Several significant pledges for global health – covering reproductive health, ‘transition’ and Ebola – were made on the fringes of last week’s United Nations General Assembly amid massive donor withdrawal from the sector.

Reproductive health, which has suffered massive funding losses, got a $337.8 million boost from the United Kingdom, which announced its pledge at an event co-hosted by the United Nations Population Fund (UNFPA).

Most of the money will go to the UNFPA’s Supplies Partnership, which ensures reliable access to contraceptives and maternal health medicines in 54 low- and middle-income countries.

Globally, UNFPA estimates that 259 million women who want to avoid or delay pregnancy are still not using safe, modern methods of contraception, and UNFPA executive director Diene Keita told UNGA that there was a $185 million deficit in contraceptive funding this year alone.

Announcing the pledge, UK Minister for Development Kirsty McNeill, said: “It is a scandal that women and girls are denied the fundamental right to make informed choices about their own bodies, free from coercion, discrimination and violence. 

“Every woman and girl should be able to make decisions about her own future. That choice can mean staying in school, finding work or surviving childbirth.”

UNFPA described the UK pledge as “the largest single government investment in reproductive health supplies worldwide this year”, making “voluntary family planning a possibility for more than 15 million women per year and could prevent 14 million unintended pregnancies and over 35,000 maternal deaths by 2028”.

Four of the world’s poorest countries – Burundi, Madagascar, Mozambique and Zimbabwe – announced increased domestic investment in reproductive health services. 

Zimbabwe has committed $250 million to improving its hospitals, 30% of which will boost maternal and child services, and $2.25 million for reproductive health supplies. Madagascar will spend $20 million on reproductive health products, Mozambique $17.6 million and Burundi, $4.5 million on products and obstetric services.

“Record-high domestic commitments show that national governments are investing more of their own resources to help prevent unintended pregnancies and reduce maternal and newborn health complications and deaths,” added UNFPA.

Longstanding donor governments, including Denmark and Norway, also announced new and multi-year support for UNFPA, while private philanthropic organisation GiveWell announced its first investment in UNFPA with a $10 million grant.

In 2024, 43% of global family planning aid – around $500 million – was funded by the US, according to US health organisation, KFF. 

Despite a US Congressional allocation of over $600 million to support global family planning programmes, the Trump administration has indicated that it does not wish to fund any family planning in future, and its bilateral ‘America First Global Health Strategy’ grant agreements do not include reproductive health.

Aid for Africa’s transition

Meanwhile, Coefficient Giving announced the launch of the Health Aid Transition Fund (HATF) to assist low- and middle-income countries to adapt their health systems amid rapidly declining aid. 

The Fund will recommend at least $165 million in grants over the next three years, with support from Good Ventures, the Livelihood Impact Fund, and a private donor. 

By 2030, health aid is projected to be more than 25% lower than 2024 levels, and LMICs will need to rapidly scale up the financing of key public health systems themselves.

“These changes are a real shock to health budgets, but they’re also a chance to fix systems that were built around donor requirements rather than people,” said Amanda Glassman, Coefficient Giving’s managing director for global health and development policy. “Whether those systems come out of this weaker or stronger depends on decisions over the next few years.”

The HATF will focus on four main issues: keeping key services running during the transition; helping governments set priorities with smaller budgets; increasing the share of money that reaches health facilities and people living in poverty by addressing blocks, including misaligned budgets; and mobilising domestic financing for health, including exploring revenue sources such as debt-for-health swaps. 

Glassman told Health Policy Watch that the fund will “primarily pay for technical teams to advise governments in managing the transition from the historic drop in aid”. 

“It will also directly fund services where there are broader benefits. For example, when philanthropic support can unlock bilateral aid that would otherwise go unspent or where there is opportunity to give governments space to pursue more ambitious reforms,” said Glassman.

“This is a multi-donor fund and our aim is for more philanthropic partners to join, increasing the overall pot of funding to support work that builds stronger health systems, even as global aid levels fall.”

Welcoming the fund, Sierra Leone’s Health Minister, Dr Austin Demby, said that his country has spent years building a health system alongside partners.

“That is rapidly changing now, and we intend to come out of it owning our systems outright. What we need from partners now is financing and expertise that strengthens what we are building,” said Demby.

Boost for Ebola response

An additional $700 million was also pledged by the G20+ foreign ministers – with $267 million from the United States – to contain the Ebola outbreak in the Democratic Republic of the Congo, as previously reported by Health Policy Watch.

Dr Jean Kaseya, head of Africa Centre for Disease Control and Prevention, described the additional money as “huge”.

“But pledges alone will not stop Ebola,” Kaseya added. “We must be able to trace every single dollar—from commitment to disbursement, from implementing partner to expenditure, and ultimately to the services delivered to affected communities. Transparency builds trust, accelerates delivery and saves lives.”