Global health financing is currently facing severe constraints as reflected in the November 2025 World Bank report on health financing. Declining Development Assistance for Health creating critical funding gaps for major global health institutions (GHIs) such as the Global Fund and GAVI.

These gaps are hard to address, and risk reducing the impacts of GHIs. At the same time, vertical programs for infectious diseases and immunization focus on narrow public health priorities that are critical but are at risk of being neglected as other policy concerns crowd out traditional issues. Is there another way?

 

Blended finance: an integrated solution

Renaud, MacGregor and Ranson point out the value of “blending finance,” essentially joint financing by piggybacking on the loans to low- and middle-income countries (LMICS) from MDBs such as the World Bank. GHIs are unlikely to transform into development banks with a broader mandate and financing with  the ability to influence overarching policy reform. However, partnerships with Multilateral Development Banks (MDBs) offer the potential for integrating vertical programs to achieve national and global health goals, leveraging additional resources and influencing how the overall health system functions.

Blended finance can ensure that infectious diseases remain at the fore of policy discussions and contribute to the delivery of integrated healthcare services. This approach can help relieve government fragmentation and reporting by broadening the focus of grants, and reducing the number of individual donors, respectively.

 

Practical benefits for governments and health systems

In fragile states like Haiti or South Sudan, the cost of even highly concessional loans from the World Bank’s International Development Association (IDA) poses financial burdens. Moreover, the limited capacity of fragile states to manage multiple financiers and their individual requirements provides significant challenges. Blending finance reduces the burden on these governments.

Both the Global Fund and GAVI invest in bolstering health systems as well as delivering vertical programs. Collaboration and blending finance with MDBs, whose major focus is system-wide health investments and providing technical advice to governments on policy directions, strengthens the integration and impact of GHI resources. It enables a broader focus on overall health system development rather than a narrower infectious disease perspective.  Combined resources can therefore yield greater returns than if delivered independently. The figure below summarizes some of the possible opportunities for GHIs in collaborating with MDBs.

 

 

Navigating the Challenges

Despite the advantages, there are obstacles to blended finance, particularly misalignment among the different agencies in timing and implementation arrangements.

Financing modalities naturally differ across institutions. World Bank investment operations—particularly those supporting long-term system strengthening—typically require more extensive preparation and therefore follow multi-year investment preparation and disbursement schedules. By contrast, the Global Fund’s grant allocation works on a three-year cycle. These differences reflect the distinct mandates and time horizons of the two institutions.

 

Taking Action: Recommendations for Scaling

The initiative proposed by Renaud, MacGregor and Ranson provides a strong foundation on which global partners can build more effective health systems and overcome current shortfalls in financing.  The World Bank and the Global Fund have already cemented a relationship that now needs to move to action, exploring opportunities to significantly scale blended finance.