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Health Sector Strategy · 2026–2028
Decades of Progress in Global Health Are Now at Risk.
Global health funding has collapsed at a historic pace in 2025, uncovering key vulnerabilities of health systems and risks. This report maps where the gaps are largest, which interventions work, and where your donation can make the greatest difference.
Development Assistance for Health peaked at $80.3 billion during the COVID-19 pandemic. By 2030, it is projected to fall to $36.2 billion. The United States alone cut its health aid by an estimated 67% in 2025.
The countries hit hardest are those with the highest rates of preventable disease and the least capacity to absorb the loss.
This is The Life You Can Save’s first Health Sector Strategy — a rigorous, evidence-based analysis of where private philanthropic funding can have the most impact on global health over the next three years.
Funding flows to Development Assistance for Health (DAH)
Adapted from Apeagyei et al. (2025) pmc.ncbi.nlm.nih.gov/articles/PMC12439094/figure/F1/
The Context
A Perfect Storm in Global Health Financing
For twenty years, Development Assistance for Health played a key role for low-income countries’ health care provision. It funded the health workers who delivered care, the medicines that reached remote communities, and the systems that kept diseases in check.
That era is ending.
As traditional bilateral donors — such as the United States, the United Kingdom, or France — retrench under domestic fiscal pressure, a structural crisis is emerging in the countries least able to respond. Sub-Saharan Africa, which carries some of the world’s highest burdens of preventable disease, has experienced a 25% drop in external health assistance in a single year.
In some countries — such as The Gambia, Lesotho, Malawi, and Mozambique — total health spending capacity has shrunk by as much as 16.5% with no domestic alternative to fill the gap.
For donors, this is not only a crisis. It is a clarifying moment. As large bilateral donors step back, the relative weight and strategic importance of private philanthropic capital increases. This report identifies exactly where it can matter most.
67%
US health aid reduction in 2025 alone
25%
Drop in external assistance to Sub-Saharan Africa in a single year
4.5M
Additional projected child deaths under five by 2030 due to aid cuts
Finding 1 · Scale
A Few Health Conditions Drive the Majority Of Suffering
To understand where donations can save the most lives, we must first understand where lives are being lost. The Life You Can Save used data from the Global Burden of Disease (GBD) study — the world’s most comprehensive framework for tracking health loss globally — to map which conditions cause the most suffering in low-income and lower-middle-income countries.
What is a DALY?
A Disability-Adjusted Life Year (DALY) is a standardized unit measuring total health loss. One DALY = one year of healthy life lost — either to premature death or to living with illness or disability. DALYs allow us to compare the impact of vastly different conditions on an equal footing.
Total disease burden by cause, 2023
Adapted from IHME, Global Burden of Disease (2025)
In Low-Income Countries
More than half (52%) of all disease burden is driven by communicable, maternal, neonatal, and nutritional diseases — conditions that are largely preventable or treatable. The top three causes of health loss are:
- • Neonatal disorders — 12% of total burden
- • Respiratory infections and TB — 10.9%
- • Malaria and neglected tropical diseases — 7.9%
In Lower-Middle-Income Countries
These countries face a "double burden." Non-communicable diseases now account for 56% of DALYs — yet the absolute volume of infectious and neonatal disease has not declined, driven by rapid population growth. The top three causes are:
- • Cardiovascular diseases — 14.3%
- • Neonatal disorders — 9.4%
- • Respiratory infections and TB — 8.2%
Top three causes of disease burden in LICs and LMICs, 2023
Adapted from IHME, Global Burden of Disease (2025)
"A common thread across both income groups: neonatal disorders remain a top driver of disease burden. Around 5.4 million children under 5 die each year — the majority from conditions that existing medical interventions can prevent or treat."
Finding 2 · Neglectedness
The Diseases Killing the Most People Receive Insufficient Funding
Knowing which diseases cause the most suffering is only half the picture. The other half is understanding whether those disease areas receive proportionate funding — or whether private philanthropic capital is flowing elsewhere.
We analyzed funding flows from IHME data to map private donor spending against disease burden. In 2025, private donors and corporate foundations allocated approximately $3.6 billion to global health initiatives. The table below shows what proportion of this funding was allocated to a sub-set of health areas.
| Health Area | Disease Burden | Private Funding (2025) | Status |
|---|---|---|---|
| Reproductive, Maternal & Child Health | HIGH | $692M~19% of total | Underfunded |
| Non-Communicable Diseases | HIGH | $151M~4% of total | Critically Underfunded |
| Tuberculosis | HIGH | $86M~2% of total | Critically Underfunded |
| Malaria | HIGH | $47.7M~1% of total | Critically Underfunded |
| Neglected Tropical Diseases | HIGH | $42.6M~1% of total | Critically Underfunded |
Reproductive, Maternal & Child Health
Non-Communicable Diseases
Tuberculosis
Malaria
Neglected Tropical Diseases
Source: IHME (2025). Private donor and corporate foundation funding to global health.
These five areas represent the leading causes of mortality and morbidity across low- and lower-middle-income countries. Yet together they receive only a fraction of available philanthropic capital.
The situation for Reproductive, Maternal, and Child Health (RMCH) — the best-funded of the five — is still insufficient. Estimates from 2025 suggest that maternal and child health aid may be cut by as much as 92% under current aid reduction trajectories, with family planning and reproductive health funding at risk of falling 94%.
The projected consequence: an additional 4.5 million deaths among children under five by 2030.
Most Vulnerable Countries
Research by IDInsight identified the countries facing the sharpest combination of funding cuts and limited domestic capacity to respond:
Tier 1 — Most vulnerable
Central African Republic, Ethiopia, Madagascar, South Sudan, Tanzania
Tier 2 — Highly vulnerable
DRC, Guinea-Bissau, Malawi, Sierra Leone, Uganda
Finding 3 · Expert Consensus
Consulted Senior Health Officials Across Africa Agree: Systems Matter as Much as Diseases
Data alone cannot tell us what practitioners on the ground experience. To align our strategy with contextual realities, The Life You Can Save’s research team conducted a Delphi-style expert elicitation workshop in Kigali, Rwanda in December 2025.
We engaged 24 senior experts — including Ministry of Health officials, chief economists, regional health organization directors, and academic researchers from across Sub-Saharan Africa.
Focus of sessions
Session 1 — Elicitation
Identify high-risk areas
Anonymous open-ended responses
Session 2 — Ranking
Prioritize health areas by funding risk and philanthropic fit
Structured survey with statistical consensus measurement (IQR)
Session 3 — Consensus
Converge on strategic principles
Facilitated open discussion
Key insights from workshop
RMCH is the top priority — and a barometer for the whole system
Reproductive, Maternal, and Child Health was the #1 priority across all three workshop rounds, cited by 23% of participants as the area at highest risk of experiencing funding gaps in the next 3 years. Experts described it as a "diagonal" priority since it is both a leading cause of mortality in its own right, and an indicator of whether a health system is functioning at all.
The health workforce and medicine supply chains are the most fragile links
Nearly one-third of participants (27–28%) identified the health workforce as the area most likely to experience critical funding gaps. Medicine and supply chain systems followed closely (22–20%). These are the "backbone" of every health program.
The most sustainable path runs through primary care
Experts reached clear consensus that the most effective way to address infectious diseases like malaria, HIV, and TB is not through isolated vertical programs, but through integrated primary healthcare systems — the same infrastructure that supports maternal and child health.
NCDs are a growing, deprioritized threat
Non-communicable diseases received the highest proportion of "largest gap" designations in session 2 — approximately 40% of experts identified NCDs as the primary funding risk. Yet government budgets consistently deprioritize them in favor of acute infectious disease.
Median expert ratings of suitability of health investment areas for philanthropic funding
"The binding constraint in health systems today is no longer simply knowing what works — it is ensuring that the structures capable of delivering it remain standing."
— Consensus finding, Delphi Workshop, Kigali, December 2025
Finding 4 · Solvability
Proven, Cost-Effective Solutions Exist Across Every Priority Area
Identifying the scale of a problem and the depth of its underfunding is necessary — but not sufficient. Our framework requires a third test: is the problem solvable? Across all priority areas identified in this report, cost-effective, evidence-backed solutions exist.
Health Systems & Community Health Workers
- •CHW programs reduce under-five mortality by up to 27%
- •Reduce infant mortality by 33%
- •Immunization coverage increased from 50% to 68% in Uganda and 44% to 74% in Kenya (Living Goods, Uganda & Kenya)
- •Cost-effectiveness as low as 0.12× GDP per capita per DALY averted
Reproductive, Maternal & Child Health
- •Kangaroo Mother Care reduces neonatal mortality ~32% for low-birth-weight infants
- •Routine vaccination prevents 45% of under-five deaths from major pathogens
- •Exclusive breastfeeding could prevent 13.8% of child deaths under age 2
- •Family planning is "very cost-effective" across Sub-Saharan Africa and South Asia
Malaria & Neglected Tropical Diseases
- •Seasonal malaria chemoprevention reduces clinical malaria by 88%
- •Cost per DALY averted: as low as $11–$27
- •Mass Drug Administration cures 70–90% of parasitic infections in a single dose
- •School-based deworming reduces worm prevalence by up to 77%
Tuberculosis & Respiratory Infections
- •New shorter TPT regimens (1–3 months) dramatically improve patient adherence
- •Community screening: $72–$167 per DALY averted in high-burden settings
- •Integrated CHW programs can double TB case-notification rates
- •Novel TB vaccines could be cost-saving in 96% of high-burden countries
Our Current Portfolio
Strong Foundations — With Room to Grow
Our current recommendations already include high-impact organizations across malaria, NTDs, RMCH, and health systems strengthening. But our portfolio assessment also reveals clear gaps — particularly in tuberculosis, horizontal health systems, and the depth of RMCH coverage.
| Area | Coverage (no. of charities focusing on area) | Growth Priority |
|---|---|---|
Reproductive Maternal & Child Health
| Two | Future recommendations should prioritize interventions focused on improving the first 1,000 days of life and under-five mortality. |
| Four | ||
Infectious Diseases
| Five | Grow portfolio around interventions focused on TB and respiratory infections. Monitor effective roll-out of malaria vaccines. Focus on programs addressing NTDs in young children (aligned with newborn and child health). |
| None | ||
| Three | ||
Health Systems Strengthening
| Three | Prioritize horizontal interventions focused on integrated primary healthcare delivery, including programs that strengthen health systems more broadly rather than targeting a specific condition (e.g., workforce upskilling, supply chain improvements, resource use efficiency, digital infrastructure). |
| Eight | ||
| One |
Reproductive Maternal & Child Health
Growth Priority
Future recommendations should prioritize interventions focused on improving the first 1,000 days of life and under-five mortality.
Infectious Diseases
Growth Priority
Grow portfolio around interventions focused on TB and respiratory infections. Monitor effective roll-out of malaria vaccines. Focus on programs addressing NTDs in young children (aligned with newborn and child health).
Health Systems Strengthening
Growth Priority
Prioritize horizontal interventions focused on integrated primary healthcare delivery, including programs that strengthen health systems more broadly rather than targeting a specific condition (e.g., workforce upskilling, supply chain improvements, resource use efficiency, digital infrastructure).
Our Strategy
Where We Will Focus — and Why
Based on our analysis of disease burden, funding flows, expert input, and intervention evidence, The Life You Can Save is organizing its health sector recommendations around three strategic priorities for 2026–2028.
Priority 1 — Targeted Interventions for Neglected Diseases
We will maintain and strengthen our focus on the areas where our existing portfolio is strongest — and expand into critically underfunded territory.
Priority 2 — Horizontal Interventions for Maximizing Impact
The evidence and expert consensus are clear: disease-specific programs alone are insufficient. We will expand into:
- • Community health worker programs — training, compensation, and retention
- • Primary healthcare delivery models — strengthening foundational systems
- • Technical assistance to governments — helping health ministries sustain reforms
- • Reproductive, maternal, and child health — first 1,000 days focus
Priority 3 — Active Monitoring: Areas Requiring Further Investigation
Some areas show promise but require more research before prioritization:
For Donors
Your Giving Has Never Mattered More
The disruption in global health financing is, in one sense, a crisis. In another, it is a clarifying moment.
As large bilateral donors retrench, the relative weight of private philanthropic capital increases. A dollar donated through The Life You Can Save today does not simply fill a gap — it is directed by rigorous evidence toward the places where smaller, focused, and flexible investments can yield an outsized effect.
Saves lives today
Through organizations like IGN, New Incentives and Malaria Consortium, your donation funds life-saving interventions with among the lowest costs per life saved in the world — reaching tens of millions of people every year.
Builds systems that last
Through organizations like Living Goods and Evidence Action, your donation helps train and sustain the community health workers and national health infrastructure that make every other intervention possible.
Fills the gaps others have left
The areas most underfunded by major donors — neonatal care, TB, neglected tropical diseases — are exactly where The Life You Can Save is focused. Your donation reaches where it is needed most.
Ready to give where it matters most?
Our 2026–2028 strategy guides every recommendation we make. Browse our current recommended charities to see exactly where your donation goes — and why.
The Full Report
For Those Who Want the Complete Picture
This page summarizes the key findings of a rigorous, 55-page strategy report. The full document includes complete quantitative analysis of Global Burden of Disease data, detailed results from the Delphi-style expert workshop, intervention evidence tables, our portfolio coverage matrix, country-level funding vulnerability assessments, and our full methodology.
It is intended for institutional donors, foundation staff, academic researchers, and policy professionals who require the complete evidence base.
Health Sector Strategy 2026–2028: Priorities for High-Impact Giving · Published by The Life You Can Save · April 2026