The Challenge: Declining and Fragmented Donor Funding
Low- and middle-income countries (LMICs) are facing mounting pressure to transition donor-funded programs to domestic resources and strengthen local delivery systems for essential services, especially as foreign development assistance declines. The funding that remains is often fragmented and poorly coordinated. With limited resources and urgent needs, it is critical that external support is both aligned with country priorities and coordinated among partners to maximize impact. Every dollar must work harder and contribute to stronger, more sustainable systems.
Yet the development assistance ecosystem remains highly fragmented. Development partners operate with distinct mandates, funding cycles, and focus areas, often leading to:
- Duplication of efforts across disease areas or geographies
- Gaps in coverage for less visible priorities
- Administrative burdens on governments to coordinate multiple partners
- Inefficient or conflicting investments that undermine system-wide progress
This fragmentation is particularly acute in health systems, where siloed investments in vertical programs can weaken sustainability and equity and lead to expensive parallel systems, processes and services.
The Lusaka Agenda, launched in 2023 by African health leaders, strongly endorses a “One Plan, One Budget, One M&E Framework” approach urging development partners to align behind national plans and shift more decision-making power to countries themselves.
Our Approach: Coordinating Donors and Aligning Behind Country Priorities
R4D has long aligned with the Lusaka Agenda principles. Our approach prioritizes country leadership and improves coordination among donors. We support governments to better understand their funding flows from different partners and create plans to integrate and better align those flows, and leverage donor funds to strengthen domestic systems. And we support donors to align their investments with government priorities and develop transformative co-financing partnerships that enable stronger, more sustainable systems.
Our work supports:
- Country-led platforms for dialogue, collaborative learning, and planning that convene government leaders and donors to develop and arrange funding for shared priorities
- Investment plans jointly developed by country leaders and funders that align behind national strategies and clarify each donor’s contribution
- Cross-donor collaboration to exchange experience about co-financing projects and facilitate the creation of new partnerships
- Co-financing mechanisms of varying types involving different types of funders, from well-coordinated joint funding arrangements (e.g., grants + loans), to innovative public-private partnerships, or even full resource pooling to create integrated funds
- Technical support for integrated systems — such as data, procurement and workforce — rather than program-specific support that leads to fragmentation
- Technical support for strengthening public financing systems and financial management practices to improve efficiency and enable donors to provide more direct (“on-budget”) support
R4D’s Role: Strengthening Sustainable Financing through Coordinated Action
Results for Development (R4D) works alongside governments and donors to improve the effectiveness and alignment of development financing. We help to strengthen country systems in practical, action-oriented ways, tailored to specific country and donor contexts.
For example:
- In Ghana, R4D is supporting the design of a unified approach to external funding for primary health care (PHC) strengthening — working closely with Gavi, the Global Fund, the World Bank, the World Health Organization (WHO) and others to ensure their investments are harmonized and reinforce a shared national vision using a new health promotion and prevention service package as a key entry point. R4D provides locally and globally sourced expert analytic and design support, while also helping facilitate agreement among donors and the government of Ghana.
- Through the FASTR initiative, R4D is partnering the Global Financing Facility (GFF), Gavi and the Gates Foundation to strengthen primary health care systems and expand access to life-saving vaccines in Ghana and Nigeria. The partnership promotes a common monitoring, evaluation and learning (MEL) approach and demonstrates how data and measurement can advance alignment across global health agencies.
- R4D hosts the Scaling Up Nutrition (SUN) Movement’s Finance Capacity Development Platform (FCDP), a country-led initiative available to all 66 SUN countries across Asia, Africa, Latin America and the Caribbean which offers technical and advocacy support to increase domestic financing for nutrition. In addition, as a multi-donor platform, FCDP helps coordinate donors to work more synergistically together and to align behind country priorities. FCDP works with country offices of the World Bank, UNICEF, regional development banks, and other partners to unlock resources for nutrition which could include matching mechanisms, innovative financing and private sector engagement.
- R4D is collaborating with Gavi to design the Multilateral Development Bank (MDB) Multiplier, a financing and technical assistance mechanism to mobilize $2–4 billion in health investments over the next 5–10 years. The platform aims to strengthen primary health care systems, expand immunization coverage, and improve financial and programmatic sustainability by blending Gavi grants with MDB financing.
- In partnership with the Asian Development Bank (ADB), R4D is helping to bring together member countries and development partners from Gavi, the Global Fund, Japan International Cooperation Agency, UNICEF, and UNFPA, to develop a common understanding of co-financing modalities, share knowledge and practical approaches to co-financing, and identify and prepare joint pipelines for health projects.
- R4D developed practical guidance to help countries and partners plan sustainable transitions from donor to domestic financing for HIV/AIDS, TB, and malaria programs. The resulting framework — Sustainability Planning for HIV/AIDS, Tuberculosis, and Malaria Programs in High Impact African Countries: Guidance for the Global Fund on How to Support a Successful Transition to Domestic Financing — supports country-level decisionmakers, donors, and implementing partners to collaboratively plan for the sustainability of key donor-funded programs well before any transition occurs. It also provides the Global Fund and other donors with recommendations for structuring future grants to align with country priorities and strengthen domestic financing.
- R4D is facilitating sustainable transitions from donor to domestic funding for HIV, TB, and malaria programs across nine countries in Latin America and the Caribbean through the Global Fund’s Financial Sustainability and Efficiency Initiative. R4D contracts and oversees technical assistance to strengthen health financing systems, focusing on three core areas: health finance strategy, policy, and advocacy; purchasing and social contracting; and health financing data. Through this work, R4D fosters strategic partnerships among national governments, civil society organizations, and Global Fund country teams, helping countries build more sustainable and efficient health programs as they move toward domestic financing.
In an era of tighter budgets and growing complexity, donor alignment to support country priorities is essential. R4D is committed to helping countries lead and donors collaborate, so that limited resources drive the greatest possible impact.
