How the Stop TB board plans to future-proof tuberculosis finance

The Stop TB Partnership’s board is asking its secretariat to work with countries to find new ways to fund and grow tuberculosis programs, as traditional donor support starts to shrink — and to make sure civil society and people living with TB are part of the conversation. The decision, made during the partnership’s recent board meeting in Manila, Philippines, highlights the precarious traditional donor funding landscape for global health, and how the sector is increasingly turning to domestic resources and alternative financing options, including through health taxes and blended finance. The World Health Organization expects a 40% decline in donor funding for global health in 2025, compared to 2023 levels, driven by funding cuts from global health’s biggest sovereign donor — the United States — but also other countries in Europe. While the U.S. — which also sits on the board of the partnership — continues to fund TB programs, its scope and focus is shifting. It is no longer funding the Challenge Facility for Civil Society — which provides grants to TB-affected communities and advocates for stronger policies and funding — for example. The facility now relies solely on funding from France and Unitaid. Potential reductions in funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria — the largest multilateral donor for TB programs globally, accounting for about 73% of external financing for TB programs — could also have an impact on TB programs globally. The Global Fund’s reprioritization exercise, which will see the fund slash $1.43 billion from grants it has already awarded, is likely to have some impact on TB programs as well. These reductions pose challenges for the TB response, which is already facing significant funding shortfalls. Funding for TB care and prevention was estimated at $5.9 billion in 2024, $16.1 billion short of the $22 billion countries committed to provide annually by 2027 during the U.N. high-level meeting on TB in 2023. Many high TB burden countries are also still reliant on external funding, with some dependent on external funding for 90% or more of their TB programs. Different ways of working Faced with financial challenges, some board members and implementing partners are already exploring or have adopted financing strategies to ensure the continuity of TB services. Nigeria’s coordinating minister of health and social welfare, Muhammed Pate, announced at the board meeting that the country will be allotting $54 million of its own resources to purchase TB drugs and diagnostics through the Global Drug Facility as it works to expand access for TB care and prevention in the country. Indonesian Health Minister Budi Sadikin, who served in the banking industry before working in government, meanwhile, encouraged others to look beyond traditional donor assistance for the TB response, arguing that every crisis also presents an opportunity. Apart from the U.S. government, he said, there are development financing institutions such as the World Bank that can help finance the TB response in countries. He gave the example of Indonesia, which has signed several loan agreements with multilateral development banks to boost the country’s health system. The country has also engaged in Global Fund-led Debt2Health arrangements, where it agreed to invest resources freed up from canceled debt from Germany and Australia into HIV and AIDS, malaria, and TB programs. Meanwhile, the Global Fund is currently working with governments to map out which TB programs are financed by external donors and how they can be covered by domestic resources and how to ensure that their budgeted funds for TB are used effectively. In Nigeria, it’s supporting a pilot in select states to expand the country’s national health insurance to include TB testing and treatment. At the meeting, civil society and groups of people affected by TB called on countries and financing institutions not to leave them behind in these discussions, and to continue to fund their work, emphasizing the significant role they play in the TB response. Cost reductions The Stop TB Partnership Secretariat continues to engage with traditional donors, the U.S. included, while collaborating with development banks, including the Asian Development Bank, toward efforts to end TB. Jeffrey Graham, senior bureau official for global health security and diplomacy at the U.S. State Department, and Eduardo Banzon, director of the health practice team at ADB, are now board members of the partnership. The secretariat is also looking at ways to drive down TB response costs, including in the rollout of new and low-cost testing tools and approaches, such as pooling sputum specimens and integrating screening for TB with other diseases. But it is also looking at further cost efficiencies in its own operations despite having a record year of signed donor agreements amounting to over $563 million. This is because most of the funding that has come in is highly earmarked for specific activities, based on information and documents seen by Devex. The secretariat has already let go of over a quarter of its staff, and is looking at other ways to reduce costs, including outsourcing the procurement of TB diagnostics and potentially sharing an office space with other Geneva-based organizations. “Even though we went through reducing our team in mid-2025, I think we need to be mindful and prepare and be ready for anything. And as such, I think we need to look at increasing efficiencies in terms of how we deliver work, in terms of partnering with other organizations for reducing space costs, operation costs, as well as doing business in a different way,” Dr. Lucica Ditiu, executive director of the partnership, told Devex.