Redefining Global Health in the 21st Century, Chpt 4: Financing Global Health in an Era of Scarcity
Episode Description
In this episode of Redefining Global Health in the 21st Century, Ben chats with authors mike Reid and Eric Goosby about how funding shocks become life-and-death realities, starting with a case from Zambia after the January 2025 U.S. pause and cuts to PEPFAR that left many without antiretrovirals and destabilized HIV services in a system heavily dependent on U.S. support. They describe behind-the-scenes efforts to warn political leaders, on-the-ground resilience and improvisation, and the emotional toll of what they view as an abandonment of dialogue. The discussion explores whether donor dependency was a design choice, the roles donors should play (equity gaps, global public goods, and underwriting transitions), and options such as co-investment requirements, government-to-government funding, debt-to-health swaps, public financial management support, domestic resource mobilization (including sin taxes), and potential roles for development finance and sovereign wealth funds, while stressing the need to define a clear destination for health financing and country ownership.
00:00 Welcome and Book Intro
00:29 Zambia Funding Shock
02:26 Why Zambia Matters
05:58 Scrambling After PEPFAR Pause
07:58 Resilience and System Fragility
09:58 Eric Goosby Reaction
15:37 Dependency by Design
18:44 Colonial Debt Reality
22:25 What Solidarity Looks Like
26:10 Donor Funding Roles
30:21 Accountability and Oversight
32:50 Co Investment and Direct Funding
35:37 Debt Relief as Co Investment
36:46 Debt for Health Swaps
37:46 Modernizing Gavi and Global Fund
41:26 Local Accountability and Trust
45:26 Post Aid Era Roadmap
48:19 Building Country Ownership
53:46 Sovereign Wealth Fund Ideas
58:04 New Finance Tools and Taxes
01:00:04 Defining the Destination
01:04:03 Call to Action and Thanks
Learn more about the book:
https://bit.ly/redefining-global-health
More from UCSF Institute for Global Health Sciences:
https://globalhealthsciences.ucsf.edu
Check Out mike Reid’s Substack:
https://substack.com/@reimaginingglobalhealth
Check Out Ben’s Substack:
https://substack.com/@benplumley1
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