Across 2025, overall funding for global health foreign assistance fell by over US$10 billion, part of a global policy realignment away from externally funded programs. The impact is still being debated, but early analyses point to some troubling signs, such as estimates that care has been disrupted for around 53 million people globally, with the majority located in Sub-Saharan Africa. In response, donors like the U.S. Government are restructuring assistance to protect essential services and empower recipient countries.

This has also led many African governments to reconsider their global health strategies. In previous years, most could rely on relatively stable funding from a small set of major donors, with grant values and timelines that rarely changed. Now, governments must identify new international partners or raise funds domestically, while choosing where to invest scarce resources amid multiple overlapping crises.

Multilateral organisations and global donors such as the UN bodies, charities, and NGOs are also adjusting. The past 14 months have largely seen piecemeal efforts to keep essential services running, such as HIV treatment or TB testing, while fewer system-wide actions have been taken to rebalance budgets, raise domestic revenue, or advocate for renewed partnerships.

Internationally, blended financing models are emerging, and the U.S. Department of State is beginning to roll out multi-year bilateral health agreements under the America First Global Health Strategy, proposing a new model that demands mutual commitments and co-investment.

Two things are clear. Partner governments, especially those signing bilateral health agreements, are expected to gradually co-finance programs and assume a growing programmatic leadership role for health programs long supported by foreign aid. And given real constraints, they will need to stretch the impact of every dollar.

To do this successfully, governments must adopt a technology-centered approach, strengthening the digital and data foundations of their health systems.

How Digital Health Fits this Moment

Digital health has played an expanding role in global health initiatives for years. More than 30 African countries, including Ghana, Kenya, Nigeria, Rwanda, and South Africa, have adopted national digital health strategies, often focused on electronic medical records, surveillance, and telemedicine.

In the context of declining funding and geopolitical uncertainty, the urgency of investing in digital health infrastructure has only increased. When applied well, technology can create multiplier effects, making health systems more efficient and less costly to run. This is especially true when they leverage U.S.-developed technologies and other innovative solutions, building win-win commercial relationships and building self-sustaining healthcare markets in partner countries.

Integrated health information systems give decision-makers visibility across the system, showing where resources are deployed, which gaps matter most, and whether interventions are working. They also facilitate early epidemic detection and health security, critical to limiting of the spread of outbreaks, such as the recent Ebola epidemic in the Democratic Republic of Congo.

In Botswana, teams are working with the Ministry of Health to scale a digital community health system, Ikitse, enabling patient data to be collected in remote clinics and synced to the national level. In Lesotho, a nationally owned logistics management system tracks drug distribution across hundreds of facilities and updates automatically when prescriptions are dispensed.

This visibility helps officials identify outbreaks, monitor medicine supplies, and reassign clinicians during emergencies. It also reduces paperwork, freeing health workers to focus on patient care.

Without a complete data picture, it is impossible to make informed decisions about transitioning services to local ownership or determining which programs still require external support. As roles shift and new partnerships emerge, governments must be able to move quickly and abandon approaches that are not delivering results.

Moving from fragmented, donor-driven programs to unified national systems is only possible through deliberate digital solutions, such as health information exchange platforms and interoperability frameworks. In Eswatini, this required a multi-year effort to integrate an HIV-focused client management system with other health programs, aligning data standards across diverse operating environments. In Nigeria, Palladium supported the Federal Ministry of Health to automate HIV and TB data processes and develop dashboards for TB diagnosis, testing, and notifications, saving staff time for supervision and quality improvement.

Beyond efficiency gains, digital systems improve data accuracy by reducing manual errors and lost files. With paper-based systems, patients may receive incorrect dosages or make repeat clinic visits if records cannot be found. For conditions like HIV, where treatment timing is critical, these disruptions can be life-threatening.

Looking Ahead

Digital health is not a silver bullet, but it is a prerequisite for transitioning donor-run programs to government ownership while building more resilient and responsive health systems. Donors and multilaterals must increasingly support government-led digital health investments, aligned with national strategies and built on open, flexible standards. As experimentation continues, value must be measured early and often, linking digital investments to clear monitoring gains and consistently demonstrating cost effectiveness.

In an era of fiscal constraint and political uncertainty, this is how global health assistance can remain catalytic and deliver lasting impact.