Health Aid Transition

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. Dozens of low- and middle-income countries now face a generational challenge: adjusting to a future where functions that external funders financed and delivered for decades — frontline health workers, supply chains, data systems — must now move under national ownership. 

Over the next few years, governments will decide which donor-funded functions to absorb, which to cut, and how to deliver care with fewer resources. Those decisions will shape health systems for years to come. The funding shortfall itself is far too big for philanthropy to fill — but philanthropy is well-placed to meet high demand from governments for technical assistance as they make this transition. 

We aim to support countries through the immediate transition, and help them to build health systems that do more with the resources they have. Our strategy focuses on four areas:

• Keeping services running during the transition, by helping governments triage and prioritize rapid response, streamline budget and payment flows, 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 cuts are landing, modeling the trade-offs between competing priorities, and proposing how to fill budget gaps in high-priority areas. 
• Increasing the share of health budgets that reach patients, by addressing limited budget visibility and accountability, misaligned budget cycles, and fragmented data and funding systems that prevent funds from being spent effectively.
• Mobilizing domestic financing for health, by making the investment case to finance ministries and heads of state, improving health-sector financial management, supporting local and regional advocacy, and exploring new revenue sources such as debt-for-health swaps. 

While we focus primarily on technical assistance, we also fund services directly when philanthropic funding can unlock bilateral aid that would otherwise go unspent or give governments room to pursue more ambitious reforms.