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Published: 15 December 2023

Resilient and Sustainable Systems for Health

The Challenge

To end HIV, tuberculosis (TB) and malaria as epidemics and fight emerging threats like COVID-19, we need to strengthen the formal and community health systems and responses that make up resilient and sustainable systems for health (RSSH).

Resilient and sustainable systems for health are the foundation of healthy, productive communities. RSSH is not just about government health systems, but also about services provided by communities, the private sector and other providers, which together should ensure that peoples’ health needs are met wherever they seek care. These systems are essential for ending HIV, TB and malaria as public health threats, producing better health outcomes for all and delivering health services in a sustainable, equitable and effective way. RSSH is also the basis for preventing, preparing for and responding to future pandemics. The whole world benefits when we build the strength and resilience of formal and community health systems everywhere.

Our Response

The Global Fund is the world’s largest multilateral provider of RSSH grants and one of the primary investors in health systems, investing US$2 billion1 a year in formal and community health systems between 2024 and 2026 through HIV, TB and malaria grants, direct RSSH grants and the COVID-19 Response Mechanism (C19RM). The total C19RM financing available until December 2025 for direct RSSH and pandemic preparedness and response interventions amounts to approximately US$2.1 billion2.

Our investments in RSSH take different approaches. We invest in the treatment and prevention of HIV, TB, malaria, and we support countries to respond to those diseases, while also improving overall health systems by boosting the quality of care, data tracking, accountability and governance, and service delivery. By reducing the burden of HIV, TB and malaria, we free up health systems’ capacity for other health priorities.

At the center of the Global Fund’s programming are the people and communities we serve. Community systems for health are designed, led and organized by communities themselves to address local needs and reach the most marginalized and vulnerable people. They play a crucial role in increasing access to equitable and high-quality services.

The Global Fund’s new Strategy recognizes the essential role that RSSH plays in ending HIV, TB and malaria and in helping countries prevent, prepare for and respond to new pandemics like COVID-19 and future health threats. In order to support countries and communities to strengthen their health and community systems, our new Strategy focuses on seven sub-objectives:

  • Deliver integrated, people-centered services to address an individual’s multiple health needs at different points in their lives, improving overall health with a more cost-effective and efficient approach.
  • Strengthen community systems and community-led programming and help integrate them into national health and social systems.
  • Support the integration of community health workers into primary healthcare systems, investing in their training and supervision and advocating for them to be paid as workers, rather than treated as volunteers.
  • Strengthen creation and use of health data at all levels so countries and communities can make decisions based on the latest evidence.
  • Strengthen supply chains to ensure medicines, laboratory services and health products are available when and where they’re needed.
  • Expand our NextGen market shaping focus on providing equitable access to quality health products through innovation and partnership, and by promoting sustainable sourcing and supply chains at global, national and community levels.
  • As part of Global Fund efforts to strengthen country oversight of the overall health system, better engage and harness the private sector to improve the scale, quality and affordability of services wherever patients seek them.
  • Deepen partnerships between governments and non-public sector actors so programming and services are sustainable and can reach more people.

Community health workers are at the heart of community systems. Increasingly relied upon to deliver health programs in remote areas and with marginalized populations, community health workers deserve to be treated as professionals – paid, trained and supervised. Their jobs should be integrated in the primary healthcare system of countries. That is why the Global Fund has partnered with the Africa Frontline First Initiative, launching a catalytic fund in 2022 to finance community health in Africa.

We support the Monrovia Call for Action for community health workers, advocating for increased professionalization. As the majority of community health workers are women, we are also committed to supporting their status and employment on an equal basis with men, and to advocating for their protection against gender-based violence.

Find out more

The Breaking Down Barriers initiative is a groundbreaking effort to confront the injustices that make some people especially vulnerable to diseases and unable to access the health services they need. The initiative provides the knowledge and the skills that are essential for people affected by HIV, TB and malaria to understand, demand and secure their health-related human rights. It works to enable health care providers, police, prison officials, judges, and parliamentarians to provide supportive and effective services to all those most vulnerable to disease.

Find out more about the Breaking Down Barriers Initiative

Communities are at the heart of everything we do. We support the role of communities in designing people-centered and effective programs, implementing and evaluating service delivery, and in helping reach those who may lack access to health care.

Find out more

It is not a question of if, but when, we will face the next pandemic threat. The Global Fund is the largest multilateral provider of grants for strengthening systems for health, the surest way to defeat today’s infectious diseases as well as prevent, prepare for, and respond to future pandemics.

Find out more

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Walking in Other People’s Shoes

[1] This figure is based on the recently endorsed Global Fund Strategy Committee methodology that integrates direct investments in resilient and sustainable systems for health (RSSH) and contributions to RSSH through investments in the fight against HIV, TB and malaria (contributory RSSH). The amount is derived from approved and signed grant budgets and RSSH-related catalytic investments and includes C19RM. This methodology excludes Global Fund Secretariat operating expenses.

[2] Based on signed budgets for 2024-2025 for C19RM, includes centrally managed limited investments (CMLIs) for the same period.

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