Devex CheckUp: Washington’s chosen faith-based org

Washington is shaking up who gets its global health funding.

That starts with its “America First” global health strategy. Rather than channeling money to NGOs, the administration wants to fund partner governments directly.

The document spells out a few exceptions, though, including for private partners and faith-based organizations. In fact, the Trump administration singles out Circle of Hope, a Zambian FBO, as exactly the kind of organization whose HIV services it hopes to leverage.

Circle of Hope’s Gibstar Makangila was as surprised as anyone to find his organization name-checked in the “America First” global health strategy. Though he has been a regular presence in Washington over the years, briefing legislators and U.S. State Department officials about faith-based health interventions.

Those efforts seem to have paid off. U.S. officials then underscored their intention to continue working with FBOs when they included Makangila and other faith leaders in talks around a bilateral funding agreement with Zambian officials last year.

Makangila tells me he used that opportunity to reinforce a message that Washington “cannot have exclusive government-to-government funding mechanisms, because of the limitations government has,” including its difficulty reaching remote places.

Now he and other faith leaders are waiting to see if these pitches will translate into direct financing from D.C. While the Trump administration has maneuvered to integrate FBOs into negotiations around funding, it hasn’t yet extended much new money to them directly. Some of the organizations in Zambia are feeling the pressure, with current grants set to expire at the end of this month.

Read: Are faith-based organizations the future of the AIDS response?

Background read: State Dept taps African faith groups for bilateral health deal consults (Pro)

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Where is Washington walking away?

In a bout of realpolitik, America also appears to be cutting off aid to countries it no longer sees as serving U.S. national interests. This includes Burkina Faso, Cameroon, Malawi, Mali, Niger, Somalia, and Zimbabwe, according to a list seen by The Atlantic.

Somalia’s exclusion, at least, seems to be confirmed as organizations operating across the country have received notice that their funding won’t be renewed after their current grants expire.

That includes the aid group Alight, which runs 13 nutrition centers supporting 200,000 Somalis. This is exactly the kind of lifesaving work that the State Department said in the “America First” strategy it intends to protect. And Alight had received assurances its U.S. funding would continue through at least October 2026.

Instead, it expired last weekend. The organization was only informed eight days ahead of time.

“They gave us assurances that funding would be there, and that’s why we have, now, a funding shock,” Adan Adar, Alight’s executive director for the Horn of Africa, tells my colleague Elissa Miolene. “Suddenly, we have to close all these facilities.”

Political interests might have overtaken humanitarian commitments, in this instance, as Somalia’s relations with Washington deteriorate. U.S. President Donald Trump has referred to Somalis as “garbage,” and “very low IQ people,” and claimed that “Somalia is not even a country.”

Read: Somalia faces ‘food crisis’ after lifesaving US grants hit their end

Where does that leave those who are left out?

South Africa has been one of the countries hardest hit by U.S. aid cuts. That includes being blocked from a U.S. program to provide African countries with access to lenacapavir, a twice-yearly injectable to prevent HIV infection.

So South Africa is jump-starting a process to make lenacapavir locally. With the support of Unitaid and a host of other partners, South Africa today launched an official call to identify at least one local manufacturer capable of producing lenacapavir to international standards. This is the first step in trying to secure a voluntary license for a prospective manufacturer from Gilead, which holds the primary patent on the medicine.

Gilead has issued voluntary licenses to six generic manufacturers already, though none are on the African continent. Unitaid and its partners actually worked with one of those manufacturers, Dr. Reddy’s Laboratories, to secure a yearly price of $40.

Robert Matiru, the director of programs at Unitaid, tells me that would be the floor for an agreement that might emerge from the current process in South Africa.

“We’re going to be trying our best to get the best access commitments, but at the minimum, what we’ve secured with other licenses,” he explains.

A potential manufacturer should be identified within a month, at which point Unitaid and its partners will work to try to facilitate an agreement between the company and Gilead. That might mean bringing in technology transfers, technical assistance, or even connecting the manufacturer to financing from a development finance institution.

“We’re bringing in different instruments to make this a successful attempt to get a local producer in South Africa,” Matiru tells me. If all goes well, he envisions the “journey to the finish line” to be anywhere from two to three years, securing an affordable supply of lenacapavir not just for the country, but the southern African region.

ICYMI: After US aid cuts, South Africa’s HIV response strains to hold the line

Is there any hope of a respite?

What happens to those communities and countries that have fallen out of favor with the Trump administration and don’t have South Africa’s resources?

Over the course of the past year, I have interviewed dozens of community leaders after Washington abruptly terminated their programs for HIV and other infectious diseases. I usually ask what they’ll do if U.S. funding doesn’t return. The answer is often that they’ll turn to The Global Fund to Fight AIDS, Tuberculosis and Malaria.

That hope also seems to have been foreclosed with the announcement that the fund is allocating $10.78 billion in grants for the 2026-2028 cycle. It sounds like a lot, until you consider that it’s their lowest allocation since 2020.

This comes after the fund was only able to secure $12.64 billion of its $18 billion replenishment goal, with major donors such as the United States, the United Kingdom, and Germany reducing their contributions.

The Global Fund Advocates Network was blunt in spelling out the impact to my colleague Jenny Lei Ravelo: “Fewer people will benefit and the risks overall for communities are significantly higher than if the Global Fund’s 18 billion dollar investment case had been fully funded.”

Read: Global Fund fundraising shortfall hits country allocations

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