CIVICUS discusses the need for community-centred approaches to global health funding and governance with Solange Baptiste, Executive Director of ITPC Global, a South Africa-based global organisation working to achieve health and social justice for all.

In early 2025, the Trump administration’s funding freeze devastated the global health sector, triggering immediate medicine shortages and staff furloughs, and disrupting HIV treatment across multiple countries. Clinics dependent on US assistance were stripped of supplies and resources virtually overnight. This crisis has exposed the fragility of donor-dependent systems and intensified calls for more equitable and resilient funding alternatives, including Global Public Investment (GPI) frameworks where all countries contribute to, participate in and benefit from shared decision-making rather than depending on the whims of major donors.

What’s ITPC Global’s mission and why is it important?

Formerly known as the International Treatment Preparedness Coalition, ITPC Global was founded in 2003, at a time when antiretroviral medicines for people living with HIV were prohibitively expensive. Its initial goal was to ensure access to treatment for everyone, regardless of income or location.

Since then, our mission has evolved. Our world is undergoing multiple crises, and when crisis hits, those closest to the problems must be at the centre of the response. We believe the top-down era of global health is over. We work for health and social justice, but we don’t view communities as passive recipients of aid or treatment but as architects of solutions. We work to shift power, putting it back in the hands of the people.

 

What has been the impact of the USA’s funding cuts?

The impact has been nothing short of devastating, not just for ITPC, but for the entire public health sector and the wider ecosystem. These cuts have led to the shutdown of life-saving services with only a few exceptions, such as services for pregnant and breastfeeding women. Programmes such viral load testing and pre-exposure prophylaxis distribution have either been suspended or drastically scaled back. We’ve seen clinics close and data systems shut down, particularly those funded by the US President’s Emergency Plan for AIDS Relief.

According to our community-led monitoring data, in countries such as Malawi and South Africa, services to key populations have simply disappeared. In just one month, 15,000 healthcare workers were furloughed in South Africa.

This isn’t just a slowdown; it’s a collapse. Governments are now struggling to figure out how to respond and fill the gap, but they lack the resources. This is money governments simply don’t have and can’t obtain through taxation. Philanthropy can’t fill the gap either.

But the crisis goes beyond funding: we’re also facing a massive trust crisis. For years, we’ve fought stigma and discrimination. We’ve worked with people living with HIV, reassuring them that treatment was safe and insisting they had to take the medicine consistently. But now, with medicines abruptly cut off, that trust is unravelling, undoing years of progress overnight.

The ripple effects are tectonic. We’re also seeing impacts on tuberculosis services, gender-based violence programmes, support for orphans and supply chains for diagnostics and medications. The entire ecosystem has collapsed overnight, simply because the funding disappeared.

What alternative funding sources are you exploring?

We’ve been exploring GPI as an alternative approach built on shared responsibility: all benefit, all contribute, all decide. This represents a radical shift from the old donor-recipient model, which the recent crisis has exposed as dangerously fragile. We can’t keep relying on a few wealthy countries to fund responses to challenges that span HIV, food security and social protection.

Rather than simply filling funding gaps, we need to redesign the entire system. This means accepting that this isn’t a temporary storm we can ride out, but a new climate we must adapt to.

The Global Fund for HIV, tuberculosis and malaria demonstrates these principles in practice: governments contribute, civil society participates and decisions are made inclusively. Yet even this model relies heavily on US contributions for nearly a third of its budget and is now facing liquidity issues.

We need to co-design something new that challenges us to ask hard questions, such as: who contributes – and what incentives drive them to do so? Who decides – and whose voices are consistently excluded? Will major donors be willing to share power in exchange for shared resilience? Can we design a funding model where equity, not dependency, is the default? That’s the conversation we need to have.

 

How can communities achieve sustainable healthcare?

Sustainable health starts with self-determination: communities must be informed and empowered to make decisions for themselves. The key, whether we’re talking about AI or new financing models, is placing them at the centre rather than treating them as an afterthought.

Technology can be a powerful ally in this process, but only if it’s used to support, not replace, communities, and if the digital divide is simultaneously addressed. In South Africa, for example, AI has been used in self-testing for HIV, freeing up resources for human-centred care. Some people might ask why we’re investing in AI when basic services are collapsing. The answer lies in efficiency: by making health systems more cost-effective, we can redirect resources to those most in need of face-to-face support.

However, technology without power-sharing is meaningless. Directly affected local communities must have real influence over priorities, design, data, budget and governance. They must be part of co-creation from the start, not add-ons at the implementation and evaluation stages. Without this fundamental shift, new technologies will simply reproduce old hierarchies and become part of the problem rather than the solution.

What immediate actions should policymakers take?

First, they should fund communities directly. It’s 2025: we’re planning to send people to Mars, yet we claim we still haven’t figured out how to get money into the hands of communities. It’s not that we don’t know how. It’s that we choose not to. The barriers aren’t technical; they are political and ideological. Time to be done with the excuses. Assess the risks, choose the right partners, trust them and let them lead!

We must also democratise global financing, treating community-led systems as essential public goods. This means embedding them into national health policies, funding them through fair and global co-investment and protecting them from political whims.

If we keep responding to crises with charity, we’re bound to repeat the same mistakes. Shifting to a justice-based model with shared responsibility is the only way to break the cycle.