KFF: Analysis of US and Global Fund funding reductions in MOU countries

KFF analysis

Worsening fiscal constraints and changing policy priorities have resulted in significant funding cuts to global health and development programs. While these reductions predated the cuts and disruptions made by the U.S. government last year, they were exacerbated by U.S. actions. The Organisation for Economic Co-operation and Development (OECD) recently reported that international aid fell significantly in 2025, driven primarily by the U.S., and that further declines are likely on the horizon. The health sector has not been immune to these pressures. The U.S. government and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the top two donors to global health in low- and middle-income countries, each took actions to reduce funding to countries starting last year and plan to further reduce funding going forward. Under the Trump administration, the U.S., as part of its new America First Global Health Strategy (AFGHS) “MOU” agreements with countries, plans to reduce funding by billions over the next few years. The Global Fund, due to reduced contributions from the U.S. and other donors, is also reducing funding in the same set of countries. Together, the U.S. and Global Fund reductions serve as a “one-two punch” to countries, who will be faced with significantly fewer resources in the coming years.

KFF released an analysis assessing the magnitude of these combined funding cuts in 29 U.S. MOU countries between 2026 and 2029, relative to prior funding levels. As it shows, the combined decline is estimated to total $4.3 billion – a 24% drop relative to prior funding levels — most of which (77%) is driven by the U.S. The cumulative cut, taking into account unexpected reductions in 2026, was even larger, reaching $5.8 billion. Moreover, further declines are likely to occur after this period. Such funding declines are unprecedented in the modern-day era of global health, which saw the creation of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. government’s flagship global health program, and of the Global Fund in the early 2000s, both of which helped to usher in significant new resources for global health.

Read the full analysis here.