Preliminary OECD data indicates that 2025 experienced the most significant annual reduction in official development assistance ever recorded, a 23.1% fall bringing global aid to levels last seen when the 2030 Agenda was adopted a decade ago. The OECD forecasts an additional 5.8% decline in 2026, with no indications of imminent recovery. For health systems reliant on this funding, as well as for women, children, and adolescents who depend on these services, this represents not only a temporary disruption but also a substantial setback with extensive implications.
Strong health systems, at the heart of the Global Financing Facility’s (GFF) mandate, deliver quality, affordable care to everyone who needs it - anchored by a skilled workforce, reliable supplies, sound financing, and accountable governance. When they work - mothers survive childbirth; children are vaccinated; outbreaks are contained. When they fail - preventable deaths rise; inequality widens; economies struggle.
What lessons from Ethiopia told us, and why it matters now
Save the Children’s 2023 Ethiopia analysis goes beyond a standard country case study, illustrating how the GFF’s health financing model achieves results and its significance for future global health funding. Three key lessons still stand out to me, highlighting urgent priorities that align with both the Lusaka Agenda on sustainable health financing and the Economics of Health for All framework.
First, the GFF is helping countries navigate fiscal constraints while strengthening health systems as an investment priority: Ethiopia’s experience shows constrained fiscal capacity and competing demands on public funding. GFF support, including through mobilising additional financing, has expanded fiscal space and strengthened how governments prioritise health spending. This aligns with the Economics of Health for All approach, which views health as a foundational investment in human capital and economic growth, rather than a residual cost. By guiding better allocation decisions, GFF helps countries protect and prioritise investments with lasting social and economic benefits.
Second, the GFF model puts the Lusaka Agenda into practice by reducing fragmentation and promoting alignment: Unpredictable funding has often hindered health systems. Ethiopia illustrates how the GFF’s country-led approach aligns domestic and external resources under one plan for better coordination and investment impact. This meets the Lusaka Agenda’s goal of aligning external finance with national systems through coherent, country-owned strategies like “One Plan, One Budget, One Report”.
Third, the GFF is advancing equity through targeted financing reforms: Equity is central, with efforts to reduce disparities and increase access for underserved groups. The GFF supports this by improving planning and funding methods that focus on those most at risk. Investing in health systems requires structuring finances to promote equity, efficiency, and sustainability, not just raising funds.
The Ethiopia results: what GFF investment has delivered
In Ethiopia, the maternal mortality ratio fell from 399 to 267 per 100,000 live births between 2015 and 2020 - a one-third reduction in just five years. This is what strong health financing delivers.
Since the GFF became operational in Ethiopia, working in close partnership with the government, with the government firmly in the driver’s seat, the data tells a powerful story. Skilled birth attendance rose from 28% to 50% between 2016 and 2019. Antenatal care (four or more visits) climbed from 32% to 43%. Modern contraceptive use among married women grew from 35.3% to 40.5%. Stunting in under-fives fell from 38.3% to 36.8%. Maternal mortality dropped by a third.
Why the GFF is uniquely placed, and what TRANSFORM 2030 MUST DELIVER
The GFF is one of the few global mechanisms designed to tackle structural constraints at the system level. By combining domestic funds, World Bank IDA, and external financing into a unified national investment case, it addresses health system fragmentation and underinvestment. Without this kind of integrated investment, the alternative is stark - fragmented services, health workers unpaid, clinics without medicines, and families pushed into poverty by out of pocket costs. The women and children who lose the most are those who had the least to begin with.
A strong start to its 2026 -2030 investment opportunity
The GFF's resource mobilisation event last week represents a significant achievement in global health financing. Amid constrained aid budgets and competing international priorities, the GFF has obtained renewed commitments from a diverse coalition of partners, reflecting sustained trust in its model and objectives.
While this accomplishment marks notable progress, further efforts are required. The GFF has established a substantial target for its 2026–2030 investment opportunity and continues to seek additional resources to fully realise this goal. Bridging this gap is crucial for enabling countries to execute their investment cases and advance health outcomes.
The UK ask: leadership at a moment of maximum leverage
This year is a crucial chance for donors, including the UK Government, to increase funding for the GFF as inflation in LMIC raises costs and limits access to essential health services. A strong uplift this year would demonstrate that Britain stands with the world's mothers and children, protecting recent progress despite economic challenges.
By advancing the GFF’s core mandate - its catalytic approach, to supporting partner countries to prioritize investments in the most cost-effective health interventions and build resilient and sustainable health systems for women, children and adolescents - external partners can help drive stronger, more sustainable health systems across countries and regions. This is not just a pathway to progress; it is the only way to protect the gains we cannot afford to lose.
