This year’s Black Maternal Mental Health Week carries the theme “Rooted in Legacy: Honoring Our Stories, Healing and Thriving Together for Generational Impact.” It is a call to celebrate the organizations, practitioners, and community leaders who have long supported Black mothers through pregnancy and postpartum, often filling gaps left by formal systems of care. 

These organizations know something that the maternal mental health field increasingly recognizes: healing happens in relationships. It happens through trusted peers, culturally rooted practices, community networks, doulas, faith leaders, support groups, and organizations that understand and adapt their support to the lived experiences of the communities they serve.^1,2 

Yet many of these community-rooted models face a paradox. The very qualities that make them trusted and responsive—local adaptation, cultural tailoring, and deep community relationships—can make them difficult to evaluate using the evidentiary standards that often determine funding decisions. As a result, some of the promising approaches to supporting Black maternal mental health struggle to access the philanthropic and public funding needed to grow and sustain their impact. 

As a field, we should ask whether current definitions of evidence are helping us identify what works or unintentionally limiting whose work counts. 

When “evidence-based” becomes a barrier 

Across philanthropy and government, there is understandable interest in funding evidence-based interventions. Rigorous evaluation helps ensure resources are directed toward programs that improve outcomes, and randomized controlled trials (RCTs) remain an indispensable tool for establishing causal impact. Many state Medicaid programs, including new federal maternal health models, condition reimbursement for services like doula and community health worker support on evidence-based status. 

But RCTs are not the only way to generate meaningful evidence, and they are not equally accessible to every organization. Community-based organizations (CBOs) often operate with limited evaluation budgets, lean staffing, and data systems designed primarily for service delivery rather than research. Conducting a large-scale experimental evaluation may simply be out of reach. Even when funding for evaluation is available, the time, technical expertise, and infrastructure required can be prohibitive.  

A second challenge, which is especially relevant in maternal mental health, is that community-rooted programs are intentionally designed to adapt: their approaches evolve in response to local culture, community priorities, participant feedback, and changing needs, and this flexibility is often central to their success. Traditional efficacy studies, however, are typically designed around implementation fidelity: if a program demonstrated impact under a particular set of conditions, future implementation should closely resemble the evaluated model. But for community-rooted approaches, their strength often lies in maintaining core principles while allowing communities to shape the delivery. This creates an uncomfortable tension: the very adaptations that build trust and relevance may make a program less amenable to traditional evaluation and less likely to be recognized as “evidence-based” under conventional funding criteria. 

What’s more, the tools used to measure maternal mental health outcomes carry their own limitations. Many standard screening instruments—including the Edinburgh Postnatal Depression Scale—were developed and validated primarily among non-Hispanic white women, yet the symptoms they prioritize and the language they use may not fully reflect how Black and Hispanic birthing people experience or describe maternal mental health challenges. Promising efforts are beginning to address these gaps. At the Policy Center for Maternal Mental Health’s 2026 Forum (MMH Forum), researchers from Virginia Commonwealth University highlighted the EPDS-US, an adaptation of the Edinburgh scale that uses clearer, more accessible language and reframes screening as the start of a person-centered conversation rather than a checklist. Other researchers are expanding what is measured altogether. For example, the recently validated Prepartum Form for Evaluating Race-Related Psychological Stressors (PP-FERRPS) captures race-related stressors experienced by Black pregnant women that traditional depression screening tools may miss.  

Why this matters for Black maternal mental health 

This conversation has particular urgency for Black maternal mental health. Black mothers continue to face significant disparities in maternal health outcomes while also navigating longstanding inequities in access to culturally responsive mental health care. Compared with white women, Black women are about twice as likely to experience maternal mental health conditions, and about half as likely to receive treatment³. Experiences of racism, stigma, bias, and historical mistrust of healthcare institutions influence whether women seek care, remain engaged, and feel supported throughout pregnancy and postpartum. 

Community-rooted organizations are often uniquely positioned to bridge these gaps. Because they are embedded within the communities they serve, they build trust over time and provide support that extends beyond clinical care to include social connection, advocacy, care navigation, and holistic well-being. At the MMH Forum, several organizations illustrated this approach in practice. The Perinatal Health Equity Initiative described how years of community partnership have enabled programs like Sisters Who Breastfeed to foster lasting peer networks among Black mothers, while its Mamas in Bloom program pairs nurse oversight with community health workers who help families navigate systems where they are too often unheard. Our Roots, a California-based peer coaching organization, similarly emphasized that healing extends beyond symptom reduction, combining peer support with navigation, advocacy, and community connection. These models demonstrate that if we want better maternal mental health outcomes, we must invest not only in clinical services, but also in the community infrastructure that makes those services accessible, trusted, and effective. 

While many community-based organizations have compelling stories, strong community relationships, and years of practice-based learning, what they often lack is the type of evidence that funding systems are designed to reward. If our evidence standards systematically privilege organizations with research infrastructure over organizations with deep community trust, we risk overlooking innovations that could strengthen maternal mental health ecosystems, particularly for populations who have historically been underserved. 

A role for catalytic philanthropy 

This is where philanthropy has an opportunity to lead. Rather than asking community organizations to fit into existing evidence frameworks, funders can help evolve those frameworks to better match the realities of community-based, culturally-relevant innovation. 

That could mean investing in evaluation capacity alongside program delivery. It could mean supporting developmental or participatory evaluation approaches that generate actionable learning while respecting local adaptation. And it could mean recognizing that causal attribution is not the only standard of rigor: theory-based evaluation and contribution analysis can test whether and how a program contributed to change even without a control group, while process evaluations, implementation science, qualitative outcomes, community-defined measures of success, practice-based evidence, and evidence syntheses round out a fuller picture of what’s working, for whom, and why. Washington, D.C.’s Mamatoto Village offers one example: an evaluation of its Mothers Rising home visiting program found improved birth outcomes among Medicaid-eligible Black mothers, evidence that helped inform the District’s 2024 legislation extending insurance reimbursement for home visiting services.  

Perhaps most importantly, philanthropy can create space for organizations to learn and improve without requiring every promising model to first clear the same evidentiary hurdle. Funder collaboratives are also moving in this direction: the Maternal Mental Health Equity Fund, a collaborative of thirteen national, regional, and state funders, invests directly in community-rooted organizations serving Black and brown communities, including several of the examples above, and pairs that support with funding to build data and evaluation capacity. 

This is not an argument against rigor. It is an argument for a more fit-for-purpose evidence ecosystem. Different decisions require different kinds of evidence. A national policy recommendation may warrant one level of proof, while a decision about whether to expand a promising community-based model may call for another. Building an evidence ecosystem that values both scientific rigor and community relevance will require expanding our standards. 

An invitation to think and measure differently  

We do not believe there is a single answer. Instead, there is an opportunity for the maternal mental health field to ask new questions together. 

What would a more inclusive evidence ecosystem look like? How might funding practices better recognize community-rooted innovation while maintaining accountability for outcomes? What can maternal mental health learn from adjacent fields, such as substance use and behavioral health, that have embraced practice-based evidence, participatory research, or adaptive evaluation models? And how can philanthropy help create pathways for community organizations to demonstrate impact without asking them to become research institutions? 

During Black Maternal Mental Health Week, we are reminded that lasting change depends not only on developing new interventions, but also on recognizing and investing in the wisdom and leadership that already exist within communities. If we want to improve maternal mental health outcomes for Black families, we should ensure that our definitions of evidence are broad enough to recognize the approaches communities already know are worth trusting.

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Two new Nigeria-based staff starting later this month mark the firm’s formal presence in the region, aiming to strengthen partner impact across social impact and international development projects 

By: Brian Leslie (CEO) and Dr. Chidiebere Ikejemba (Director, Climate & Environment Sector Lead)

This month, Camber Collective will formally launch the firm’s first office in Africa in Abuja, Nigeria. The new Abuja office will strengthen Camber’s connections with local and regional organizations while enhancing its ability to advise on strategy, coordination, and local implementation projects.  

Camber Collective currently has regional offices in Seattle, San Francisco, Washington, D.C., and Paris. The Abuja office marks the firm’s first formal presence in Africa after working closely with partners in the region for over 15 years. In adding this fifth office to Camber’s global footprint, the firm is continuing to deepen local partnerships and support community- and government-led implementation of transformative global strategies in health, environment, prosperity, and gender equality.  

One of Camber Collective’s largest efforts in the country to date has been providing support to the Nigerian Federal Ministry of Health and Social Welfare’s Collaborative Action Strategy (N-CAS) through the Health Campaign Effectiveness Coalition. Camber has supported the first-ever effort to radically shift how the country runs health campaigns through systematic collaboration and integration across issue areas, partners, funders, providers, and government agencies. Camber has also worked with global partners in the region on research, strategy, and coalition-based projects addressing maternal health, family planning, nutrition, infectious disease, sanitation, and environmental issues. 

“Ever since we started Camber Collective, our global projects have been at the core of what we do. Bringing on team members with deep ties and years of expertise in Africa represents the culmination of years of meaningful work with partners in the region,” Brian Leslie, CEO of Camber Collective, said. “I’m eager to see how this move will strengthen our partners’ impacts and promote equitable change across the region.” 

Camber is a strategic partner to the organizations and fields dedicated to addressing the world’s most urgent challenges. Our purpose is simple: to create the conditions for an equitable and sustainable world. We work locally and globally across health, prosperity, climate, and gender equality to help our partners drive lasting impact. 

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Mobilizing the private sector is essential to closing persistent gaps in financing, infrastructure, and innovation.  While much of this capital and innovation originates in Western or global markets, its application and value must gear towards that of emerging economies, where health systems face the greatest climate risks. Done right, this approach can protect the most vulnerable from climate-health risks while also reinforcing economic stability, reducing long-term costs, and opening new markets for inclusive growth.

Private sector engagement must therefore be framed not only as a corporate social responsibility, but as a return-on-investment opportunity: healthier, more resilient communities reduce supply chain risks, stabilize workforces, and expand consumer markets. The report outlines four key domains where private sector action can strengthen health system resilience: 

• Innovative Financing, such as blended finance, green bonds, and outcome-based mechanisms.
• Infrastructure & Technology through renewable energy-powered facilities, and scalable digital platforms and solutions.
• Risk Management & Insurance, including climate-triggered insurance models; analytics, and protection products.
• Collaborative Partnerships that align commercial expertise with public health priorities and that build capacity to ensure workforce resilience.

Despite this potential, private sector engagement remains limited by misaligned incentives, regulatory uncertainty, weak impact measurement frameworks, and structural challenges. This report presents actionable solutions ranging from policy incentives to standardized metrics and inclusive investment models—to unlock meaningful participation.

The report calls for a shift toward more practical, results-driven collaboration between sectors, with equity—especially inclusion of women, youth, and local communities—as a core design principle for health system resilience.

Learn more about our Climate & Environment sector portfolio.

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Around the world, 2025 was a year of unmistakable challenges. Cuts to foreign aid and development programs brought devastating human consequences. Wars and genocide continued, and governments used the most vulnerable at home and abroad as pawns in deadly political games. 

But amidst this darkness, we also witnessed meaningful progress. Across the social sector, partners, funders, and communities stepped up to fill gaps and adapt to uncertainty. At Camber, we found ways to meet the moment and drive impact for those most affected. 

In the spring, we launched a new strategy outlining our next chapter with a focus on field-building—a discipline aimed at breaking down siloes, cultivating shared agendas and collective action, and amplifying the impact organizations have across entire fields of practice. We also achieved B Corp recertification, executed our first Internal Equity Survey, welcomed six new colleagues, and celebrated nine promotions—including bringing our colleague and Shared Prosperity lead Marc Allen into the partnership.  

In 2025, we partnered with 27 organizations around the world on 42 projects. From women’s health innovation to climate resilience to income inequality, our work touched on some of the most important issues of our time. But don’t just take it from me. Below, we highlight work from across our sectors and the meaningful impacts each project has made. 

As a team, we found joy in personal accomplishments and milestones. We celebrated Camberians’ weddings and welcomed new Camber babies. We cheered on colleagues who became certified fitness instructors, one who earned a sommelier certification, many who ran full and half marathons, one who won a poker tournament, and several who completed new degrees. Our team also deepened their commitments to board and community service, volunteered locally, and directed $30,000 in nonprofit giving to make a difference. 

As we head into 2026, I’m holding the highs and lows with equal clarity and gratitude. The highs remind me of what we can build together, while the lows show me both why our work matters and why we must persevere. 

Read on for some of our most significant accomplishments from 2025. If you want to learn more about what we do and how we might work together, please reach out. 

With gratitude,  

Brian Leslie

Rethinking Resilience: Drawing Connections Between Climate and Health 

The Brief: Public health and climate change are inextricably linked—but too often addressed in isolation. In the fall, we partnered with Gavi and the Asian Infrastructure Investment Bank (AIIB) to challenge this narrative through a novel report: Protecting Our Future: An Investment Framework for Quantifying the Climate Adaptation Benefits of Health and Immunisation Investments establishes a first-of-its-kind framework that quantifies the value of health investments for climate adaptation.  

The Solution: The report was released at COP30, the United Nations Climate Change Conference in Brazil, in November 2025. Our findings highlight the often-overlooked role that health systems play in helping communities adapt to climate change, particularly around immunization.  

The Impact: The report has sparked new conversations among multilateral development banks, donors, and country actors by bridging technical evidence with advocacy and policy potential. Stakeholders have been equipped with shared language and tools to advance long-term systems change in vulnerable communities around the world.  

Read the full report here or via AIIB’s website. Additional thanks to the World Bank, Asian Development Bank, and our other collaborators for their support. 

Investing in Healthcare and Rural Economies: Strategic Planning for United Indian Health Services 

The Brief: Last year, we worked with the United Indian Health Services (UIHS) to help them chart a course for the organization’s future and determine how to make amplify their impact. UIHS is a coalition of nine American Indian tribes who focus on lifting up culture, community, health, and economic prosperity for their members—many of whom live in rural communities. 

The Solution: This was not a typical strategy project—it required careful and equitable systems thinking and expansive conversations across the region. We conducted research on comparable organizations, interviewed board members and community stakeholders, and laid out options to illustrate key trade-offs and strategic choices for UIHS. 

The Impact: After close collaboration, UIHS decided to establish a new foundation focused on investing in the healthcare workforce and care model innovation to improve tribal career opportunities in their rural communities. The result will go beyond healthcare—these investments will improve the health, economic opportunities, and quality of life for generations to come. 

Learn more about UIHS’s important work. 

Spotlighting Women’s Health Innovation: Pushing for Investments Around the World 

Photo Credit: Gates Foundation / Marlena Waldthausen

The Brief: For years, women’s health research and development (R&D) has been underinvested in and underrepresented, despite the $1 trillion opportunity that closing this gap represents. In 2023, we partnered with the Gates Foundation and National Institutes of Health to establish the Innovation Equity Forum (IEF), a group of more than 250 global experts in women’s health research and development. This diverse group is committed to advancing a more equitable, coordinated, and innovation-driven ecosystem for women’s health R&D. 

The Solution: We kicked off 2025 by publishing the 2024 Women’s Health Innovation Opportunity Map Progress Report, highlighting promising strides made in 2024 and areas for immediate action. In order to translate the data into action, we coordinated across the forum to develop actionable concepts to advance women’s health. Our efforts culminated in IEF’s global convening in October in advance of the World Health Summit in Berlin, bringing together more than 150 stakeholders to refine and align on these concepts and infuse them into the broader women’s health innovation ecosystem.  

The Impact: The Opportunity Map website, which launched in the fall, provides a new home for the IEF’s work and highlights tangible ways for stakeholders—from investors to policymakers—to drive meaningful advances in women’s health innovation over the next 15 years. These resources have strengthened awareness of critical R&D gaps across academia, philanthropy, the private sector, and policy circles. 

Learn more about the IEF and explore the Opportunity Map. 

Putting Data into Action: Informing Funding, Strategy, and Policy Development for Economic Mobility 

The Brief: Economic mobility is widely considered to be a cornerstone of American life – available to all who set their sights on it. But in reality, economic mobility has been declining steadily since the 1940s. Our Mobility Experiences initiative aims to support efforts across the country to ensure that future generations have the power to access opportunities that will advance prosperity and well-being for all.  

The Solution: In 2025, we converted our breakthrough Mobility Experiences research into action by equipping 15 place-based initiatives to apply the research in order to develop their strategies, mobilize capital, and improve their programs and services. We provided direct technical assistance to community organizations while also hosting broader public awareness events (like this one in Iowa). 

The Impact: Over time, our data reached more than 100,000+ people, helped inform several hundred million dollars in investments, and improved programs for tens of thousands of people. We supported 15 direct grantees to mobilize capital and improve programs improvement initiatives, and collaborated closely with key ecosystem actors like Harmony Labs and Fisher Strategy Partners to expand the reach and impact of our work. 

Explore the Mobility Experiences dashboard and this video unpacking the efforts. 

Scaling Up Health Campaigns: Improving Global Health & Wellbeing Through Collaboration 

Photo Credit: Federal Ministry of Health & Social Welfare, Nigeria / SWAp Office

The Brief: The Collaborative Action Strategy (CAS) on health campaign effectiveness is a first-of-its-kind commitment by the global health community to align in support of countries and their planning, implementing, evaluating, and financing of health campaigns in a more collaborative way. It is designed to bolster countries’ existing efforts while improving the effectiveness, efficiency, and equity of campaigns for a range of public health issues. 

The Solution: In 2025, we helped the Health Campaign Effectiveness Coalition put the CAS into action. We supported the implementation of CAS in two focus countries, Nigeria and Ethiopia. In Nigeria, we piloted efforts in three states to integrate malaria and neglected tropical disease campaigns into the largest measles and rubella vaccination campaign in the country’s history, which aims to reach over 100 million children. We developed a customized strategy and provided hands-on support through workshops, stakeholder engagement, and project management. Our efforts culminated in a major integrated campaign in October and the official adoption of the Nigerian CAS in December. These efforts united global, country, and local stakeholders, including the Gates Foundation, UNICEF, World Health Organization, Global Fund, CBM, and Nigeria’s Federal Ministry of Health and Social Welfare and National Primary Healthcare Development Agency. We also coordinated closely with the Measles & Rubella Partnership, where Camber colleagues serve as the Project Management Unit, to coordinate across initiatives.

The Impact: Health campaigns are a critical way that countries like Nigeria tackle a range of public health issues, from measles to nutrition. For too long, these issues have been siloed. Taking a collaborative, interdisciplinary, and integrated approach through CAS is more cost effective, efficient, and less burdensome on communities and health workers than running separate, siloed campaigns. This is a particularly critical need given recent cuts to global health infrastructure. Through our work in 2025, stakeholders in Nigeria showed that future campaigns will be more integrated through early planning, shared calendars, strong collaboration, robust and integrated data systems, harmonized payment structures, and improved advocacy and communications. They have committed to advancing these objectives as they scale up this work across the country in 2026.

Learn more about the CAS and explore its resources.

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When we established Camber Collective more than 15 years ago, we wanted to build a social impact consultancy that put strategy into action. Over time, we came to recognize the need to think beyond individual projects and shape systems-wide change. Our resulting evolution toward field-building has helped fill critical data and evidence gaps for whole fields of practice, mobilize greater and more effective capital, and inform collective impact agendas supported by shared metrics of success.  

In recognition of this shift, I am excited to share that our colleague Marc Allen is stepping into a new role as Partner at Camber Collective. This comes after spending several years successfully leading and scaling our Shared Prosperity work in economic, civic, and democratic inclusion. 

Marc brings a wealth of knowledge and a vast network of leaders and organizations who drive change across the field. He has been instrumental in bringing our own field-building objectives to life, combining deep subject matter expertise and diverse partnerships to advance economic vitality through the lenses of income, wealth, and place. Marc is also spearheading Camber’s engagement with Public Interest Technology, a growing enabler of economic and civic inclusion.   

The impact of his work speaks for itself: more than 100,000 people reached by the groundbreaking Mobility Experiences research, several billion dollars in capital cumulatively raised or redirected toward income- and wealth-building opportunities, and a strategic footprint that spans many of the most eminent national institutions and place-based initiatives in the United States. Marc embodies the Camber ethos of converting data into an agenda, and an agenda into action.  

This promotion comes at a time of heightened uncertainty around the world. Now more than ever, we must align data, capital, programs, and communities to make a thriving future attainable for all. In the work led by Marc and other Camber colleagues, I see mounting evidence that this is possible.   

I am eager to see how our Shared Prosperity impacts — and Camber Collective as a whole — continue to evolve with Marc’s continued leadership.

With gratitude,  

Brian Leslie 

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As we celebrate Camber’s 15^th birthday, it is remarkable how much our nascent vision, team, and impact has evolved. Camber has grown from a small team supporting individual institutions to a collective that works across sectors, geographies, and stakeholders to help build the ecosystems that enable lasting change. We’ve had the privilege of partnering with over 110 organizations, across more than 400 projects. We’ve celebrated over 50 alumni who have grown to be social entrepreneurs, leaders, strategists, and contributors to making the world a better place. Through our work and network of partners and collaborators, we’ve seen what’s possible when insight, intention, and action align.

But we’ve also seen what stands in the way. Siloed efforts, ineffective translation of agenda to action, and structural inequities continue to limit progress across the social sector. And in a world facing compounding crises due to shifts in policy, funding, public discourse, and governance— the cost of inaction is growing.

We’ve taken this moment to reflect on our role and the needs of the sector — and to evolve with greater clarity and intention. We’ve refined our mission and strategy to meet what this moment demands: building the knowledge, infrastructure, and capacity of social and public sector institutions and fields.

This isn’t a departure. It’s a natural evolution — grounded in our history, shaped by what we’ve heard and experienced, and guided by what we know the moment demands.

At the center of this shift is the belief that institutions and fields must grow stronger together. That data and insights must be actionable. That shared agendas must lead to collective implementation. And that equity must move from intention to practice.

Our 2024 Impact Report showcases Camber’s new strategy in action —a collection of stories of insight, collaboration, and impact. They are proof points of what we believe: that when people, organizations, and partnerships are aligned, resourced, and supported, transformative change is not only possible — it’s inevitable.

Click here to read the full report

We’re deeply grateful to our funders, clients, partners, team, and alumni who continue to shape Camber’s path and impact. We’re excited for what comes next — and we look forward to building it together.

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This is not just a crisis of funding—it is a fundamental shift in how global health will be resourced and sustained in the years ahead. Across the global health community, people are feeling the weight of this shift deeply: most acutely in the communities served. Programs that once had stable funding are now in jeopardy. The UN is halving food rations for Rohingya refugees in Bangladesh; one of the only clinics on the Myanmar-Thai border has been closed, cutting off access to essential life-saving services; and a mysterious Ebola-like illness has broken out in the Democratic Republic of Congo, all following the cancellation of 90% of USAID’s international development projects. Colleagues who have spent their careers building critical health infrastructure are suddenly left without resources to continue their work. 

At the same time, within global health itself, a long-running shift toward decentralization and localization has been gaining momentum. For years, practitioners, policymakers, and leaders have argued that the global health system must transition from a top-down, donor-driven model to one that empowers national and local health systems to lead. The sudden withdrawal of funding is forcing an acceleration of this transition—whether we are ready for it or not. This crisis has exposed the vulnerabilities of a system that was built for a different era and has now been outgrown.

Change is no longer optional—it is imperative. This moment must be used not just to patch gaps in funding, but to rethink how we deliver global health—decentralizing decision-making, integrating efforts, and ensuring that national and local actors have the power and resources to lead.

The Consequences of an Incomplete Shift

Historically, the overconcentration of decision-making power in global institutions and donor agencies has led to misaligned priorities, inefficiencies, and fragmentation. Competition for funding, rigid mandates, and lack of coordination across organizations have contributed to duplication, wasted resources, and fragile health systems that rely too heavily on external actors. Meanwhile, efforts to strengthen national capacity have often lacked the structural changes and political will needed to transfer leadership—they have failed to establish the robust foundations and local ownership needed for countries to sustain their own programs – leaving countries dependent on outside interventions rather than progressing toward self-sufficiency.

These flaws are not theoretical—they have played out in real time. When the Ebola outbreak struck West Africa in 2014, affected countries struggled to respond due to fragmented global health coordination. In Haiti, multiple organizations launched competing cholera response programs, wasting resources and creating service gaps. The COVID-19 pandemic further exposed the weaknesses of global health dependency, as delays in vaccine distribution left low- and middle-income countries waiting for a slow, fragmented, and insufficient response.

The current global health model is no longer sustainable. While effective in delivering large-scale impact, it struggles to reach the last mile. More critically, it remains deeply exposed to funding cuts, shifting donor priorities, and geopolitical instability. Unless the system evolves, we will continue to face cycles of crisis, where essential programs collapse every time political or financial conditions shift.

The Way Forward: Collaboration, Adaptation and Resilience

The global health system is unraveling before our eyes. We do not have the option to preserve it as it was. Instead, we must adapt, reshaping global health institutions to function as true partners in a locally led ecosystem.

The international community must take this opportunity to not only shift decision-making power and resources to national and local levels but to do so in a way that fosters cooperation, alignment, and collective problem-solving. The shift toward decentralization cannot simply be a reaction to shrinking donor budgets—it must be an intentional strategy that strengthens health systems in the long run.

Not insignificant is the additional challenge of funding. Beyond the political will to increase collaboration and streamline programming, financial support will be imperative to translate this vision into reality. We don’t have a solution yet: we must come together and chart a path forward to meet this challenge.

This is not about abandoning the institutions that have driven decades of progress, nor is it about resisting change out of fear of uncertainty. It is about leaning into transformation—building a global health system that is adaptive, responsive, and truly aligned with the people it serves.

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