A letter from our CEO: How R4D is supporting what countries need in this moment

Dear friends,

2025 has been a year of upheaval. At R4D, we were forced to abruptly shut down some of our programs in January, but I am proud that we have refocused our ongoing work — and started several new initiatives to address what the world needs now.

Although it’s been challenging, this moment of structural change offers an opportunity to rethink how health and education services are financed, how innovations are scaled, and to reimagine technical support with a greater focus on helping countries build strong, enduring systems that continue to improve long after aid recedes.

This has always been central to our mission at R4D, so we are feeling motivated. The opportunity to reshape our field for the better is within reach. At this inflection point, we are redoubling our commitment to support country leaders by:

• Strengthening countries’ domestic financing systems to fund essential health and nutrition products and services and align external donors with national priorities.
• Providing evidence and support to help countries assess, adopt, and responsibly scale emerging technologies, including AI.
• Testing new ways for countries to access technical expertise so it more effectively reflects country priorities and strengthens local and national systems.
• Strengthening the “connective tissue” needed to make the global development ecosystem more effective, better able to capture and translate learning, and more responsive to local leadership.

I’m pleased to share an update about how R4D is working in these four areas alongside our partners in countries around the world.

New pathways to sustainable domestic financing

As external aid diminishes, leaders in low- and middle-income countries (LMICs) are making bold commitments to mobilize more domestic resources for priorities like life-saving health products and services. But as we’ve seen time and again, true sustainability requires more than raising new revenue. It means building and connecting elements of a system — where clear priorities are set for essential medicines and services, where budgets are grounded in realistic demand forecasting and costing of those benefits, where procurement practices deliver quality products at affordable prices, and where funding and supplies reliably reach frontline facilities and patients.

At R4D, this is work we’ve been committed to for years, but it feels especially urgent now. That’s why we partnered with the Gates Foundation to articulate realistic approaches and practical models for health systems planning and budgeting that make sense for this moment, when so much external aid has vanished. And now we’re rolling up our sleeves to help implement these approaches with our country partners. For example, in Ghana R4D is working with the government to plan for the launch of free primary health care (PHC) for all, including a new health promotion and prevention service package. Our teams are providing locally and globally sourced analysis to design this package of services, estimate its cost, and help ensure it can be effectively delivered through PHC networks.

We’re also helping address a more specific health financing emergency: the need for countries to sustainably fund and procure life-saving health products. Again with the Gates Foundation, we recently mobilized our health financing and market shaping teams in Ethiopia, Ghana, Nigeria and Tanzania — along with several global experts — to rapidly assess domestic systems for financing and procuring health commodities in those countries. What emerged were clear pathways to better align supply chain, market shaping, and health financing functions and policies, so countries can sustainably finance and procure drugs and other medical products on their own.

Ethiopia is a powerful example of what’s possible. The country has already made significant progress aligning these functions to achieve results. We are proud of our support over the past eight years to the Ethiopia Pharmaceutical Supply Service and Ministry of Health to strengthen these systems. Today, Ethiopia is domestically funding more than 50% of its essential reproductive, maternal, newborn, and child health (RMNCH) commodities — which were previously primarily donor-funded, creating unpredictable and fragmented support.

Navigating disruptive technologies

At the same time, country leaders are grappling with another profound shift: the rapid spread of new technologies, particularly those driven by artificial intelligence (AI). These tools have the potential to improve learning outcomes for kids and to transform how health care is delivered. But they also bring risks that are still poorly understood, and we know from experience that effectively scaling technology solutions across health and education systems is complex.

At R4D, our role is not to champion specific tools, but to help leaders make sense of the landscape — to discern what works, anticipate risks, and understand what it takes to responsibly and equitably scale technology. For instance, this year our EdTech Hub launched an AI Observatory that tracks how artificial intelligence is being applied in education around the world. The insights we are generating about what works to materially improve teaching and learning are in high demand by education policymakers in many countries.

But our work does not end with generating global knowledge. We help countries put it into practice. For example, we’ve helped Sierra Leone create a National Digital Learning Strategy which will strengthen the digital skills of teachers and expand student access to localized technology and content. We’re also helping the government and its partners embed data and evidence into important resource allocation decisions such as where to deploy teachers. Support for these EdTech programs comes from a mix of global partners — the UK government, the Gates Foundation, Global Partnership for Education (GPE), IDRC, the World Bank, and UNICEF.

We’ve moved quickly to respond to the rapidly evolving needs of country leaders anxious to capitalize on emerging technologies. And by grounding technology adoption in evidence and supporting leaders to effectively and sustainably scale, we help ensure that new tools enhance equity instead of undermining it.

Ensuring cost-effective, country-led technical support

As governments leaders in LMICs chart new paths, they will need specialized technical expertise that meets the needs and realities of the moment. But with the demise of USAID, much of the traditional technical assistance (TA) architecture has evaporated. Truth be told, previous approaches to technical support were expensive, out of sync with country decision-making cycles, didn’t rely enough on local experts, and were often driven by external imperatives rather than the needs of country leaders.

Although the old TA models were overdue for an update, country leaders still need practical ways to quickly identify and pay for the expertise they need. This isn’t unique to LMICs; government leaders everywhere rely on outsourced expertise to analyze problems, generate evidence, and offer sound policy and implementation advice.

The challenge at this moment is that countries’ limited domestic funding is being channeled to direct service delivery, so paying for expert technical advisory services is difficult. But without such support, ambitious new plans might fail. How countries request, receive and pay for technical support is a realm that is now ripe for innovation.

R4D has been working for more than a decade to create nimble, responsive, low-cost models that enable countries to access specialized technical expertise. For example, technical specialists live all over the world, but country leaders often struggle to identify and fund the right expertise at the right time. R4D is increasingly serving as a technically savvy matchmaker — connecting government leaders to global networks of experts, channeling resources to fund their work, and ensuring that the latest knowledge and evidence are synthesized and shared.

The HelpDesk model is one way we’re enabling leaders to request rapid, targeted, evidence-based advice on pressing issues. Questions and answers are shared across countries to amplify impact beyond the original requestor. Already in use by EdTech Hub and the Frontier Tech Hub, the HelpDesk model is also being employed by the newly launched Sankore program. In partnership with the UK Government, Sankore supports leaders in Ghana and Nigeria to strengthen their science, technology and innovation ecosystems so that promising local research and innovations lead to real world impact. Part of R4D’s role is establishing a HelpDesk to provide on-demand, quick-turn, tailored support and guidance to innovation actors as questions and challenges arise.

Collaborative Learning is another model R4D has pioneered. It brings together peer-to-peer communities of policymakers and practitioners to tackle common challenges by exchanging knowledge and co-developing promising approaches. We’re applying this approach as the host of the Scaling Up Nutrition Financing Capacity Development Platform (SUN-FCDP). FCDP is a country-led platform that provides tailored support, demand-driven tools and resources, and opportunities for peer-to-peer exchange. Its goals are to increase funding for nutrition — both domestic and external — ensure that funding is aligned with country priorities, and promote more strategic use of funding across sectors. R4D also facilitates the Linked Immunisation Action Network in partnership with Gavi, which has enabled countries around the world to improve access to vaccines for their people.

Connecting the global ecosystem

The global development ecosystem is notoriously siloed and fragmented, which, as I noted in this 2024 piece, has hindered country leadership. But current structural changes are offering an opportunity to reshape how development partners coordinate, complement each other, and align around country priorities and plans.

At R4D, we are leveraging our experience working closely with country governments on their domestic financing systems and our understanding of external funding flows from multilateral development banks, foundations, and global health partnerships, to rethink how this ecosystem works in partnership.

For example, we are helping development partners create innovative co-financing mechanisms such as the Gavi-MDB multiplier, which will ensure that Gavi’s immunization investments unlock complementary financing from multi-lateral development banks (MDBs) like the World Bank, the Asian Banks, and other MDBs.

In another example, R4D is partnering with Access Accelerated, the World Bank, and African regional partner Afidep on The Financing Accelerator Network for NCDs (FAN), which supports countries to address the challenge of financing the prevention and care for non-communicable diseases such as diabetes, hypertension, heart disease, cancer, and mental illness, which have traditionally been neglected by donors.

And through an innovative three-way partnership between R4D, the World Bank’s Global Financing Facility (GFF), and the Gates Foundation, R4D helps countries create systems for health data collection, analysis, and use that complement and enhance the impact of World Bank grants and loans to country governments via the GFF’s FASTR initiative for rapid-cycle analytics and data use.

R4D is often in the background in these partnerships, but our deep technical expertise, global network of staff and partners, and nimble operating model is helping to bridge gaps and make the global ecosystem work better. And in the process, we are ensuring that lessons from different countries are shared across the global ecosystem.

Looking forward

Change can be difficult, but at R4D, we are motivated to help shape this new era for the better. Our mission has always been to support local change agents who are building strong systems for health, education and nutrition. And in this moment, we are feeling called to harness rapid structural change in the global development ecosystem and humbly do our part to chart a new path in support of strong, locally led, enduring country systems.

I appreciate how our global community stood together throughout this challenging year. And I couldn’t be more proud of our team.

With gratitude,
Gina