The Role of Spain and the Global Fund in the Global Health Financing Crisis

On 13 November, ISGlobal brought together in Madrid representatives of the Global Fund, journalists, and political and administrative stakeholders to address an urgent issue: the decline in international financing for global health and the role Spain can play in this context. This meeting provided a space for analysis on how to sustain progress made in HIV, tuberculosis, and malaria at a time marked by the withdrawal of key donors.

Immediate effects of the withdrawal

The decline in international funding is already being reflected across the global response to major epidemics. Reduced contributions from key donors are slowing the scale-up of recent technologies, limiting the capacity of national programmes to maintain treatment coverage, and hindering the strengthening of health systems that rely on these funds to support human resources, laboratories, supply chains, and data systems.

Budget uncertainty jeopardises progress that has helped save more than 70 million lives, has reduced mother-to-child transmission by 73% globally, and prevented 20 million new infections since the creation of multilateral mechanisms such as the Global Fund.

Identified priorities for HIV

During the meeting, four priority areas for action were identified: improving prevention with new tools such as long-acting injectables, including Lenacapavir; moving towards the elimination of mother-to-child transmission; adapting health systems to an ageing HIV-positive population; and strengthening digital information systems that require stable financing.

A key Global Fund and middle-income countries under pressure

The Global Fund remains a central pillar of the global health architecture and is progressing towards more integrated, primary-care-centred models aimed at reducing fragmentation and enhancing programme sustainability.

However, middle-income countries face growing challenges: without access to licences that reduce the cost of new innovations and with diminishing international cooperation, sustaining essential programmes becomes increasingly complex. Although many countries show economic growth, they still fall short of commitments such as allocating 15% of the national budget to health.

When progress stalls, inequality grows

Stagnation in the fight against HIV and malaria hits the most vulnerable groups hardest —young children, pregnant women, adolescents, and stigmatised populations— while international funding cuts, particularly from the United States, threaten the Global Fund’s response and the stability of already fragile health systems.

Spain’s role

Amid this challenging context, Spain has increased its contribution to the Global Fund from 130 to 145 million euros, a move that reinforces its role in the international debate and its capacity to help build coalitions for the reform of the global health system.

The meeting highlighted that the future of global health depends on decisions being taken right now. Science has shown what works, but insufficient financing threatens to reverse historic gains. Spain now has the opportunity to help sustain international commitment and promote solutions that prevent hard-won progress from slipping backwards.

This chronicle has been drafted based on the original text by Lalama Jabby and Laura Agúndez.