In the first few months of 2025, the global health landscape faced significant change. The new US administration froze all U.S. foreign aid in January—and by March, 83% of all USAID programs were eliminated resulting in 5,200 projects halted. The UK also followed this trend, cutting its own foreign aid budget by 40% an bringing its commitments to the lowest levels since 1999.
These are not symbolic cuts. They are systemic shocks with devastating immediate and long-term consequences.
Health systems around the world are collapsing under the weight of these decisions. Clinics are closing. Frontline workers are being laid off. Millions of people, especially women and girls, are losing access to life-saving care. From maternal health and HIV prevention to mental health services and gender-based violence response, essential programs have gone dark. And this is just the beginning.
Philanthropy has an urgent role to play.
A Rapid Unraveling of Services
In March, Columbia University’s Global Health Action and Evidence (GHAE) program convened more than 300 stakeholders at the UN Commission on the Status of Women to take stock of the damage. I had the opportunity to join a panel of researchers and leaders to explore philanthropy’s role in this moment.
New data collected between January and March 2025 paints a grim picture: widespread shutdowns of health facilities, deepening inequities in access to care, and a looming crisis in global public health infrastructure.
Survey responses from aid workers in 36 countries revealed extensive disruptions across gender-based violence prevention, HIV treatment, maternal and reproductive health, and mental health services. Entire communities have been left without access to care.
The impact is particularly severe for the most vulnerable: pregnant women, LGBTQIA+ individuals, sex workers, people living with HIV, and displaced populations. Clinics that once served these groups are shutting down. Health providers are warning of sharp increases in preventable illnesses, unattended births, and untreated mental health conditions.
A Gendered Crisis
The burden of this crisis falls disproportionately on women and girls. According to amfAR’s data, the pause in funding is leading to more than 1,700 preventable pediatric HIV transmissions every day and leaving over 10,000 women without access to essential HIV services. Almost every organization surveyed reported that without continued support from PEPFAR—the U.S. government’s flagship HIV/AIDS program—they would be forced to shut down.
Mental health services are experiencing similar devastation. The Global Mental Health Action Network estimates their reach has dropped by over 95% in just three months. The workforce providing this care, which is predominantly women, is shrinking rapidly, just as global needs skyrocket.
This is not only a health emergency. It is a social and economic one. When women lose access to care, the ripple effects are generational. When female health workers lose employment, families fall into poverty. When girls lose safe spaces, their futures are threatened.
What Philanthropy Can—and Must—Do
Philanthropy cannot—and ultimately should not—replace billions in lost government funding. But it can play a unique and critical role in responding to this moment and shaping what comes next.
- Act swiftly and flexibly
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Philanthropic capital is often more nimble than public funding. Now is the time to issue emergency grants, provide unrestricted funding, and reduce administrative burdens to keep frontline organizations operating.
- Fund holistically
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Women’s health is intersectional. Investments should reflect this reality—supporting integrated care that addresses HIV, maternal health, mental health, and gender-based violence together, rather than through siloed funding streams.
- Trust local leadership
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Organizations led by women and based in affected communities know best what their people need. Philanthropy must commit to shifting power and resources to local actors and ensuring meaningful community engagement in funding decisions.
- Invest in data and long-term resilience
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Reliable, real-time data is essential for directing resources effectively. Philanthropy should also help build the systems that will prevent future collapses: sustainable financing mechanisms, locally governed health networks, and stronger coordination across sectors.
From Emergency to Transformation
While the collapse of U.S. and UK aid is deeply destabilizing, it also opens space for new thinking. The current model—over reliant on a few governments, rigid in structure, and slow to adapt—is clearly no longer viable. We now have an opportunity to reimagine global health funding in ways that are more diverse, equitable, and grounded in the needs of communities.
We can—and should—support the development of integrated, population-based health systems. We can seed regional coalitions that pool and direct resources more effectively. We can help amplify the leadership of national governments across the global south.
Philanthropy is uniquely positioned to accelerate these shifts. We can serve as a bridge, supporting innovation, convening new partnerships, and investing in the infrastructure that traditional donors often overlook. As one example, Bill Gates recently pledged to distribute nearly all of his wealth, approximately $200 billion, toward global health over the next two decades. That kind of clear and upfront commitment signals the transformative potential of philanthropy when aligned with long-term strategy and bold vision.
We are at a turning point. If philanthropy responds boldly and strategically, we can help stabilize systems in crisis and lay the foundation for a more resilient, more just global health ecosystem.
This is not a moment for half-measures. The stakes are simply too high—for women, for girls, and for everyone who depends on a functioning, compassionate global health system.
