As thousands of global development leaders gather for UNGA80 this week, one question overshadows the conversation: How will we protect fragile health gains at a time when it feels like foreign aid has collapsed?
Less than five years from the 2030 target of the Sustainable Development Goals, we have seen one of the bleakest years in global health to date. The elimination of over 90% of USAID contracts this year, along with rollbacks of foreign aid in the United Kingdom, Germany and France, make it certain we’ll see millions of deaths that could have been prevented, risking fragile gains against the Goals.
Seemingly overnight, billions of dollars have been lost in the fight against HIV, maternal and newborn mortality, malnutrition, and so much more. In all likelihood, those billions aren’t coming back.
We know that philanthropy can’t “replace” what’s been lost. Nor should it: We’re experiencing the decline of a system that yes, saved tens of millions of lives, but also too often – even if inadvertently – perpetuated colonialism and paternalistic giving practices, and failed to put trust in local leaders.
In Africa alone, a continent where just 4% of the world’s health workforce bears 24% of the global health burden, there will be a six million healthcare worker gap by 2030, according to the WHO. Bridging that equity gap simply won’t happen with incremental change – it will take a fundamental rejection of the status quo.
This moment requires a bold reset of our business-as-usual mentality: We must act, quickly and with great intention, to prevent our global health system from falling into even greater disrepair.
Backing proximal leaders like we mean it
If there is a silver lining in all of this, it’s that we have a chance to put better principles to work around who gets funded, and how. The Lusaka Agenda, launched in December 2023, puts forward a set of five shifts we need to realize to achieve universal health coverage, calling for donors and implementing organizations alike to align their efforts behind national plans to strengthen health systems.
In Malawi, where my colleagues at Seed Global Health partner closely with the national government, the ministry of health has launched a clear, compelling call to action with its Health Sector Strategic Plan – asking donors and nonprofits alike to align their efforts and resources behind “One Plan, One Budget, One M&E,” an integrated and more efficient use of resources to improve primary health care nationally.
Malawi’s plan is steeped in data-driven recommendations and conclusions developed by Malawian health professionals, government leaders, and financial experts, drawing closely on those experts’ firsthand experience with their own public health system. And yet, for too long, we have asked governments like Malawi’s to adapt their plans to our (largely Global North-derived) strategies – and not the other way around.
From the early days of Seed Global Health’s work, we’ve worked only on invitation from national governments and designed our initiatives to support and grow the health workforce around those governments’ plans, rather than the other way around. Without a doubt, it takes more time to co-create our work together than it would to go it alone – sometimes we take one step back together to move three steps forward. But it’s an approach that not only centers local leadership, knowledge and expertise, but also ensures that results are more sustainable in the long run.
Philanthropic partners like the newly launched Beginnings Fund are taking this approach, and others including Bloomberg Philanthropies and Abbott have seen success with this model, building the health workforce in Tanzania, for example.
Unlock more capital, and protect what works
A common refrain over the past several months has been that surely philanthropic giving cannot replace the scale of giving that a USAID, for example, was able to deliver.
But that argument assumes philanthropic giving stays flat. We know, however, that philanthropy has the resources to grow, far beyond modest increases year-over-year to match inflation. As Katherine Hayes wrote in her Chronicle of Philanthropy op-ed in early September, “Private foundations’ assets in the U.S. increased twice as fast as GDP from 1985 to 2020, reaching an all-time high in 2024.” According to Bloomberg, foundation assets hit $1.64 trillion dollars last year.
While some foundations (e.g., MacArthur, Marguerite Casey, Freedom Together) have led the way, stepping forward to increase their planned payouts, and others like the Catalytic Impact Fund and ELMA Philanthropies have moved quickly to mobilize emergency resources and ensure life-saving programs continue, the vast majority of foundations will stick close to a a 5% minimum federally mandated payout this year.
Why are we holding back rainy day funds for a rainy day that’s already here? We’re living in a national and global crisis of historic measure, but we’re certainly not acting like it.
A May 2025 survey by the Global Aid Freeze Tracker indicated that of the respondents – largely global and local development organizations – more than 50% indicated a possibility their organization could shut down entirely as a result of USAID cuts, and over 80% had less than six months of cash on hand to keep their operations running.
Foundations should not only increase their giving to efforts that the evidence shows are effective and impactful, but also act as matchmakers, supporting strategic mergers and acquisitions of important programs and approaches that might be lost entirely if they don’t find new homes.
We must also avoid analysis paralysis in moments like these – data is important, but it should be enabling us to make good decisions, not perfect ones, especially when lives are at risk. This is a moment to take bets on what we know works. For instance, we know people power our health systems. WHO and World Bank data shows us investing in health workers delivers some of the highest returns in global development, with every $1 yielding up to $20 in economic and social value.
Employing long-term, patient capital
With the collapse of USAID, the gap between the reality of global health funding, and, for instance, the aspirational Abuja Declaration target of 15% expenditure of GDP on health across Africa, feels vast. It can be bridged (unlocking more capital and backing proximal leaders is a good place to start), but it won’t happen overnight.
Ensuring strong global health systems is going to take patient, flexible capital, largely from philanthropy, as countries work toward increasing domestic financing for health. But too often, philanthropists are reticent to partner on longer timelines.
It’s an understandable reaction – this is an urgent moment for global health and it makes sense that the funders who are stepping up want to act quickly to save as many lives as possible. But building a stronger and more sustainably financed global health system for our collective futures is going to take trust and time. Philanthropic partners like Hewlett Foundation (with 5 to 7-year grant commitments), and the Ford Foundation (through its unrestricted BUILD grants) are finding ways to make this work and seeing results: stronger local institutions that last.
Until we expand our scope of thinking about the problem, recognizing that progress in bridging the financing gap will likely take 10 or 15 years rather than a two-to-three-year grant cycle, we cannot have a productive conversation about what driving success in sustainable health gains looks like. Rethinking our timelines opens opportunities to consider how, for example, we can accompany a national government to reach those Abuja Declaration targets.
Philanthropy cannot and should not replace bilateral aid — but it can do what aid could not and accompany the building of something new and better. It can move faster, take risks, and stand behind local leaders whose plans are investable and ready. If philanthropy steps up with courage, patience and humility, this moment of crisis can become the foundation for stronger, more resilient health systems tomorrow.
Lauren McKown is Chief Partnerships Officer at Seed Global Health and has spent her career helping organizations and leaders scale solutions that strengthen institutions and improve health, equity and opportunity globally.
