Reflections from and beyond the Financing for Development conference

As the world grapples with mounting debt, shrinking aid, and fractured multilateralism, health systems are collapsing under the weight of political and economic neglect. The recent Financing for Development conference in Seville laid bare a sobering truth: global health is no longer safeguarded by shared solidarity, but increasingly shaped by domestic priorities and dwindling global cooperation. The following blogpost by GFAN Speaker Dumi reflects on Botswana’s health crisis’ intersection with shifting income classifications and aid withdrawals, the conversations at, and beyond, the FFD reveal a critical moment for reimagining financing, accountability, and advocacy in global health.

Botswana’s health system collapsed. An official announcement made on 04 August 2025 reiterated what civil society raised alarm for at least two years beforehand. The Ministry of Health reported a state-wide shortage of commodities and pausing of non-critical surgery. This impacted mental and sexual reproductive health, cancer, diabetes and tuberculosis among others. Presenting a contrast to the Government’s decentralisation of primary health care and commitments to universal health coverage. A higher middle income country with ambitions to become a high income country, Botswana remains a paradox of advancements and regression. On 25 August 2025, President Boko declared a state of public health emergency. This declaration came with the establishment of a BWP 5 billion pooled fund for strengthening the country’s health system.

Economic recovery from maladministration and a change in government have dominated public discourse in Botswana. This is one of the many other narratives that dominate public discourse globally: misaligned state spending, public safety concerns and poor immigration responses. Embedded in this is overseas development assistance (ODA) and stressed state service delivery infrastructure. Many countries with these narratives face a cost-of-living crisis, increased military spending, state debt and other competing interests. This myriad of narratives exclude public, global, mental and reproductive health respectively. The wide-reaching sector that impacts everyone, regardless of socioeconomic status or income level. This is the context under which the Financing for Development (FFD) conference was held. A decade after limited progress from 2015’s Addis Ababa Action Agenda.

Seville, Spain became the focus of global policy, development and multilateralism. Dialogues grappling with the increased heat temperatures (literally), along with other climate issues, migrant crises and the increasingly challenging landscape for civil society participation. Global health remained obscure, as ongoing conflicts, humanitarian and debt crises took hold during two pre-conferences: the feminist forum and civil society conference. This continued throughout the main conference. There were however some interesting insights, for example, during a session on reforming international financing architecture; Trevor Manuel illuminated how servicing debt channels resources to past burdens and not the future of democratic institutions. One of the key recommendations of the session was the need to review credit rating methodologies that unfavour majority world countries.  

World Health Organisation’s Director-General Tedros Adhanom Ghebreyesus referred to inequality of state debt causes. Mentioning how 3.4 billion people live in countries that spent more on debt than on health in 2024. Meaning almost 42% of the world’s population, under ideal circumstances, lost out on much needed resources due to state debt. This, in Ghebreyesus’ words, leaves health as a cost issue and not an investment one. Denying countries’ investment in their “people, stability and economic growth” through channelling resources to health. UNAIDS’ Executive Director Winnie Byanyima illuminated how this is further compromised in Africa, with over 66% of countries in this debt challenge and losing the equivalent of over 122% of its ODA to illicit financial flows. Illuminating how deeply compromised health systems are across the region. Notably Botswana, which already had limited ODA investments due to its income country status. Namibia, however, has been moved to lower middle-income country status. An unusual development given the country’s focus on economic growth over the past decade.

Global funding cuts, anti-rights advancements, and continuously shifting geopolitics reflect how uncertain global advocacy, multilateralism and human rights are. As the United Nations prepares to celebrate its 80 year anniversary during the UN General Assembly, proposed reforms along with the CSW revitalisation process all reflect a challenging environment for civil society and global health. The solidarity that emerged at the height of HIV and COVID-19 has run out. The multilateral infrastructure that improved vaccine access, reduced Tuberculosis and Malaria, coordinated maternal health and many others has been compromised. The FFD provided a stark reminder of this, as the United States of America withdrew from the process. Notably, many Western countries also shifted away from meaningful commitment to global financing architecture and tax reforms. Communities, civil society and multilateralism are on their own.

This reality is not new, as we embark towards a challenging landscape in multilateralism, ODA and philanthropic resourcing. The 8th replenishment of the Global Fund is not safe either. Whilst current replenishment commitments have sparked hope towards the $18 billion needed to save 23 million lives, countries are at a crossroads. Member state voting and negotiations in multilateral spaces no longer serve as an indicator of commitment. Global health is no longer just a multilateral agenda, but a domestic one. Needing communities across movements, civil society across donor projects and private stakeholders with interests in the value chain to sustain advocacy efforts. A starting point for this is in the need to reshape narratives. To normalise citizen participation in state budget allocations and spending reviews. This is why GFAN’s Reframing solidarity &Tackling Anti-ODA Narratives campaign is important, ensuring truth to power and sustaining the gains made in eliminating the three diseases.

Dumi Gatsha is a GFAN Speaker, grassroots feminist activist, founder of Success Capital.