NGOs have for decades been a major pillar of US-funded global health programs. Whether it is HIV, malaria, maternal health, immunization, nutrition, or emergency response, non-profits have frequently taken funding and transformed it into on-the-ground services for communities. But the how of that funding has been changing.
Increasingly, US approaches are focusing on bilateral government-to-government agreements, putting more emphasis and responsibility on national governments to manage and implement US-supported health programs.
These changes are a part of a larger realignment in US foreign assistance following the shuttering of USAID. For NGOs, this poses an obvious, “What role will NGOs be in this new reality where it’s about government-to-government? It is a slightly more complex story than you might immediately think. NGO work may become much more of working alongside the government or the prime implementers than receiving directly funded awards.”
A New Direction for U.S. Global Health Funding
The new strategy relies more on bilateral agreements between the U.S. Government and individual countries. These agreements are intended to set a broader health cooperation agenda in the longer run, and the expectation is that individual countries will bear more responsibility over time for funding and managing their own health sectors.
The notion is to gradually build up domestic health financing and increase ownership over programs which have traditionally been based heavily on external aid.
National health priorities and budgets will likely more and more be dictated by governments.
NGOs will need to adapt, however, with new funding modalities, new partnership arrangements and new roles in large-scale health programs.
Does This Mean NGOs Are Being Cut Out?
Maybe not. That’s one point we can’t overstress. Even as government becomes more crucial for global programs such as the U.S.
Invests in, the U.S.
Government is leaving NGOs a path to the door when it comes to American-backed efforts across the globe. Indeed, in March, the State Department introduced a $4.5 billion funding mechanism that applications can come from international NGOs, local NGOs, governments, faith-based organizations, and universities as well as private businesses for, potentially, all varieties of health care and services. In this instance – the possibilities of an “either/or scenario are surely going out the window – NGOs may become the technical arms, the people who get it all done within any system established by the US government.
Why the Change Matters for NGOs
Over many years, many NGOs have gained hands-on experience working with communities. They know local cultures, languages, needs, and practical obstacles to getting health programs delivered to the population. This local knowledge is very hard to substitute for.
A national ministry of health may have the authority and resources for a big program, but local NGOs may be better at building community trust or reaching excluded populations.
NGOs could be very helpful. Their role may well change in new ways though. Rather than being funded directly by a major international donor some organizations may increasingly work within government programs or with large international agencies or consortia.
The Challenge for Smaller NGOs
The transition could be particularly difficult for smaller organizations.
Large international NGOs often have dedicated teams for compliance, finance, monitoring, proposal development, and donor reporting. Smaller NGOs may have only a few employees managing all of these responsibilities.
If funding increasingly flows through larger government-led programs, smaller organizations may need to compete as local implementation partners rather than applying for large grants independently.
This makes partnership building increasingly important.
A small NGO may not have the capacity to manage a multimillion-dollar health program, but it may have something equally valuable: strong community relationships and local expertise.
Working with larger organizations could allow smaller NGOs to contribute those strengths while gaining access to larger programs.
An Opportunity for NGOs to Show Their Value
The changing funding landscape could also encourage NGOs to become more strategic about demonstrating their impact.
Organizations will need to clearly communicate:
- Who they serve
- Where they work
- What challenges they understand
- What results they have achieved
- How they measure those results
- Why communities trust them
This is where strong monitoring and evaluation systems can become a major advantage.
An NGO that can demonstrate measurable outcomes, maintain reliable financial records, document its activities, and clearly explain its impact may have a stronger position when approaching governments and larger funding partners.
In other words, being able to prove your value may become just as important as having a strong project idea.
Funding Diversification Becomes More Important
The changing U.S. funding model is also a reminder of a broader lesson for NGOs: relying too heavily on one donor can create serious risks.
Organizations can consider developing a more balanced funding strategy that includes domestic philanthropy, CSR funding, individual donors, foundations, institutional grants, international donors, government partnerships, and private-sector collaborations.
Diversification does not mean abandoning international funding.
Instead, it means making sure that the organization does not become completely dependent on a single funding source.
For NGOs working in global health, this could become increasingly important as international aid priorities continue to evolve.
Transparency and Compliance Matter More Than Ever
As NGOs enter new partnerships, they will also need to pay close attention to compliance.
Organizations working with government-led programs may face requirements related to financial reporting, data protection, safeguarding, monitoring, procurement, and program performance.
Strong internal systems can make this transition much easier.
Maintaining accurate financial records, documenting activities, protecting beneficiary information, and keeping clear evidence of project results can help NGOs demonstrate that they are reliable partners.
For organizations working in sensitive areas such as healthcare, data protection is particularly important because beneficiary information can be highly confidential.
The Role of Technology and Data
Technology could also become increasingly important as NGOs adapt to this new funding environment.
Digital systems can help organizations collect beneficiary information, monitor projects, track outcomes, prepare reports, and communicate with partners more efficiently.
AI and data-analysis tools may also help NGOs identify trends, organize large amounts of project information, and reduce repetitive administrative work.
However, technology should support—not replace—human expertise.
An organization still needs people who understand local communities, can interpret data correctly, and can make responsible decisions based on the realities on the ground.
What Should NGOs Do Now?
But while waiting for the funding systems to evolve even further, NGOs are able to begin planning the adjustments today. They should focus on improving their M&E systems, developing sophisticated systems for finance and compliance, building relations with government and bigger organizations, and collaborating with other NGOs in partnerships and networks. It is also important to invest in staff capacity, strengthening proposal development skills, and collecting documented evidence of success from projects.
Above all, NGO will need to be able to answer one question: What unique value does your organization contribute to a health program?
The answers could be, for example, community trust, local knowledge, specific technical expertise, strong outreach networks, expertise in working with marginalized groups, or the ability to operate in remote areas. Understanding the value – and proving it – will help NGOs remain useful in an environment of changing funding.
What Could the Future Look Like?
The shift toward bilateral health agreements does not necessarily signal the end of NGO involvement in U.S.-supported global health programs.
Instead, it could lead to a different relationship between governments, donors, and civil society.
Governments may take greater responsibility for national health planning and financing, while NGOs contribute specialized knowledge, community outreach, technical support, implementation capacity, and monitoring.
Some organizations may struggle during this transition, particularly those heavily dependent on a single funding channel.
Others may find new opportunities by becoming stronger partners within larger health programs.
The difference may come down to how prepared an organization is to adapt.
Final Thoughts
US move to bilateral health treaties is more than changing fund structures, and is part of a larger rethink about how international health assistance might be structured moving forward. NGO Message: The bottom line for NGOs: the way funding will work has to evolve, and organizations need to be in front of that evolution. It doesn’t mean shunning international funding or vying directly with Governments; rather, it does require NGO engagement with adaptability, stronger partnerships, funding diversification, increased accountability, and providing evidence of the unique benefit they bring to people in need.
As countries in the developing world increasingly take the lead, their need to see themselves supported by international donors in a way that aligns with their priorities through bilateral engagement is only set to rise.
The future of funding will likely include Governments taking on greater responsibility, but international health organizations’ deep expertise in communities, and in ensuring that funding transforms into effective, impactful programmes, will not decline in importance. The question for an NGO today is no longer solely, “Where will my next grant come from?” It also must be: “How can I provide value as a partner such that the governments, donors, and the communities I serve simply cannot afford to pass on my assistance?”
