Transforming global health to maximise impact and speed up self-reliance – opinion piece

November 13, 2025

The last twenty years have seen extraordinary progress in global health, with tens of tens of millions of lives saved, mortality rates plummeting, and life expectancy dramatically increasing even within the poorest countries.

However, the context has modified. Donors are cutting aid budgets. Implementing countries need to take the lead. Communities are demanding more agency. The model that has made such progress is not going to be the model that may take us forward.

To adapt, we must transform the worldwide health ecosystem, making it more efficient, more aware of countries’ needs, and more integrated and progressive.

Just over 20 years ago, the Global Fund Partnership was created to fill a glaring gap in the prevailing system. Combining the facility of presidency with the fervour of communities, the reach of civil society and the pragmatism of the private sector, this unique private-public partnership has proven extremely effective, saving 70 million lives and reducing the combined death rate from AIDS, tuberculosis and malaria by 63%.

Now we must reinvent ourselves: getting more out of each dollar, supporting countries on their path to self-reliance, and contributing to the broader transformation of the worldwide health ecosystem.

Maximizing the impact of each dollar

Maximizing the impact of each dollar means providing quick and reasonably priced access to life-saving innovations. That’s what we’re doing with lenacapavir, a brand new, 100% effective, long-acting injectable HIV prevention tool. For the primary time in history, this latest medicine to forestall HIV infection shall be launched concurrently in low- and middle-income countries and high-income countries. The first deliveries to Africa will happen this month. A general version shall be available soon, reducing costs even further.

We’ve taken the same approach with the most recent generation of anti-malaria mosquito nets, that are 45% more practical than traditional nets and price only 70 cents more, and AI-powered digital X-rays that facilitate advanced TB screening in a few of the most difficult and distant environments.

By working with partners, we will act even faster. When it involves delivering life-saving innovations, time equals life. Scale equals influence. We cannot afford years of pilot programs or slow implementation.

However, innovations only improve health outcomes once they reach those that can profit most from them. Unavailability of economic resources, weak healthcare systems, stigma and discrimination remain huge barriers. Overcoming these barriers isn’t only a matter of health equity and human rights; it’s an epidemiological and economic imperative. If innovations don’t reach those most in danger, we lose impact and waste resources.

Maximizing the impact of each dollar also means breaking down health product and disease silos. A more integrated, people-centred approach that addresses communicable diseases, non-communicable diseases and mental health can deliver higher outcomes and get monetary savings – if done well. Incorporating multi-pathogen treatment options into disease-specific interventions also strengthens our line of defense against emerging health threats. For the Global Fund, such changes have profound consequences. We must work with partners to vary the design and delivery of programs without being distracted by disease outcomes.

Continuous performance improvement can be essential. With operating expenses around 6% of donor funds disbursed, the Global Fund is already very efficient, but by utilizing technology, including artificial intelligence, to further streamline and automate processes, we’re reducing costs by an additional 20% while reducing the burden on partner countries.

Accelerating the trail to independence

Sharp cuts in external financing underscore the necessity for countries to speed up their path to self-reliance. However, it is a journey, not a direct change. Too abrupt a transition will derail progress and price tens of millions of lives. The readiness of nations for transformation varies significantly.

The Global Fund will work with countries to speed up their path to self-reliance – supporting, motivating and ultimately getting them on the road.

That is why now we have renewed transition planning and co-financing. For some countries, we’ll agree a transitional timetable that may make this three-year grant cycle the last one. For others, the trail to passage may involve two grant cycles. For all however the poorest and conflict-affected countries, we’ll work with governments to develop robust transition plans.

To support the transition, we’re increasing our support to countries to strengthen their public financial management systems and leverage latest sources of financing. We have already conducted 14 Debt2Health swaps and 14 blended-finance transactions. We directly support the event of national medical insurance systems in several countries.

We may also help countries maintain access to reasonably priced, quality-assured medicines by making it easier for them to make use of our pooled procurement mechanism with their very own money. Countries in transition often pay significantly higher prices and incur significant transaction costs, but these will be avoided by leveraging our global scale and digital procurement platform. By offering advance payments and partnering with regional procurement platforms, we give countries more options.

Of course, there are countries where the mixture of economic difficulties, conflict and governance weaknesses, in addition to the dimensions of the disease burden, make the transition to self-reliance a more distant prospect. But even in these contexts, we’d like to put greater emphasis on sustainability, helping to construct the systems and capabilities that may underpin the long run.

Development assistance for health stays essential – to defeat the deadliest diseases, support countries on their path to self-reliance and strengthen global health security. Countries which have benefited most from globalization even have a responsibility to take a position in global public goods comparable to health – not only out of generosity, but in addition in their very own self-interest. But we must smarter mix subsidies, domestic fiscal resources and personal capital to create paths to self-reliance.

Transforming the worldwide health ecosystem

The Global Fund was born out of disruption – out of the idea that the established ways were too slow, too bureaucratic, too disconnected from the front lines. The same restless energy must fuel us now.

To adapt to latest realities, the Global Fund is committed to creating significant changes: reducing costs, simplifying the way in which it operates, and higher responding to countries’ needs. We also recognize that the worldwide health ecosystem as a complete should be transformed and that we must play our part to make this occur.

For all its successes, global health care has grow to be far too complex and fragmented, with duplication and bureaucracy creating challenges for countries and weakening their influence. We have to rationalize the architecture – merging or closing agencies where appropriate, clarifying roles and changing the way in which we work together and with countries.

As the biggest multilateral funder of worldwide health, each across three diseases and health systems generally, the Global Fund has assets that will be leveraged more broadly – ​​for instance, our market-shaping capabilities, our global procurement platform, or our unique role in strengthening local health systems. However, the evolution of the Global Fund by way of mandates and priorities mustn’t be defined in isolation, but inside a broader vision for the long run of the worldwide health ecosystem, including WHO, Gavi, disease-specific entities comparable to UNAIDS, product development partnerships comparable to Unitaid and CEPI, and our engagement with the World Bank and other multilateral development banks.

Moving to a bilateral approach isn’t the answer as it’s going to increase complexity and undermine efficiency and effectiveness. The best solution is to strengthen our multilateral system – but provided that we’re prepared to make difficult decisions. Given inevitable resource constraints, we must rigorously discover where external funding adds essentially the most value and the way best to allocate roles between agencies based on comparative advantage. What matters is how we approach it. The transformation of worldwide health can’t be imposed from Geneva or New York, but must reflect the leadership of nations and communities, in addition to regional bodies comparable to the African Union.

From disruption to rediscovery

Progress in global health over the past 20 years has shown what the world can do after we come together. As skepticism, nationalism and a more transactional approach dominate the talk, the facts – tens of tens of millions of lives saved, a pointy decline in mortality, an enormous increase in life expectancy, huge economic advantages – are compelling reminders that considering big and acting together can produce extraordinary results.

However, the model that has worked to date must change. The progress that has been made during the last 20 years is one in every of humanity’s biggest achievements in public health. The next 20 will test whether we will be as brave in reinventing the system as we were in creating it.

The alternative is straightforward: evolve or erode. We must adapt to the brand new reality and do it boldly, protecting what made success possible and never falling into the trap of the past. Above all, we must remain committed to our goals – saving lives, ridding the world of the world’s deadliest infectious diseases, and constructing health systems that keep everyone healthy and safer. When humanity stands together, no challenge is insurmountable.

This article was originally published on Forbes.