A year of significant aid cuts and institutional reform has reshaped where influence sits across the global health sector.
WHO projections indicate there was a 30-40% decline in global health funding last year – a loss of around $10 billion – driven largely by the closure of USAID and wider UK and European cuts. In this context, the sector is now facing growing pressure to move beyond traditional donor-led models, by strengthening country and regional leadership and advancing systemic reforms that deliver better value for money.
In this context, conversations at last month’s World Health Assembly centred on fundamental questions around who funds health systems, who drives them and who is left behind when they fail, setting the direction for how global health advocacy is likely to evolve towards 2030 and beyond.
Theme 1: Power, money and legitimacy is being redistributed
When global health funding was withdrawn at scale last year – with some countries reporting cuts of up to 70% – it exposed just how fragile health systems worldwide really were, with many life-saving services coming to a halt almost overnight. Affected countries are determined to ensure this does not happen again, taking deliberate steps to reduce their reliance on external aid. Notably, momentum is building behind a transition from aid dependency to economic sovereignty and local leadership, catalysed by the Ghana-driven Accra Reset, and an increase in bilateral agreements.
This is driving a clear shift in expectations for organisations operating in global health. Calls for funding cannot focus solely on filling short-term gaps; instead, initiatives must show how they strengthen durable national systems – through workforce and surveillance capacity to sustainable domestic financing. Perhaps more importantly, they must also demonstrate alignment with country priorities, offering governments the flexibility to tailor approaches to their own contexts.
Theme 2: Integration will be paramount, but clarity is also key
There is increasing consensus that global health today must move beyond disease-specific approaches towards investment in the systems that fight disease. Investments in primary care, community health workers and data infrastructure are increasingly considered an efficient and resilient approach to address health challenges at scale. Yet the term ‘integration’ remains loosely defined – and without clear guardrails, it risks being used to justify consolidation or cuts.
Digital transformation also sits at the centre of this shift. While AI tools offer significant opportunities to tackle growth, they also introduce new risks. The digitisation of health systems alone will not drive integration if these solutions remain disconnected from each other. And if countries remain passive users of externally developed technologies, they risk being left behind.
Theme 3: Pandemic preparedness remains a key governance challenge
After the world’s experience with the COVID-19 pandemic, one might assume that PPR remains high on global policymakers’ agendas. But last month, the World Health Organization declared the aggressive new outbreak of Ebola as a global health emergency – requiring a $500 million response. Media reports point to systematic failures that allowed the disease to spread – ranging from bureaucratic missteps and weak surveillance systems to workforce shortages and a lack of public trust in the health system.
And, although the Pandemic Treaty was formally adopted last year, it is not yet delivering on its promises. Last week, the WHO Director-General and the President of Brazil called on Member States to urgently agree how the benefits of shared pathogens will be fairly distributed, leaving one of the most politically sensitive elements of pandemic governance incomplete.
Moments like this highlight that pandemic response and preparedness is still shaped by politics and gaps in governance. In a world where action is driven by urgency, the challenge is therefore to make the case for sustained investment in preparedness before outbreaks escalate into full-blown emergencies.
The Portland view: Raising the bar for global health advocacy
Lives saved, diseases averted or funding secured are no longer the only measures of success. To achieve cut-through, global health initiatives must also demonstrate how they are helping to build locally led systems that can withstand political, financial and health shocks, requiring:
- Stronger political intelligence – with advocacy strategies grounded in a clear understanding of how donor priorities, bilateral relationships and domestic political incentives are shifting.
- Credible local partnerships – where local actors are the ones truly shaping priorities, implementation and accountability.
- Clear system-level value propositions – that demonstrate how disease-specific investments strengthen the system at large, from workforce capacity and surveillance to primary care, data infrastructure, domestic financing and preparedness.
- Broader advocacy and resource mobilisation strategies – that go beyond the traditional donor ecosystem to engage ministries of finance, bilateral partners, development banks, the private-sector and national stakeholders.
Ultimately, those that succeed will be those that can operate politically as well as technically: aligning with country priorities, building durable coalitions and making a credible case for investments that strengthen systems long after an immediate crisis has passed.
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At Portland, we help global health organisations strengthen their reputation, shape policy debates and mobilise support for critical health priorities.
Our team brings together senior communications advisers and specialists in global health and policy, with deep experience supporting governments, multilaterals, foundations, pharmaceuticals and life science companies.
