishment through Strategic Engagement 

To secure adequate funding, multilateral organizations must continue to demonstrate clear, measurable impact. It’s not enough to highlight global health needs—instead, they must align messaging with donor priorities and make a compelling case illustrating how every dollar invested leads to measurable improvements in health outcomes, economic productivity, and system resilience.

Step 2: Improve Internal Operations to Drive Efficiency—and Better Health Outcomes 

Once funding is secured, the next challenge is using resources effectively. Many multilateral organizations operate in complex, fragmented delivery ecosystems where ineffective operations, bureaucratic hurdles, and misalignment between funding and on-the-ground capacity can slow progress. To maximize the impact of donor contributions, multilaterals must focus on internal reforms that enhance effectiveness and drive better health outcomes. We recommend:

• Conducting rapid delivery capacity assessments: Before allocating resources, evaluate whether implementing partners—such as Ministries of Health, NGOs, and local service providers—have capacity to absorb and effectively utilize funds. 

• Strengthening performance management and accountability: Use an outcome-based financing model (in which funds are released based on demonstrated improvements in health indicators) to link contributions to measurable progress. 

• Embedding continuous learning and adaptive management: To adjust to rapidly evolving global health challenges, remain flexible, track performance in real-time, utilize feedback loops, and adopt a culture of innovation. 

Step 3: Reduce Government Overburden and Strengthen GHI Coordination

Global Health Initiatives (GHIs) are multi-stakeholder partnerships that address global health challenges. Yet GHIs’ fragmented approach often leaves governments struggling with overlapping funding streams, duplicative reporting requirements, and disconnected disease-specific programs. The World Bank’s Aid Efficiency at a Glance – Country Snapshots 2024 report examined challenges, such as the fragmentation of aid flows, among 19 recipient countries. Splitting funds into smaller projects, for example, strains government capacity. And nearly 40% of official flows circumvent national government systems, which reduces government ownership and efficiency. These issues are exacerbated by the reality that some countries manage over 200 donor agencies.

Multilaterals need to work better among GHIs to streamline governance, reporting, and implementation. Launched in 2023 to improve global health financing, the Lusaka Agenda was developed collaboratively by global health experts, representatives from donor governments, multilateral organizations, and stakeholders from low- and middle-income countries. The Agenda highlights “five key shifts for the long-term evolution of the GHI ecosystem” to work towards Universal Health Coverage. One key shift is to "Achieve strategic and operational coherence,” which involves strengthening governance and operating models to reduce government burden, scale operations efficiently, and continually respond to the world’s health needs. The Agenda  suggests:

• Simplifying funding application processes and aligning reporting requirements to help foster strategic and operational coherence.

• Integrating funding streams and reporting mechanisms so countries can focus on health service delivery—not administrative compliance. 

• Improving efficiency at scale through joint planning and pooled funding mechanisms. 

The funding threat is an enormous public health challenge. It doesn’t have to become a roadblock.

Instead of viewing this moment through a lens of gloom and doom, multilaterals can take a minute to breathe—to assess the situation carefully—then take thoughtful action to improve health for people around the world. 

In Part II of this series, coming soon, explore how governments ​​can utilize the Public Value Framework to make smarter investments from multilateral organizations and maximize return on public health spending.

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Banner photo by CDC on Unsplash

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