Why We Showed Up: Global Health, FFD4, and the Power of Community

In July 2025, the world came together in Seville for the Fourth International Conference on Financing for Development (FFD4), a landmark event meant to reorient global financing toward achieving SDGs. A moment to take stock, to course-correct, to make things better…

Yet, when the Outcome Document/Compromiso de Sevilla was released (and approved before the conference and without any NGO consultation), we were struck by what wasn’t there. Health, already struggling to stay afloat in global development debates, barely appeared. A few lines on pandemic preparedness. A vague reference to UHC. Nothing close to a commitment to sustain or scale up community health systems or support the people holding them together.

That silence is loud. And dangerous.

Why GFAN went to Seville

GFAN doesn’t usually operate in the halls of development finance. But we went to Seville because we believe that advocacy for global health can’t be confined to traditional health spaces anymore. And we faced mistrust, humbling expertise from colleagues in other fields, and of course the heat… The future of health, especially community health, will be decided in rooms where tax rules, debt relief frameworks, and ODA allocations are debated.

We also went because we believe in showing up, even in spaces that don’t expect us.

And truth be told, FFD4 didn’t make it easy!

The civil society space was coordinated by a global NGO whose main focus is… UN processes, and its core members are primarily global tax justice networks and economic think tanks. Health was largely absent, both in the agenda and in the crowd. And yet, we were there.

The Compromiso de Seville and Global Health: what comes out of FFD4

Global health is in crisis because the financial systems meant to fund it are cracking. Official Development Assistance (ODA) is stagnating or decreasing. Domestic Resource Mobilization is being heralded as the new normal, often without safeguards to protect communities. Meanwhile, debt service is leaving governments in the Global South with impossible trade-offs: pay creditors, or pay for healthcare? Pay for healthcare or for education ?

For a “financing” novice like myself, all of the areas for improvement noted in the Outcome Document seem important and worthy in and of themselves. However, what is lacking is any sense of timelines or scale of the many improvements, adjustments and innovations that are needed – how far are we from the countries with the most need for strengthened financing for development being able to implement meaningful reforms nationally and for global institutions like the World Bank, IMF, the regional Development Banks, TRIPS and other trade financing questions being able to be changed to live up to some of the norms and ideals set out in the Compromiso de Seville? This isn’t answered anywhere, I think probably because it is not known.

The issues are wide and varied – national revenue systems can only be strengthened by improving taxation systems, reducing reliance on external debt and the consequent debt servicing payments; a very large set of issues, policies, regulations and frameworks nationally and internationally to address. It may be because I’m an outsider to the issues, but the lack of any sense of scale, timelines and massive systemic change needed to accomplish the normative and actual changes mentioned in the Outcome Document feels like a glaring omission.

I mean, in health and HIV/AIDS, TB and malaria we are often accused of being a bit too ambitious, simplistic or overly optimistic but I’d refer you to the blanket statements in the Outcome Document around things like “making sure that all companies, including multinationals, pay taxes to the Governments of countries where economic activity occurs and value is created” and challenge any government official or head of state to identify a plan to do this that doesn’t take 25+ years, require significant investment and broad consensus to adjust key financing levers and tools.

We know that health is political. But it’s also financial. If we want health for all, we need to talk about how we pay for it, and who gets left out when the math doesn’t add up – both in the short and the long-term.

We believe in DRM for health, yes, but not if it comes at the cost of stigmatized communities and not if investing in changes nationally and internationally subvert the need for continued, increased investment now. The sad reality for health – as well as education, climate etc – is that we can’t wait 10, 20, 30+ years for these things to be funded under “ideal” circumstances by improved and modernized systems. And leaving that paradox unaddressed and unanswered feels dangerously simplistic despite the complexity of the FFD4 conversations and, ultimately, leaves me a bit skeptical of what the Compromiso will concretely achieve. 

What we did in Seville

We co-organized a side event with Médecins Sans Frontières, Salud por Derecho, and Friends of the Global Fund Europe: Global Health at Risk – The Urgency of Renewed Leadership. We brought together European government representatives, civil society advocates, and community voices to highlight what was missing in the FFD conversation: a real commitment to health equity.

Once again, the Schengen visa system stood in the way of ensuring strong community representation: despite all efforts, our colleague Farida Tiemtoré wasn’t able to join us in Seville. Denying access to civil society advocates from countries most affected by underfunded health systems and heavy debt burdens is a bad look in a country who proudly authored .

Still, Farida found a way to be present. She sent u  reminding us that behind the numbers, there are lives. Her words resonated deeply, and were echoed by every speaker that followed, from Peter Sands to Marisol Touraine.

We also partnered with ITPC to bring the White Coat Campaign to FFD4, a visual reminder that health is not just a budget line or a technical debate, but a matter of human rights. The campaign helped create a sense of visibility and connection among health advocates, especially those coming from non-traditional backgrounds.

We created a safe space, a warm, welcoming corner of an otherwise technical and often exclusionary event. And that space mattered. It allowed us to reconnect with old allies, meet new ones, and talk openly about what we need: sustained, inclusive, community-driven solutions to financing for health.

What next: This is only the beginning

This blog is the first in a series we’ll be publishing to explore the links between debt, health, justice and equity. We won’t claim to speak for everyone, and we don’t want to because that’s not our style and ultimately, we aren’t the experts on development finance here at GFAN – but we know that some of you are and we want to learn from you and support your work.

What we want is to open up a space where health and financing can be discussed differently, with honesty and pluralism within GFAN – by and for its members. GFAN is engaged with a consortium of partners who will be consulting the broader global health community over the coming 6-8 months to collate civil society and community visions for the future of the global health architecture.

Building on our long-standing support for initiatives like Global Public Investment, our support for the work done by the Impact Coalition on Health we intend to stay active on these broader issues of financing for development: because the world is changing, and so must the way we fight for health equity within the broader financing systems for sustainable development.
– Katy