Global Health Funding at a Crossroads

by | Feb 18, 2025 | Activities, News & Updates, Webinars

Webinar Notes

On 11 February 2025, the Global Fund Advocates Network Asia-Pacific (GFAN AP) and the Seven Alliance jointly convened “Global Health Funding at a Crossroads” to unpack and discuss the current funding crisis in global public health affecting communities and civil society across Asia-Pacific.

This call aimed to engage community and civil society stakeholders for collective analysis of the current public health funding crisis and its implications for the Asia-Pacific region; enhance awareness and foster a sense of urgency within communities and civil society to respond proactively to these changes; and to initiate a collaborative process that creates space for information sharing and strategic collaboration to move forward collectively.

The 90-minute call was attended by over 90 participants across Asia and the Pacific, Europe and America, representing advocates working in HIV, tuberculosis (TB) and malaria spaces. The webinar was conducted under the Chatham House Rule to preserve the safety of the discussion space; therefore, the following round-up of discussion points will not include specific information about speakers and contributors, nor will the recording of the session be made publicly available.

The Current Global Health Funding Context

The webinar began with context setting: this health funding crisis threatens to unravel decades of progress made in HIV, tuberculosis (TB) and malaria. It is threatening programme continuity, organisational stability, and the well-being of millions of people from key and vulnerable communities who rely on these health resources. The freeze on USAID has been devastating for key populations across Asia-Pacific, including men who have sex with men (MSM), transgender people, sex workers, people living with HIV, and people who inject drugs (PWID) – similar impact is also being felt across other diseases.

At the same time, the ongoing shrinkage prior to this freeze in funding dedicated to global health, gender, equality, and human rights is also threatening to undo the broader progress we have made in building equitable and resilient health systems in Asia-Pacific. Lastly, the funding crisis may have significant implications for the upcoming Global Fund Eighth Replenishment and commitments made on global health aid.

Next, five speakers representing different communities and civil society across Asia-Pacific shared about the immediate impact on key and vulnerable populations observed on the ground.

HIV services in Asia

The US government has historically funded key HIV-related programmes for young people which provide essential preventative services, medical care, counselling and case management, including in Vietnam, the Philippines, Bangladesh, and Mongolia. However, the recent stop work order has forced many organisations to halt operations, resulting in immediate service disruption, staff layoffs, and severe funding gaps. Key and vulnerable populations including LGBTIQ individuals, sex workers, and people who use drugs are left without critical health services, mental health support, and harm reduction and prevention tools such as PrEP and self-testing kits. The funding freeze also worsens stigma and discrimination against people living with HIV and LGBTIQ communities, reinforcing harmful stereotypes and fuelling misconceptions about HIV transmission and prevention.

In several countries, prevention programmes and other services have been suspended. In Vietnam and Myanmar, HIV prevention programmes including PrEP services and other community outreach programmes have been stopped. If global health funding sources such as the Global Fund continue to face cuts, this could seriously impact the supply of antiretroviral (ARV) drugs, monitoring and other critical lifesaving services.

HIV services for sex workers

The funding freeze has severely impacted Nepal’s sex worker community and resulted in the shutdown of community-based organisations and networks in the country, causing widespread disruption of HIV services. Community support services such as mental health, education, awareness, and capacity building for sex workers have also been impacted. Another concern is the impact on ART (antiretroviral therapy) support and medication as well as Prevention of Mother-to-Child Transmission (PMTCT), which are important for female sex workers living with HIV.

Malaria services in the Greater Mekong Region

The funding freeze is a humanitarian crisis. The biggest impact on malaria programming is in the Mekong region: Thailand, Cambodia and Myanmar. Because the President’s Malaria Initiative (PMI) funding is designed to be complementary to the Global Fund, when one funding stream is halted, it causes disruption in malaria services. For example, Cambodia, a country which was significantly reducing malaria cases and moving towards elimination, is now facing a disruption of malaria services for more than 400,000 people. Refugee camp health programmes along the Thailand and Myanmar border are also similarly affected by programme disruption, and in Thailand, more than 18,000 migrant children studying at learning centres are impacted, depriving them of not only education but also health and humanitarian aid.

TB services in Cambodia and Asia-Pacific

In Cambodia, a five-year TB programme intended to cover a population of 4.2 million people across 9 provinces was disrupted after just 24 days, impacting a large team of 200 full-time staff and 5,000 community health workers who had to suddenly stop work. After the initial stop work order, the team had received a limited waiver to proceed with the project, then received another request to refrain from submitting a 30-day budget. This ambiguity has generated significant uncertainty and funding challenges for the team to bridge the interim gap in salaries and office costs.

Excerpt of statistics shared by participant:

  • Around 100,000 people missed TB screening activities within the 90-day award suspension, mostly supported by the project interventions which aim to intensify TB case findings through community-based TB screening methods: Seed-and-recruit, Contact Investigation and Mobile Active Case Finding (ACF).

  • Around 300 DR-TB and 10,000 DS-TB undetected (approximately 30% of DS-TB case notifications of the national DS-TB notification are from COMMIT) per year.

  • The award suspension directly affected 200 project staffs and 5,000 TB networks and community volunteers across 27 supported ODs, out of 103 ODs in Cambodia.

  • Around 25,000 people missed TB diagnoses within the 90-day award suspension, supported by COMMIT 2 where TB diagnosis heavily rely on community networks, including referral of presumptive TB, sputum collection and referral. The Award Suspension will also affect the important roles of mobile ACF in bringing digital tools closer to the community and hard-to-reach populations.

  • The impact of US Government funding freeze will cause the lives of TB patients in dangers including DR-TB and TB/HIV treatment as they miss treatment and care support, resulting adverse effects such increasing drop-out rate, becoming depression, drug-resistance and mortality

  • Around 2,500 close contacts, who are living with bacteriologically confirmed pulmonary TB patients, missed TB prevention treatment within the 90-day award suspension, supported by COMMIT 2.

  • It will affect around 10,000 TPT enrolments (approximately 60% of TPT enrolments of the national DS-TB notification are from COMMIT), per year.

Country-specific situations and immediate responses

The session proceeded to a discussion about immediate actions and mitigation strategies communities and civil society organisations have taken in response to the health funding crisis, summarised as below:

Cambodia

CSOs in Cambodia are in discussion with other partner donors as alternative funding sources, as well as the Ministry of Economy and Finance who is the chair of the Country Coordinating Mechanism (CCM) to develop mitigation plans.

There has also been engagement with the Global Fund principal recipients (PR) to discuss emergency funding needed to cover the financial gap. For example, malaria programming in Cambodia has identified a rough figure of US$400,000 needed to sustain the minimum of live-saving operations during the three-month funding gap period.

Indonesia

The US funding freeze coincided with a cost efficiency exercise by the new government and parliament in Indonesia, which has heavily impacted the Ministry of Health’s budget. The Ministry of Health’s approved budget of approximately US$ 7 billion is expected to be cut by 18.5%, though essential health programmes and procurement of life-saving drugs for HIV, TB and malaria are unlikely to be affected. What is likely to be affected are costs related to travel, meetings, and the funding for test kits.

The funding freeze by the US has primarily affected PEPFAR-funded PrEP programming, whereas ARV treatment is funded domestically and unaffected. However, even if PEPFAR funding were to resume, there is a concern about the continuity of programming for transgender persons due to the US’s new policy denying identities that fall outside the gender binary.

USAID funding for HIV in Indonesia primarily supported technical assistance to partners, especially the Ministry of Health. USAID funding also supported the community systems strengthening, including community-led monitoring and advocacy for HIV and TB. There were a few organisations who also received direct funding from USAID for service delivery. Without funding to these areas, the achievement of HIV, TB and malaria targets will be impacted.

As of this call, there had not been a response from the Indonesian government to the global health funding crisis. CSOs had conducted a mapping exercise to identify alternative donors but have found that most other donors are not focused on the three diseases; instead, their focus is on climate change and other issues.

India

While procurement of TB and HIV drugs remains unaffected by the US funding freeze, challenges in last-mile connectivity have emerged. USAID-funded programs that previously ensured medication and nutritional support have been disrupted, leading to a loss of personnel capacity within organizations. Even if funding resumes, many affected staff may have already sought other employment opportunities.

Vietnam

While the Ministry of Health in Vietnam has confirmed that the distribution of ARV drugs, PrEP, and HIV test kits can continue despite the funding freeze, there is no government funding to support the delivery of these services, which means communities will need to pay out of pocket to cover the costs of testing and treatment.

To address these issues, efforts are being made to engage with the Global Fund’s Country Coordinating Mechanism (CCM) and other key partners to secure emergency funding and alternative support for community organisations. In addition, a community clinic in Hanoi has begun informing clients about the situation, providing counselling, and exploring sustainable funding models, including providing commercial services to those who are more able to pay while maintaining free services for low-income individuals.

The broader funding environment and its implications to Global Fund funding in Asia-Pacific and the next replenishment

United States

The development sector in the United States is in a chaotic state, one that threatens the international aid infrastructure. Marginalised groups, particularly trans people, have become targeted as scapegoats in the current political climate.

Despite the waivers on treatment and PMTCT programmes under PEPFAR, it is challenging getting that clear directive to providers because the USAID staff force has largely been obliterated. This also calls into question the long-term provision of PEPFAR, given that around 60% of PEPFAR funding goes through USAID. Also concerning is that PrEP is now restricted to pregnant women only, and not to other populations.

A lawsuit was recently filed by AVAC asserting that the cancelling of USAID contracts was illegal. What is most important now is to document the impacts of the pause on aid, the waivers, and the situation on the ground. Videos that document the realities on the ground, even if recorded on cell phones, could be powerful to influence lawmakers. Hearing from government leaders in partner countries could also be really powerful in advocacy efforts to Congress.

The Global Fund has not received a stop work order, as of now, and are not in immediate danger in terms of financing. However, if the aid freeze goes on much beyond the 90-day period, the Global Fund could also face potential issues. The Global Fund’s Eighth Replenishment is closely dependent on the President’s Budget Request, expected in March or April, which would signal the US’s pledge to the Global Fund.

Leading up to this, communities and civil society in Asia-Pacific have a role to play in reaching out to Congress. It is also really important for governments and CCMs to communicate to the Global Fund about funding needs and areas of support needed – while keeping in mind that the Global Fund does not possess much additional funds and is working also to a limited budget.

Japan

Given the drastic actions by the US administration to close down USAID, suspend foreign aid, and orders to erode human rights for LGBTIQ+ persons, migrants, and the like, Japan’s society feels a strong responsibility to develop alternative financing streams to fight AIDS, TB and malaria in Asia-Pacific. However, Japan is also facing challenges with inflation, rising prices of commodities, heavier taxes and social security fees, as well as pressure from the middle class and centre-right government. Japan’s aid and foreign assistance has been restructured to be more business-oriented and include subsidies to the Japanese private sector.

Some of Japan’s strengths are that the country has been traditionally a big donor in the Asia-Pacific region and the fifth largest donor to the Global Fund. Global health and universal health coverage (UHC) remain major priorities for aid.

However, Japan also faces weaknesses such as a looming economic downturn due to an ageing and shrinking population, which impacts the Japanese national budget. Japan’s international grant and multilateral aid is also on a decreasing trend. Additionally, Japan prefers providing government-to-government aid and economic assistance, an approach which unfortunately tends to ignore civil society and communities, especially in the context of HIV/AIDS and other health issues.

Opportunities for engagement include TICAD 9 (the 9th Tokyo International Conference on African Development) taking place in August which focuses on Africa, the Global South, youth and women. TICAD 9 will be an opportunity to push for Japanese international assistance for health not just in Africa but also other regions such as Asia-Pacific. The Sustainable Development Goals (SDGs) has high recognition and popularity in Japan and is a key concept in government policies. This year, Japan will undergo a Voluntary National Review with the UN on the achievement of SDGs. This could be a point of leverage to increase Japan’s assistance towards the SDG on Good Health and Well-being. Lastly, Japan would respond well to business-focused approaches, such as how the Global Fund benefits the Japanese private sector, and could be a strategy to keep Japan’s commitment to the Global Fund.

Some of the threats include the influence of foreign policy shifts by other governments, which may prompt the Government of Japan to follow in their policy footsteps. There is stronger political influence exerted by the far-right and a spread of disinformation on health. There is also a threat of political instability with the upcoming Upper House election in July, which could be swayed by far-right influences. Japan also faces a constant risk of disasters such as floods and earthquakes, which could impede Japan’s ability to contribute to international aid.

Q&A and Ways Forward

A point was made that in this critical time, collective advocacy and action is needed to make sure our voices are heard and that stakeholders are aware of the impact and emergencies communities are facing, so that we are not left out in upcoming decision-making processes.

With the concern around potential impact on the Global Fund’s next replenishment, it is also important for advocacy to focus domestically to ensure countries are setting up the right systems, infrastructure, processes, and taxation systems to be able to fund equitable, rights-based and gender transformative health services for their own citizens.

Besides the US, other European donors such as the Netherlands and France have also cut their donor aid and official development assistance (ODA) significantly. That said, a silver lining is that the Australian Government has announced that gender equality will be a strategic priority for their foreign aid. We need to work more collaboratively with private sector and government donors, to see how they can step up to fill in the gaps at the country level.

One key action in response to the US funding freeze is documenting and collecting data points, including videos, that show the degree in which the stop work orders and waivers have had an impact on service continuity and the lives of people on the ground. Besides that, writing letters and engaging the US media to highlight the impacts from Asia-Pacific would also help with visibility to stakeholders.

There were also points made about creating a pooled grant to cover funding gaps and the necessity to develop multiple financial sources and a structure for domestic resource mobilisation (DRM) in order to reduce mid- to long-term dependency from traditional donor resources.

It was proposed that a smaller working group is formed for ideation, information sharing, and mutual support with advocacy activities and efforts.

  • Interested parties may email Jennifer Ho (GFAN AP) at jennifer.ho@gfanasiapacific.org to be included.
  • Communities and civil society were also encouraged to sign on to a Thank You letter for donor countries coordinated by GFAN Asia-Pacific and GFAN Africa. (Note: The form has closed at the point of the article publication)

The call concluded with appreciation from GFAN AP to all participants and speakers for their input, engagement, and continued resilience and solidarity during these extraordinarily challenging and uncertain times.