The Global Fund to Fight AIDS, Tuberculosis and Malaria will appoint its next Executive Director this week. The Board meets in Geneva from 28 to 30 October to choose from five finalists. The new leader will take office in early 2027, replacing Peter Sands, who has led the organization since 2018.
A Smaller Budget, A Tougher Climate
The new director inherits a smaller budget. The Global Fund’s Eighth Replenishment raised US$12.64 billion. This is below the US$18 billion target and the US$15.7 billion pledged in 2022. The Board has approved US$10.78 billion for country allocations from 2026 to 2028.
This funding decline mirrors a wider collapse in aid. Official development assistance fell by 23.1% in real terms in 2025, the largest annual drop ever recorded, according to preliminary OECD figures.
Funding Decline and Global Impact
The stakes are especially high for Nigeria. The country is a priority portfolio for the Global Fund. It received about US$792 million in the latest grant cycle for HIV, tuberculosis and malaria, though this is less than in the previous one. This support now comes with a stronger emphasis on efficiency and national ownership.
To understand the skills needed for the next leader, Nigeria Health Watch asked seven senior global health professionals for their views. Their responses dealt with shifting geopolitics and funding cuts, and on what the new director should prioritize in their first year.
Diplomacy and fundraising were seen as essential. The next leader must manage relationships with the U.S. administration, European donors facing financial pressure, and low-income countries focused on health financing sovereignty. Holding donors to their pledges and finding new revenue sources, including private philanthropy, was a common early priority.
However, expectations went beyond fundraising. The next Executive Director must “engage ministries of finance as effectively as ministries of health” and build trust with implementing countries. Operational and financial stewardship, including a track record in complex people management and proactive risk management, was also deemed critical.
Courage was highlighted as a key trait. One leader noted, “The next leader will need the courage to remain engaged and strengthen national systems rather than create workarounds or fund parallel delivery organisations.” This means making transparent choices when resources are constrained and building consensus around difficult trade-offs.
Immediate Priorities and Challenges
There was broad agreement on immediate priorities. The first is to protect HIV, tuberculosis and malaria services to prevent reversing two decades of progress. The second is to make transitions to domestic financing deliberate, with clear timelines agreed in advance, not imposed when funds run short.
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A “credible transition compact” was proposed to protect gains while accelerating country ownership. Another suggestion was to agree and monitor transition and co-financing roadmaps with every recipient country, using a transparent process to decide what gets funded first. A rushed transition was warned to risk undoing 20 years of progress.
Beneath this consensus lies a sharper argument. The Global Fund’s model since 2002 was questioned. The organization has set a high funding threshold for government agencies, but has historically channeled funds through non-governmental organisations. “Given the scale of its resources, this approach has distorted national systems and created perverse incentives, often leaving the government agencies picking up the crumbs,” one professional noted.
This raises questions about how authority is distributed in global health. When authority follows money, financiers expect influence over priorities, while recipients may accommodate agendas instead of taking full responsibility for reforms. The next leader is seen as needing to work with Africa CDC and regional institutions as partners in shaping priorities and accountability, not just as implementers.
Health Systems and Community Role
Views differed on the Global Fund’s scope. Others saw deeper investment in primary healthcare, laboratories, and supply chains as essential for integrating disease programs into national health systems.
Responses also stressed the need to keep community-led organizations and community health workers at the heart of the response. “Commodities are essential, but without the people and systems that deliver them, particularly at community level, their impact will remain limited,” the report states. Calls were made to formalize community-led monitoring so their data shapes grant design and improvement.
Calls for internal reform focused on what was described as a “bloated internal bureaucracy.” Proposals included a smaller Secretariat and a leaner funding request process based on costed national plans. A review of the operating model was also proposed, with an implementation plan that includes measurable outcomes and a reduction in operating costs.
Expectations for concrete progress after 12 months centered on deliverables: a transition framework, a roadmap, and a reform plan. The standard was more demanding: measurable gains against published baselines, including fewer stock-outs, faster grant disbursement, and domestic contributions released as promised.
Nigeria’s Funding Gap
This applies directly to Nigeria. The country pledged US$15 million to the Eighth Replenishment. Across all replenishments, it has pledged US$109.28 million and contributed US$38.79 million. The gap between allocation and release is familiar. In 2025, Nigeria’s Coordinating Minister of Health and Social Welfare told the House of Representatives that only ₦36 million of the ministry’s ₦218 billion capital allocation had been released.
Any transition plan with the Global Fund will only succeed if Nigeria releases the funds it has committed. The responses leave a clear challenge for the next Executive Director: turn promises of reform into visible changes. How soon will funding requests become simpler? Will disbursements be faster? Will Secretariat costs be lower?
