The money for women’s and girls’ health exists. It is committed, announced, and tracked. What does not exist is a system that allows the organizations closest to communities to access it. For example, in Kisumu, a community health worker knows exactly which girls have dropped out of school, which mothers have stopped coming to the clinic, and why. She has built that knowledge over years. The organization she works for is effective by every measure that matters on the ground. It is largely invisible to the system that controls funding. This is not an isolated case. It is how the system works.
There is growing interest in locally led and outcomes-focused financing. The intent is right, but the design is not. Most funding systems were built for large international actors, with layers of compliance, reporting, and risk management that smaller, locally led organizations were never resourced to carry. The result is a contradiction we are not naming clearly enough. Funders say they want to resource local organizations, while continuing to use systems that exclude them. What we are seeing is not a capacity gap. It is a design failure. Until that is addressed, the organizations with the deepest reach into communities will continue to sit outside the funding structures that claim to prioritize them.
How the system was built, and why it is holding.
For the past two decades, global health funding has followed a familiar structure. Donor governments and major foundations allocate funding to international organizations, multilateral agencies, and large contractors. These actors then subcontract local partners to deliver work on the ground.
This model created scale, but it also created distance. By the time funding reaches a community health worker, it has passed through multiple layers of management, compliance, and reporting, each shaping what is funded, how it is delivered, and how success is defined. That system is now under strain. Funding is tightening. Political priorities are shifting. Large bilateral flows are becoming less predictable. The question is no longer how to restore that pipeline. It is whether that pipeline was ever designed to support locally led delivery in the first place.
The localization gap is structural
The gap between intent and reality is not subtle. Most funding systems rely on due diligence processes, financial management requirements, and reporting structures designed for large organizations with established infrastructure. When these same systems are applied to locally led organizations with smaller teams and deep community relationships, the conclusion is often that they are “not ready.”
That framing misses the point. The infrastructure required to meet these expectations was never something most local organizations were funded to build. Expecting it to exist without investing in it creates a circular logic that keeps the same actors at the center of funding flows. The focus, then, remains on strengthening individual organizations to meet existing standards, rather than questioning whether the standards themselves are fit for purpose.
New financing models are often presented as a way forward, but they are not a silver bullet. Two approaches in particular are receiving increased attention : trust-based giving and outcomes-based financing. Both respond to real limitations in the current system. Neither automatically resolves them. Trust-based approaches shift the relationship between funders and organizations. They reduce administrative burden, extend timelines, and place more emphasis on long-term outcomes, creating space to respond to what is actually happening in communities. But access remains uneven. Entry into these funding relationships is often relational, and many locally led organizations remain outside those networks.
Outcomes-based financing shifts the focus to results rather than activities. In principle, this should favor organizations that deliver meaningful outcomes, regardless of size. In practice, it introduces new requirements. Organizations need upfront capital, reliable data systems, and the ability to absorb financial risk if results fall short. These conditions tend to advantage larger actors. These models are not flawed in themselves. They are operating within a system that has not been redesigned to support them.The conversation we are not having enough: aggregation
There is one idea that remains underdeveloped, and it is central to making any of this work. Individually, most locally led organizations will not meet the threshold that large funders require. The transaction costs are high, the perceived risk is concentrated, and the infrastructure needed to manage large grants is difficult to sustain at that level.
The sector’s default response has been to strengthen individual organizations, improve their systems, support proposal development, and build compliance capacity. That work matters, but it is not enough. The issue is not only the capacity of individual organizations. It is the unit through which funding is structured.
Aggregation changes that unit.
When locally led organizations operate as networks with shared accountability frameworks, pooled data, and coordinated delivery models, they become legible in a different way. They shift from being seen as small, high-risk actors to being recognized as collective delivery systems with scale and reach. This is not about merging organizations or creating additional layers that dilute value. Poorly designed aggregation can replicate the same inefficiencies the sector is trying to move away from.
When done well, aggregation distributes risk across multiple organizations rather than concentrating it in one, creates shared infrastructure for financial management, data, and reporting that no single organization would realistically sustain alone, and allows funders to engage at scale while maintaining the contextual depth that sits within each organization.
In our work with locally led organizations, one pattern is becoming clear. The most significant shift is unlikely to come from any single organization becoming more “fundable” on its own. It will come from organizations becoming visible and credible together in ways that none of them could achieve individually. This is where aggregation becomes a viable pathway, not as theory, but as a practical response to the concerns funders are already raising around scale, risk, and accountability. If outcomes-based and trust-based financing are to work for locally led actors at scale, aggregation is not a side idea. It is one of the few pathways that can make both models viable in practice.
What practitioners can do now
Most organizations do not have the luxury of waiting for systems to change. There are practical steps that can be taken within current constraints. The first is clarity on outcomes. Not activities or outputs, but what is changing in the lives of the people you serve. This requires disciplined thinking and consistent documentation. The second is strengthening core institutional foundations. Financial records that can withstand scrutiny. Governance structures that function in practice. Clear accountability mechanisms. These are the basis on which trust is built. The third is intentional network building. Identifying peer organizations working on related challenges and investing in relationships before a funding opportunity requires them. Networks built over time are more likely to function as genuine delivery systems rather than transactional alliances.
What needs to change
The community health worker in Kisumu will continue doing her work regardless of how the system responds. The question is whether the system will continue to operate at a distance from that reality. What needs to change is structural. Funders will need to redesign due diligence processes, so they are proportionate to organizational scale. They will need to invest in institutional infrastructure as part of funding, not as a precondition for accessing it. And they will need to engage with aggregation models that allow impact to be understood and supported at a collective level. For locally led organizations, the path forward is not to replicate systems that were not built for them. It is to define, together, what credible, accountable, and scalable delivery looks like in their context, and to build toward that collectively. This is where the next phase of work sits.
At Orpesi, we are working alongside organizations and networks that are navigating this shift. The work is not about helping individual organizations fit existing systems. It is about redesigning how strategy, institutional strength, and financing come together so that locally led actors can deliver, grow, and be trusted at scale.
The money and ambition exist. The missing piece is the system that connects them in a way that reflects how change actually happens on the ground. That system can be built. The question is who is willing to build it differently.