Coefficient Giving Launches $165 Million Health Aid Transition Fund
Amid historic drop in aid, initiative will support low- and middle-income countries as they decide how to prioritize scarce resources and build more resilient, self-reliant health systems.
SAN FRANCISCO – Today, Coefficient Giving announced the launch of the Health Aid Transition Fund, a multi-donor initiative to advise low- and middle-income countries as they adapt their health systems amid rapidly declining aid. The Fund will recommend at least $130 million in grants over the next three years, with support from Good Ventures, the Livelihood Impact Fund, and a private donor.
Aid is falling faster than at any point on record. Total assistance dropped by more than 20% in 2025 and is projected to keep falling, leaving health aid more than 25% below its 2024 levels by 2030. During this period, governments in low- and middle-income countries must decide which donor-funded programs they can afford to keep and which they’ll have to drop. They’ll need to rapidly scale up the financing of these key public health systems themselves, and the decisions they make now will shape their health systems for years to come.
“These changes are a real shock to health budgets, but they’re also a chance to fix systems that were built around donor requirements rather than people,” said Amanda Glassman, Managing Director for Global Health and Development Policy at Coefficient Giving. “Whether those systems come out of this weaker or stronger depends on decisions over the next few years.”
Dr. Austin Demby, Sierra Leone’s Minister of Health, added: “Sierra Leone has spent years building a health system alongside partners. That is rapidly changing now, and we intend to come out of it owning our systems outright. What we need from partners now is financing and expertise that strengthens what we are building.”
The Fund aims to support countries through the immediate transition, and to help them build health systems that do more with existing resources. Its strategy focuses on four areas:
- Keeping services running during the transition, by helping governments triage and prioritize rapid response, select local partners to take over from international contractors, consolidate and own data systems and supply chains, and train staff to replace lost expertise.
- Helping governments set priorities under a smaller budget, by identifying where the cuts are being felt, modeling the trade-offs between competing priorities, and proposing how to fill budget gaps in critical areas.
- Increasing the share of health budgets that reach health facilities and people living in poverty, by addressing misaligned budget cycles and fragmented data and funding systems that prevent funds from being spent effectively.
- Mobilizing domestic financing for health, by working with finance ministries to increase and allocate resources, improving health-sector financial management, supporting local and regional advocacy, and exploring revenue sources such as debt-for-health swaps.
Coefficient has already made roughly $18 million in related grants, largely for technical teams helping countries manage the transition, which the Fund will build on. While it focuses primarily on technical assistance, the Fund will also fund services directly when philanthropic support can unlock bilateral aid that would otherwise go unspent or give governments room to pursue more ambitious reforms.
The Fund builds on the model of Coefficient’s other multi-donor initiatives — including the Strep A Vaccine Fund, Abundance & Growth Fund, and Lead Exposure Action Fund — as Coefficient continues to bring its collaborative, cost-effective approach to giving to a wider set of partners and funders.
Read more about the Fund’s approach here.