Building resilient health programs through lessons from PEPFAR’s funding challenges

The global health landscape has been profoundly shaped by initiatives like the President’s Emergency Plan for AIDS Relief (PEPFAR), which has made significant strides in combating HIV/AIDS worldwide. However, recent funding challenges faced by PEPFAR have highlighted vulnerabilities within the programs it supports, raising critical questions about the sustainability of health initiatives that heavily rely on external donors. This perspective explores the impact of PEPFAR’s funding uncertainties, drawing lessons from its experience to inform the development of more resilient and locally sustainable health programs. Through examining how PEPFAR’s challenges have affected key populations and program effectiveness, we uncover the pressing need for local ownership, strong leadership, and adaptive strategies to build robust health systems. The perspective present strategic recommendations for transitioning toward sustainable health programs that can withstand financial instability, emphasizing the importance of long-term planning, cross-sectoral collaboration, and the collective responsibility of all stakeholders in global health.