December 18, 2025
Unlocking a new era of global health financing
By Frieda Arenos, Chris Collins and Aria Vyas
The Trump administration’s new America First Global Health Strategy outlines key goals for future global health investments by the US government. The strategy highlights the importance of moving to sustainable, locally-driven health care systems that shift away from donor dependence and instead enable domestically-owned service delivery. As the Trump Administration works to operationalize its strategy, global actors continue to engage in similar dialogues, such as the Accra Reset, to move beyond a heavy reliance on official development assistance (ODA) toward country-driven programming. Doing this effectively requires partnership and innovative methods to unlock financial capital, all while ensuring the needs of beneficiaries are at the center of decision making.
Global health needs are growing and the need for new financing strategies has never been more important. The World Bank estimates a $176 billion annual health funding gap in the lowest-income countries by 2030. Meanwhile, many countries are forced to choose between servicing debt and investing in people’s health.
To support the evolving conversation on global health finance, Friends of the Global Fight, ONE and RESULTS teamed up to produce a report on the future of health financing. It is based on a global consultation of more than 50 health financing experts and offers ideas to continue to build ODA and domestic resource mobilization while leveraging additional financing options.
The goal is not to find one solution to expand global health finance, but rather to present a coherent set of choices that countries can access over time. Aid transition is a pathway, not a cliff. Done well, it supports growing country leadership and resilience; done poorly, it risks backsliding and lost lives.
Preserve ODA and expand domestic resources for accelerated, sustainable transitions to country leadership
Domestic financing must be the foundation of health financing. Countries that have increased their own spending—often catalyzed by strategic ODA—are better able to sustain gains. That means strengthening tax collection, introducing “sin taxes,” expanding national health insurance and increasing investments in primary health care in national budgets. ODA remains indispensable, particularly for public goods and for communities that markets will not reach. The task is to preserve grant making while aligning donor funds with domestic efforts, so that external resources crowd in—not crowd out—country investment.
A practical menu of financing options for countries to choose
Because contexts differ, countries need clear financing pathways that match country needs. A practical menu should include sustained ODA, debt relief, debt swaps, concessional lending, national health insurance schemes, taxation reforms, remittances, blended finance and private sector investment. Multilateral development banks can expand concessional lending, facilitate debt restructuring and channel Special Drawing Rights into health. Debt swaps are especially promising: they can convert unsustainable obligations into targeted health investments while improving fiscal space.
Which instruments are most useful depends on the country’s debt dynamics, revenue base, absorptive capacity and political priorities. New platforms that are emerging can help. A debt swap hub in Spain is building technical capacity and matchmaking for debt-for-health deals, while the Health Works Leaders Coalition is focused on mobilizing public–private collaboration for health workforce investments—critical for making any financing effective. These efforts should be connected to country financing plans rather than operating in parallel.
Leverage private sector partnerships
The private sector also has untapped potential. Social impact bonds, vaccine bonds and pooled procurement mechanisms can mobilize capital and lower prices. Remittances—measured in the trillions over the last decade—can be channeled through voluntary health contributions or diaspora-backed facilities. But private investment will only flow at scale if risks are managed and impact is measurable. The pneumococcal vaccine advance market commitment, which accelerated product development and reduced vaccine prices by 43%, shows how mechanisms like structured de-risking and pooled procurement can unlock innovation while optimizing efficiency and impact.
Invest in efficiency and integration
Financing alone will not deliver results without greater efficiency and service integration. Countries and partners should prioritize reforms that reduce waste, pool funds more effectively, integrate vertical programs with primary care, and digitize procurement and supply chains. Every dollar can and must go further—especially during transition.
Multilaterals can help drive efficiency. The Global Fund, for example, leverages its unique market-shaping capacities to bypass structural barriers like high costs, fragmented markets and inefficient supply chains. In the case of the New Nets Project, the Global Fund and other partners delivered 56 million dual-insecticide bed nets across 17 countries—cutting production and delivery time in half, preventing 13 million malaria cases and saving nearly $29 million.
Moving forward
This is a moment for both political leadership and robust global collaboration. Health ministers cannot do it alone; finance and planning ministries, parliaments and presidents must champion health as a national growth strategy. Donors should safeguard ODA, recruit new contributors and simplify access to blended and innovative finance. Multilaterals should help countries map clear financing pathways and provide hands-on technical support. Advocates should press relentlessly for prioritizing health investments, rallying domestic and external commitments and holding all actors to account.
Global health financing is complex and evolving rapidly, but there is a path forward: build political will globally and in countries, provide a practical menu of financing options, invest in efficiency and integration, and equip ourselves with the data to steer the course. If we act now, the world can unlock a new era of health financing that is sustainable, rights-based and sufficient to deliver health for all.
Frieda Arenos is a Director of US Government Relations for the ONE Campaign where she supports the organization’s engagement with Congress and leads global health initiatives. Prior to joining ONE, Frieda spent more than a decade working in government (with USAID and the US Senate) and worked with the National Democratic Institute where she led the organization’s global engagement on legislative development.
Chris Collins is the president and CEO of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria where he leads the organization’s efforts in Washington, D.C. to secure investment in the Global Fund and related global health programs. Chris holds a master’s degree in public policy from Harvard University.
Aria Vyas is the senior manager of digital communications at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria; Aria received a Master of Public Health from the University of Pennsylvania.
Additional resources: Expanding global health finance: Convening report and agenda for action