With aid funding in sharp decline, experts like CHAI’s Neil Buddy Shah say the global health community must rethink priorities, improve efficiency, and find new financing sources. The future, he argues, must be more country-led — and action is needed quickly.
Also in today’s edition: Gates to boost women’s health, philanthropic giving in Asia, the State Department put in its first order with RUTF maker Edesia, and Food for Peace.
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Global health has made huge strides in recent decades — and now, with aid funding in freefall, Neil Buddy Shah, CEO of the Clinton Health Access Initiative, said it’s time to rethink, not just rebuild.
At a recent Devex Pro Briefing, Shah pointed to one of his favorite stats: In 2000, the average life expectancy of someone born in Malawi was around 42 years. “In just one generation, 25 years later, the average life expectancy of someone born in Malawi today is something like 64 years old. And that is tremendous.” But instead of trying to “recreate what happened,” he wants a future where “someone living in Malawi lives as long as someone living in Japan.”
That vision collides with reality, writes managing editor Anna Gawel. A “multibillion-dollar gap” in global health financing is looming, and Shah predicts “massive reductions in expenditure” within two to four quarters. CHAI is working with ministries of health to help them get their bearings in this time of “confusion,” and he sees three trends emerging:
Finding efficiencies, such as swapping repetitive four-day trainings for one-day hybrid sessions, prioritizing spending on lifesaving needs — like Burkina Faso did with its $7 million shift from workshops to maternal health commodities and contraceptives — and deciding who pays for what by distinguishing between countries that can self-fund and those that still rely on aid.
Shah wants to tap multilateral banks, create more bankable health projects, and pull in philanthropy — noting that “the wealth creation of the richest 5,000 individuals in the world … dwarfs aid spending.”
Technology, especially artificial intelligence, could help “leapfrog” high-income countries, but only if companies are pushed to tackle “the most important problems on Earth” in low- and middle-income nations.
And while big donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and PEPFAR still matter, Shah said future market-shaping must be “much more country-led,” with governments pooling budgets to give pharma the confidence for “low prices and high volumes.”
But the clock is ticking. “We don’t have forever to figure out what the new system will look like,” Shah warned.
Watch: ‘Cataclysmic’ aid cuts offer chance to rethink future, not recreate past (Pro)
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The Gates Foundation is putting $2.5 billion into more than 40 innovations to improve women’s health over the next five years — its biggest-ever investment in the field and a one-third increase over the past five years. It’s backing everything from new contraceptives to AI-enabled diagnostics — and tackling conditions that Dr. Anita Zaidi, president of the foundation’s gender equality division, says are too often “misunderstood, misdiagnosed, or ignored.”
The funding will target five areas: obstetric care and maternal immunization; maternal health and nutrition; gynecological and menstrual health; contraceptive innovation; and sexually transmitted infections. That includes research into hormonal IUDs for heavy menstrual bleeding, AI ultrasounds for diagnosing multiple conditions, and drugs to treat the root cause of preeclampsia. The foundation is also supporting practical tools like a low-cost postpartum blood-loss drape, rapid HIV/syphilis tests, and self-injectable contraceptives, Devex Senior Reporter Jenny Lei Ravelo writes.
Zaidi says contraceptive innovation is still critical: “Women need more from contraception — more control, fewer side effects, and options that match their lives and preferences as their needs change.” She stresses that “collaboration is essential” to overcome decades of underinvestment and ensure breakthroughs don’t “stall in labs.”
Just as important, she adds, is making sure these innovations reach women — especially the 257 million who want contraception but can’t get it. “Just developing new tools is insufficient. Ensuring they are delivered into the hands of women who need them most is critical.”
Read: Gates Foundation will spend $2.5B to boost women’s health innovations
Related: How the Gates Foundation spent $5.4 billion in 2024 (Pro)
The U.S. Department of State just put in its first tender for ready-to-use therapeutic foods — enough to feed nearly 818,000 malnourished children in Ethiopia, Nigeria, Sudan, and nine other African countries.
It’s part of a broader push to get these lifesaving peanut pastes moving again, my colleague Elissa Miolene tells me. A State spokesperson said last week the U.S. was putting $93 million into RUTFs to reach nearly a million children, adding that the purchase would empty the “entire prepositioned stock” and keep production going “to meet ongoing needs.”
Edesia, a Rhode Island maker of RUTFs, has had a rough few months — contracts extended, canceled, then uncanceled — but this is the first tender issued directly by the State Department since it took over what’s left of USAID. The awards have not been announced yet, but it’s good news for manufacturers like Edesia, which is now bringing back laid-off staff and ramping up production to get the peanut paste out the door as fast as possible.
Earlier this year, Secretary of State Marco Rubio told Rhode Island Rep. Gabe Amo there “were no State Department delays” in shipping RUTFs — even though 123,000 boxes were at that moment stuck en route to Sudan, where over 1 in 3 kids face acute malnutrition, per the World Food Programme. They finally shipped in June.
“Let me be clear, the supply chain disruptions have a human cost. Hundreds of thousands of children’s lives have been impacted and it will take us time to catch up,” Edesia head Navyn Salem wrote in an Aug. 6 newsletter, adding in an email that it’s “critical to have our own supply chains as well as the partnership with the U.S. government.”
ICYMI: Aid factories reboot after US quietly amends food contracts
Related: The Trump administration’s flip-flop on treating malnourished children (Pro)
The State Department is making other news this month — not for cutting aid, but awarding it.
On top of the $93 million for RUTFs, the agency will also be sending $52 million to WFP to deliver emergency food assistance from “American farmers and producers” to the Democratic Republic of Congo, Djibouti, Ethiopia, and Haiti, likely through the country’s flagship food assistance program, Food for Peace.
That will amount to just over 12,700 metric tons of food from USAID warehouses in Houston and Djibouti and will be enough to reach 1.9 million people, according to State Department spokesperson Tommy Pigott. That includes yellow split peas, rice, vegetable oil, and super cereal-plus, which is a type of protein-rich whole grain, Elissa tells me.
“The United States is the largest donor of humanitarian food assistance globally, and the department continues to call on other donors to provide additional contributions to address global humanitarian needs,” Spigott said at a briefing.
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With just 710 square kilometers, Singapore may be tiny, but it’s one of Asia’s wealthiest nations — home to over 300,000 millionaires. It’s also the launchpad for ImpactCollab, a new AVPN initiative to get the region’s richest to give more.
Backed by the Monetary Authority of Singapore and the Gates Foundation — which is opening a Singapore office — the goal is big: “By 2030 we want to be able to be at the level of channeling $100 million per year [for philanthropy],” Kevin Teo, head of ImpactCollab, tells Jenny. With $1.2 trillion in assets under management locally, he notes that just 1% of the income could mean $1 billion easily.
ImpactCollab offers a vetted database of charities, NGOs, and social enterprises across Asia, plus a twist: working directly with private bankers and wealth advisers to plant the idea of social impact with high-net-worth clients.
“We feel that it is critical to engage this group … enabling philanthropic and social impact capital to flow into the sector,” Teo says. The aim is to make giving easier by tackling hurdles like due diligence costs, lack of verified organizations, and cross-border barriers.
Currently engaged with 13 banks, the platform lists 482 impact organizations in nine Asian countries, including those working on health to climate to nutrition. And Teo says it’s just the start: “We will be engaging with other wealth centers like Hong Kong and Dubai.” Groups can apply via the website — and a track record with AVPN members can speed up the vetting process.
Read: New initiative targets Asia’s millionaires for philanthropic giving
Related: Asia’s wealth is booming. What about its giving? (Pro)
Environmental activists and Indigenous leaders urge countries to finalize a legally binding global treaty on plastic pollution as negotiations in Geneva conclude Thursday. [PBS]
Funding to address political and economic instability in Haiti this year has only met 9.2% of the $900 million target. [Al Jazeera]
Afghanistan's capital, Kabul, could face a full-scale water crisis by around 2030 as nearly half its wells have dried up and up to 80% of the remaining supplies are contaminated, according to a Mercy Corps report. [The New York Times]
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Update, Aug. 13, 2025: This story has been updated to clarify that the State Department issued a tender for Edesia. The organization’s Sudan RUTFs shipped in June, but have not arrived yet.