The year 2025 will be remembered as the moment global health’s foundations shifted beneath our feet. Funding collapsed to levels not seen in 15 years. The US stepped back from decades of global health and development leadership. And for the first time this century, child mortality reversed course and began climbing again.
But these crises revealed something else: The donor-dependent model that has defined global health for generations is breaking down. What emerges in its place will determine whether we’re witnessing a system-wide collapse or the painful start of a more fraught yet sustainable model.
What’s at stake isn’t just funding, it’s whether the world still believes that health is a universal right rather than a privilege rationed by donor priorities and borders. Will 2025 be marked as the year “country ownership” stops being a buzzword and starts being a strategy?
Funding retreats as needs grow: exposing the flawed aid system
According to the latest data from the Institute for Health Metrics and Evaluation, development assistance for health (DAH) has plummeted by roughly 50% since its post-pandemic peak from $80 billion in 2021 to around $39 billion this year, returning to the lowest level in over a decade. This isn’t solely an American phenomenon, although the US led the retreat with a 67% cut. The UK reduced health assistance by 39%, France by 33%, Germany by 12% and Finland by 11%.
Other traditional development funding streams are following suit. The International Federation of Red Cross and Red Crescent Societies, the world’s largest humanitarian network, cut its 2026 appeal by nearly half a billion dollars despite surging crises. As donors abruptly cut funding, the human cost is materializing, and the need for reimagined solutions remains greater: Child deaths increased in 2025 for the first time this century. If current funding trajectories continue, projections suggest 12 million additional children could die by 2045.
The fragility of the donor-led system that has been exposed by these cuts has forced institutions to reckon with the state of global health. In May, global health leaders issued a public call for a “leaner, more coherent architecture” with fewer agencies competing for shrinking resources. We heard the subtext: The sprawling, overlapping system built during flush times cannot survive the new wave of austerity.
Traditional Global South “recipients” respond
With no return to the old funding landscape in sight, a “new normal” is being enacted in some low and middle-income countries. The African Union and the Global Fund formalized a partnership in November to strengthen health systems and accelerate domestic resource mobilization, an explicit hedge against external funding volatility. In December, the Africa Centers for Disease Control and Prevention (Africa CDC) partnered with Zipline International to expand drone-based medical supply chains and epidemic early warning systems across the continent, prioritizing African-designed solutions over imported models.
Joint financing mechanisms have evolved to match the momentum. In December, the World Bank and Gavi committed at least $2 billion through 2030 for immunization, primary health care strengthening, and regional vaccine manufacturing. Unlike traditional aid, these funds emphasize long-term sustainable financing to strengthen local health systems and economies rather than encourage dependency.
These new, emerging initiatives represent a strategic pivot by countries and regions, releasing old “donor-dependent” narratives, and moving from “policy-takers” to “policy-makers”. For years, “country ownership” and “Global South leadership” were buzzwords in donor strategies and conference declarations. 2025 stands as the year that these words are becoming an operational reality.
What comes next
As we look forward to 2026 and beyond, we know the old system isn’t coming back. What remains to be seen is whether what replaces it will be better for some of the poorest countries that have historically needed health aid the most.
If implemented “right”, consolidation and in-country-led projects could mean more efficient resource allocation. Regional institutions, accountable to the populations they serve rather than distant donors, could prove more responsive and potentially sustainable. Domestic financing mechanisms could provide stability that donor whims never guaranteed. Integration of vertical disease programs into primary health care could strengthen systems rather than fragment them.
If done “wrong”, this means critical gaps where funding vanishes faster than alternatives can scale. Countries with already weak governance structures or ongoing conflicts fall further behind, and our most vulnerable populations bear the cost of a transition they didn’t choose.
Global health has reached its inflection point this year: the donor-driven architecture that defined the field is breaking and regional institutions are stepping forward, sometimes by design, often by necessity, with the world’s most vulnerable populations caught in between. The year 2026 must be when the sector chooses a direction: cling to a model built for a different era, or embrace one in which countries and regions drive global health agendas, with donors in supporting roles.
[Luna Rovira edited this piece.]
The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.
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