Global health financing is changing at different levels as development assistance for health continues to decline. Countries eligible for Global Fund financing, including Rwanda, are now receiving lower allocations while being expected to increase domestic resource mobilisation to sustain health services at both national and global levels. This shift is putting pressure on many African countries to rethink how their health systems are led, financed and organised. The discussion is both about expanding healthcare services, and how to sustain the progress made over the years toward universal health coverage with fewer external resources. Under Grant Cycle 8 (GC8), the Global Fund is encouraging countries to strengthen integration within health systems and prepare for a gradual transition from donor support. The focus is also on equitable access to services and value for money. For Rwanda, these discussions came at an important time as preparations began and are in progress for the 2027–2029 funding cycle. Continued leadership from the Ministry of Health, the Ministry of Finance and Economic Planning (MINECOFIN), the Rwanda Biomedical Centre (RBC), and the Rwanda NGOs Forum on HIV/AIDS and Health Promotion (RNGOF on HIV/AIDS & HP) remain important as the country responds to these changes. Rwanda has already taken steps toward building a more integrated health system. One of the major reforms was the establishment of RBC in 2011, which brought together more than ten health institutions under one structure. This marked a shift away from vertical programming toward a more integrated approach aimed at improving coordination, reducing duplication and strengthening the delivery of affordable and sustainable healthcare services for the Rwandan population. The country has also consistently promoted financing systems that align with national priorities. In its partnership with the Global Fund, Rwanda has supported Results-Based Financing and direct support through the Ministry of Finance and Economic Planning, while favouring a single-stream funding model instead of dual-track financing. Funding mechanisms were also established to support programmes implemented by both government institutions and civil society organisations, including RNGOF on HIV/AIDS & HP. At the civil society level, integration has increasingly become necessary in responding to changes in health financing. Through RNGOF on HIV/AIDS & HP, work has continued across HIV, Tuberculosis, Malaria, Non-Communicable Diseases (NCDs), Neglected Tropical Diseases (NTDs), Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH), Mental Health and health promotion. The Board of RNGOF on HIV/AIDS & HP recognises that Civil Society Organisations need to adapt to the changing financing environment and strengthen their ability to support communities effectively during this period. An Integrated Community-Led Monitoring (iCLM) model combining monitoring for HIV, TB and malaria, alongside an iCLM system for community data management, has already been piloted under the Covid-19 Response Mechanism (C19RM). Preparations are underway to extend this model further into pandemic prevention, preparedness and response, as well as other diseases. As donor funding continues to shrink, there is rising concern about how community programmes will be sustained, especially those supporting vulnerable populations. Civil Society Organisations are expected to show clear results and work more closely with national health priorities. Community responses and interventions led by Civil Society must remain part of Rwanda’s strong health system. There is also a need to improve advocacy for increased domestic resource mobilisation while helping communities and organisations better understand changes in global health funding. Discussions around integration, equitable access and value for money have been ever more important in shaping GC8 and universal health coverage efforts in Rwanda. There is a need to build on experiences from programmes addressing Neglected Tropical Diseases (NTDs), Malaria and outbreaks such as Marburg and Mpox to boost the One Health approach, which connects human, animal and environmental health. This is becoming more important as climate change and emerging health threats continue to strain health systems and communities, making clear the need for a more balanced approach between people, animals and the environment. The writer is the Executive Director of RNGOF on HIV/AIDS & HP.
