When the funding tide recedes, who is left carrying the weight of change?
This afternoon, I joined a session hosted by YieldHub and FEMNET on Financing Youth and Feminist Futures: From Tokenism to True Investment. Again and again, I heard the same refrain: we have been asked to show up, share our stories, and move mountains while receiving short-term project funds, rigid frameworks that stifle innovation, and almost no trust. Young people in the room said they do not only need a seat at the table but resources to back their ideas and their work. As leaders gather this week in Sevilla in Spain to renew global financing commitments, I can’t help but wonder: How many more decades will we diagnose the problem without building the courage and flexible, sustained funding to finally do something about it?
The last few months have been hard. I’ve watched the dismantling of global health programs, the quiet retreat of investors, and the shrinking of aid that so many communities rely on.
I spend a significant amount of my time working alongside small organizations. These are people who show up every day with big dreams for their communities and a commitment that is humbling. Organizations like LVCT Health in Kenya, which has pioneered community-led HIV prevention. Or Reproductive Health Uganda, which has expanded reproductive care in rural areas. Or Pakachere Institute in Malawi, where Malawian professionals lead social behavior change grounded in local realities.
These groups know their context better than any consultant could. Yet, despite years of impact, they are still held to thresholds that few can meet without predictable support: compliance systems, reserves, and boards that tick every box.
At times, it feels like the market is correcting itself after years of inefficiency, but in a haphazard, not planned, way. The rhetoric of localization has become a convenient exit ramp. “It’s your turn now,” donors say as resources evaporate.
Where is the truth here? It lives in the tension between aspiration and infrastructure. Between calling for locally led transformation and actually funding the patient, the unglamorous work it takes to get there.
How do we move the middle?
It begins with being honest about the cost of building strong institutions. Rethinking what “risk” looks like and who gets the benefit of the doubt—funding not just programs but the backbone systems that sustain them.
And it also means remembering this:
This is not about the Global North versus the Global South. It is not a zero-sum contest where one side wins and the other loses. There is a place and a responsibility for both. Years of progress were achieved through collaboration: the innovation of a lab in Europe, working in conjunction with the insights of a nurse in Africa, and donor dollars combining with local government efforts to scale up treatment.
We should not throw away the good that has been built. There is space at the table for all contributors, including international and local NGOs, governments, community leaders, and private sector partners. What needs to change is how that table is arranged, and who sits at its head.
In an ideal future, communities in the Global South will be firmly at the helm of determining their health priorities. They must be, because they have the most at stake and the deepest understanding of what works. The Global North can still play a supportive role. That can mean funding (yes, funding will still be needed), sharing technology, convening responses to cross-border threats, and sometimes stepping back and listening more than talking.
The relationship must be built on mutual respect and accountability, not paternalism.
I remain a cautious optimist. Budgets are tightening, and uncertainties loom large. Yet I see determination in the local organizations I work with. I see donors grappling with how to do things differently, some earnestly trying to reform.
We may need a shock to force conversations that were easy to ignore during the boom years.
If we truly put our money where our mouth is, we can turn this into a turning point, not a disaster.
For me, the guiding light is leaving no one behind. In health, that means every community has access to care. And it also means no capable, passionate organization should be left behind because of arbitrary barriers or lack of support.
To solve the challenges ahead, we need all hands on deck. That includes small-town NGOs with big dreams and seasoned global funders alike.
Our challenge now is to move the middle and find the balance where local leadership and global solidarity meet.
If we can achieve that, then even in an era of shrinking aid, we will not be shrinking our ambitions to build a healthier, more equitable world for everyone.