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
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