Redefining Global Health in the 21st Century, Chpt 4: Financing Global Health in an Era of Scarcity

In this episode of Redefining Global Health in the 21st Century, Ben chats with authors mike Reid and Eric Goosby about how funding shocks become life-and-death realities, starting with a case from Zambia after the January 2025 U.S. pause and cuts to PEPFAR that left many without antiretrovirals and destabilized HIV services in a system heavily dependent on U.S. support. They describe behind-the-scenes efforts to warn political leaders, on-the-ground resilience and improvisation, and the emotional toll of what they view as an abandonment of dialogue. The discussion explores whether donor dependency was a design choice, the roles donors should play (equity gaps, global public goods, and underwriting transitions), and options such as co-investment requirements, government-to-government funding, debt-to-health swaps, public financial management support, domestic resource mobilization (including sin taxes), and potential roles for development finance and sovereign wealth funds, while stressing the need to define a clear destination for health financing and country ownership. 00:00 Welcome and Book Intro 00:29 Zambia Funding Shock 02:26 Why Zambia Matters 05:58 Scrambling After PEPFAR Pause 07:58 Resilience and System Fragility 09:58 Eric Goosby Reaction 15:37 Dependency by Design 18:44 Colonial Debt Reality 22:25 What Solidarity Looks Like 26:10 Donor Funding Roles 30:21 Accountability and Oversight 32:50 Co Investment and Direct Funding 35:37 Debt Relief as Co Investment 36:46 Debt for Health Swaps 37:46 Modernizing Gavi and Global Fund 41:26 Local Accountability and Trust 45:26 Post Aid Era Roadmap 48:19 Building Country Ownership 53:46 Sovereign Wealth Fund Ideas 58:04 New Finance Tools and Taxes 01:00:04 Defining the Destination 01:04:03 Call to Action and Thanks Learn more about the book: https://bit.ly/redefining-global-health More from UCSF Institute for Global Health Sciences: https://globalhealthsciences.ucsf.edu Check Out mike Reid’s Substack: https://substack.com/@reimaginingglobalhealth Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! What would it take for global health to avoid decline? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health — and look out for a dedicated sub channel for Redefining Global Health in the 21st Century under A Shot in the Arm’s YouTube home. Redefining Global Health in the 21st Century: The Podcast (Playlist on Youtube) https://bit.ly/rgh-book A Shot in the Arm Podcast Youtube (Main Channel) https://youtube.com/@shotarmpodcast