July 2, 2026
Community-led accountability in global health transition: Cote D’Ivoire, Kenya, Mozambique, Nigeria, Philippines, Uganda and Zimbabwe in practice
By Regis Chirenga and Mark P. Lagon
Significant shifts in historically impactful global health programming and funding bring significant risk to the fight against HIV, TB and malaria. As low- and middle-income countries transition to country led ownership in global health programs, the role of robust civil society oversight is central.
This is especially important in the context of calls for health sovereignty, the so-called “Accra Reset” led by Ghana’s President, the bilateral roadmaps negotiated by the U.S. and partner countries under the America First Global Health Strategy and the Global Fund’s acceleration of its longstanding policies on co-financing and transition. For continued progress, shared governance mechanisms and community-led accountability should take the center stage. A recently released study, Protecting civil society’s critical role in HIV and TB programs during and beyond donor transition, demonstrates, that the capacity of local civil society organizations in strengthening accountability for both government and donor investments should not be undervalued.
The Global Fund, among other partners in global health fighting HIV, TB and malaria, has utilized shared governance models that put communities at the forefront of response mechanisms, harnessing accountability through civil society partners. Through its country coordinating mechanisms, the Global Fund has capitalized on participatory decision-making that brings together national governments, civil society and local communities to design, oversee and adapt programs, including oversight of Global Fund investments. Cote d’Ivoire’s country coordinating mechanism is often referenced by peer nations as a gold standard for Global Fund grants implementation, accountability and sustainability. Through different partnerships, including civil society and affected communities, Cote d’Ivoire has seen a 83% reduction in AIDS related deaths, nearly a 90% reduction in new HIV infections and a 40% reduction in new TB cases since 2002. These significant achievements are evidence of the success of shared governance models tailoring interventions to local epidemiological and social realities and reinforcing accountability to communities whose lives depend on these services.
Through continuous engagement with local communities, civil society organizations generate reliable, timely information on whether governments are effectively using donor funds–particularly through community-led monitoring and other open data initiatives. As a core component of Global Fund and historically PEPFAR-supported programs, this monitoring entails community and civil society organizations collecting and analyzing qualitative and quantitative data on HIV, TB and malaria services, identifying gaps, and advocating for corrective action for just access to healthcare.
Historically, civil society partners have also enabled communities to assert their political voice and hold governments to account for health service delivery in their communities. In Mozambique, grassroots justice organizations in the Namati network have worked alongside village health committees at 62 health centers, gathering feedback from communities and health workers while assisting them in identifying barriers to care. Since 2013, Namati has helped resolve over 37, 000 health related grievances in Mozambique related to lack of running water and functioning toilets at health facilities, as well as breaches of confidentiality around HIV testing and clinical consultations. Civil society acts as the voice of the communities and their needs to their local governments and authorities, and this role is a prerequisite of success in transition to greater domestic funding and
It is not possible to end epidemics without reaching everyone affected, including the poor and socially marginalized. During the COVID-19 crisis in Zimbabwe we witnessed health policies that overlooked the needs of LGBTQ+ communities, exacerbating their vulnerability. This was the case across numerous LMICs. Uganda and more recently Ghana have advanced and passed extreme anti-LGBTQ+ laws and policies that will undercut programs and progress in disease prevention and control among key populations where new infections are highest. Against these adversities, civil society organizations in Uganda—Ugandan AIDS Commission and AIDS Support among others—created a coalition and developed an adaptation plan which maintained continuity of HIV services for the LGBTQ+ communities and liaised with law enforcement officials on the importance of those communities’ access to services. Successful global health transition requires that needs of marginalized populations remain included in in program implementation.
Civil society oversight remains indispensable, pushing partner governments to meet and exceed their commitments to health financing. Civil society’s sustained budget advocacy measurably increased local budget appropriations and held the government accountable for committing resources for health in Nigeria. Coordinated advocacy by civil society organizations contributed immensely to more than doubling federal budget appropriations for the Nigerian Centre for Disease Control (NCDC) for epidemic preparedness and response. Advocates engaged budget officials in the Federal Ministry of Finance, Budget and National Planning to prioritize funding for NCDC and implementation of the country’s National Action Plan for Health Security.
Additionally, faith-based, civil society and scientific visitors involved in malaria response in Kenya, Mozambique, Senegal, Zambia and other African countries coming to Washington D.C. in March 2026 testified how they play a critical accountability role, making sure every dollar is best optimized to yield accessible, quality healthcare. Faith based advocates and program monitors can play this role as much as more secular ones. Efficiently optimizing global health investments depends on ensuring that programs continue to be responsive to local needs.
More recently, countries such as the Philippines have gone further by institutionalizing civil society as non-voting observers in national budget deliberations, recognizing that civic actors and grassroots participation strengthen fiscal oversight and the integrity of budget processes and outcomes. This model of social accountability helps align public spending with citizen priorities and provides a practical mechanism to hold governments to their national health commitments. As the U.S. winnows global health assistance, such mechanisms will be even more important to assure that healthcare is locally funded, provided and accessible by all who need it.
Without civil society at the table, budget and performance data are more vulnerable to opacity and manipulation, and in the context of international health assistance, this can mask institutional-level corruption and frustrate program implementation. Civil society and community organizations in Kenya such as the Lean on Me Foundation work with national networks including Health NGOs Network (HENNET) and the Kenya Legal and Ethical Issues Network (KELIN) to strengthen health budgeting accountability. Because local civil society organizations operate close to service delivery and communities, they are uniquely positioned to flag discrepancies between announced and actual spending outcomes, documenting both successes and shortfalls, thereby assuring the impact of international health investments by the U.S government and others.
In terms of demonstrable results, excluding or deprioritizing in-country civil society in global health programs directly threatens hard-won, evidence-based gains against AIDS, TB and malaria. It risks frittering away the United States’ highly impactful past investments in global health. The goal of epidemic control of infectious diseases is unachievable without leveraging civil society as an asset. Proven community delivery and oversight mechanisms help increaseservice uptake by fostering trust and program quality for the populations most burdened by AIDS, TB and malaria. Successful transition and meaningful health sovereignty depends on shared governance with civil society along with faith-based and private sector partners– The Global Fund is entirely based on that multistakeholder approach as it walks with countries on that path on an accelerated pace.
Regis (Mwaka) Chirenga, a Zimbabwe national, was a Georgetown University O’Neill Institute Health Law Professional (HELP) Fellow, and Mark P. Lagon is Chief Policy Officer at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria.