Redefining Global Health in the 21st Century, Chpt 4: Financing Global Health in an Era of Scarcity

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