Exploring Global Health Funding Landscape: Implications for the Tuberculosis Response

Dahdaleh Global Health Graduate Scholar Yuliya Chorna’s doctoral research project aims to understand how financial resources for the global Tuberculosis (TB) response are allocated and delivered. Yuliya’s ethnographic field work in Geneva (April 11, 2025 – June 06, 2025) involved interviews with a wide range of actors working within the global TB community to ask them about their experiences in global TB policy-making circles, especially with regard to resource allocation and its impact on practices of TB care. Yuliya’s research supervisor is Dr. Margaret MacDonald, a medical anthropologist and Associate Professor in the Department of Anthropology at York University. Dr. Alexandra Widmer and Dr. Amrita Daftary serve on her dissertation committee as faculty members in anthropology and global health. While conducting her fieldwork in Geneva (April 11, 2025 – June 06, 2025) Yuliya was hosted by the Institute of Global Health at the University of Geneva as a visiting researcher. Her hosting supervisor was Prof. Dr. iur. Stéphanie Dagron, Institute of Global Health, Faculty of Medicine, University of Geneva, whose perspectives offered important insights into the area of multilateralism and international health legislation related to Yuliya’s research.

During her fieldwork in Geneva, she conducted seventeen in-person interviews with global health actors hosted by multilateral and technical agencies. As a participant-observer, she attended global health events where discussions about the global health policy, governance and funding took place to understand how global health actors frame priorities for funding and program interventions. These engagements also allowed her to explore the adaptation strategies of the global health agencies employed to address funding gaps amid ongoing cuts to global development aid.

Additionally, she conducted archival work at the World Health Organization’s (WHO) archives to analyze the historical developments related to the global TB response and changes in the funding flows in the context of the transition of the international health to the global health paradigm. She paid particular attention to how the concept of the international health — where states were perceived as the primary actors responsible for addressing health challenges and controlling the spread of infectious diseases beyond their national borders -  evolved into the concept of global health, in which responsibility for health response and funding broadened beyond states to include public-private partnerships and non-state actors, such as private corporations,  philanthropic  and non-governmental organizations. In her conversations with the interlocutors, she looked into how the concepts of the ‘global health solidarity’, ‘health as a human right’ and ‘investment in health’ are perceived by various global health actors, and how these understandings inform the morals of the funding decisions and subsequent practices of TB care.

Building on Erikson’s (2015) ethnographic work on money circulation in global health, Yuliya explored how approaches to resource allocation generates different sets of values in global health and differential stakes in well-being. In her ethnography, Erikson makes a distinction between ‘direct funding’ and ‘financing’ in the way global health money flows to countries that need it. Global health funding, for Erikson, refers to countries’ internal allocation of public funds or resources provided by outside countries or organizations working to address global challenges. She uses the term financing, on the other hand, to refer to a process by which private philanthropists and investors invest money in health-related areas suggestive of an ultimate market success.  Erikson’s work (2015) has informed Yuliya’s approach of studying new financial instruments, partnerships and ideas that govern monies flows in the global TB response. 

Scholarship in critical global health studies and medical anthropology guides Yuliya’s dissertation research. She draws on the following theoretical frameworks, to plan data collection and approach her analysis:  literature that views the development of the field of global health within the historical perspective; structural violence as political and social conditions that perpetuate poverty and disease; regimes of governmentality determining discourse and practice around health and risk; global health as a form of transnational humanitarianism (Birn 2014a, 2014b; Biehl 2016; Chorev 2013; Farmer 2004; Keshavjee 2014; Lakoff 2017; Fassin 2011). In her research she also applies an anthropological lens to explore the logic of financialization and economization of life and explore how it shapes institutions, policy and practice of the global health enterprise to unpack the meanings of investment in the TB response (MacDonald 2019; Murphy 2017; Widmer 2023).

Yuliya’s doctoral research aims to analyze the social space of global health funding and financing for TB. There is a long history of TB response in global health, and despite the fact that it is a preventable and curable disease, in 2023, an estimated 10.8 million people got sick with TB worldwide (WHO 2025: https://www.who.int/news-room/fact-sheets/detail/tuberculosis ). Funding available for TB prevention, diagnostic and treatment services in low resource countries historically falls short of the globally estimated need.  In 2023, the total funding available in Low- and Middle-Income Countries (LMICs) was US$ 5.7 billion. This is only 26% of the of the amounts estimated to be required according to the global target set at the United Nations high-level meeting on TB that was held in September 2023 which aims for reaching US$ 22 billion per year by 2027 to ensure universal access to quality prevention, diagnosis, treatment and care for TB (WHO Global Tuberculosis Report 2024).

Despite permanent funding shortages, according to WHO, in the past two decades the global progress made in TB prevention, testing and treatment services has saved more than 79 million lives. However, this progress has been heavily reliant on the funding flows generated from the foreign aid to LMICs. About one quarter of the total amount of international donor funding for TB was provided by the United States government in approximately US$ 200–250 million annually in bilateral funding for the TB response at country level. In 2025, the funding cuts for international aid made a devastating effect on TB programmes and put millions of people at risk of TB disease and death, especially for the countries with the highest burden of TB which depended on 89% of the expected United States funding for TB care. In this challenging context, global health partners are under the pressure to find solutions in securing funding and news ways to collaborate in the global health efforts to safeguarding the health of people affected by TB (WHO 2025: https://www.who.int/news/item/05-03-2025-funding-cuts-to-tuberculosis-programmes-endanger-millions-of-lives ).

Yuliya’s research documents the state of flux in the global health funding landscape and knowledge produced by her research can be applied for a better understanding and reforming global health philanthropy and international aid/development for the global TB response and global health. She believes that her PhD research, which unpacks current challenges in the global health funding landscape and global health actors’ visions on the future of global health and TB funding, aligns well with the DIGHR’s thematic area focused on the Global Health Foresighting.

"My fieldwork was supported by the Canada Graduate Scholarships - Michael Smith Foreign Study Supplements (CGS-MSFSS) and the Dahdaleh Institute (DI) for Global Health Research (DIGHR) travel grant, which allowed me to cover travel and living expenses in Geneva. Since 2022, I have been honored to be a Dahdaleh Global Health Graduate Scholar; and since 2020 I have been a contributor to the Social Science and Health Innovations Network for Tuberculosis (SSHIFTB) at the DIGHR. Within my affiliation to SSHIFTB and DIGHR, during 2024-2025 I participated in the bi-monthly meeting of the SSHIFTB journal club, which helped me to strengthen my theoretical orientation in the global health and TB. I also express my sincere gratitude to the Institute of Global Health at the University of Geneva for hosting me as a visiting researcher during my fieldwork"

— Yuliya Chorna, Dahdaleh Global Health Graduate Scholar

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