Non-state perspectives on the future of bilateral development cooperation in the health sector

International cooperation in global health is currently facing headwinds in Germany from two directions. Firstly, public support for the German government's international engagement is declining — consider, for example, the debate about cycle paths in Peru. Secondly, billions of euros are to be cut from the federal budget, including a significant proportion from the Federal Ministry for Economic Cooperation and Development's budget line.

Since taking office, Federal Minister Reem Alabali-Radovan has emphasised the importance of multilateral cooperation in her public statements. This has prompted concerns, including among Hub members, that the Federal Government may be withdrawing from health-related bilateral development cooperation. During the summer recess, various non-governmental stakeholder groups addressed letters to the Minister to highlight the importance of bilateral development cooperation. These letters have been made available to the editorial team and are summarised below.

Health as a Human Right and a Central Cross-Cutting Issue

Health is a fundamental human right, while also being a central cross-cutting issue for tackling poverty, promoting peace and stability, adapting to climate change, and strengthening women's rights, education, and equality. Global health also affects Germany directly, as health risks such as pandemics and the consequences of climate change do not stop at national borders. Therefore, prevention and the development of resilient health systems in partner regions are of crucial importance.

Global Health Promotion as a Triad: Multilateral, Bilateral and Civil Society Engagement

Bilateral development cooperation in global health is considered a key instrument for responding to growing health challenges, multifaceted geopolitical dynamics and a strained financing landscape. Against this backdrop, stakeholders emphasise the need for a diversified approach combining multilateral, bilateral, and civil society cooperation as complementary pillars.
A frequently cited example is the BACKUP Initiative by GIZ, which is a central implementation and consultation mechanism for the Global Fund's multilateral instrument. Furthermore, bilateral measures are considered to enhance multilateral approaches by enabling targeted, needs-based support for partner countries, particularly in strengthening health systems and providing services for vulnerable groups.

Civil society and academic projects, with their proximity to local communities, including those in remote areas, help build trust, foster participation, and strengthen local ownership. The flexibility of bilateral cooperation enables swift adjustments and innovations that can serve as models for larger programmes. Moreover, these partnerships build capacities through close collaboration with local actors while fulfilling important advocacy and accountability functions.

In particular, the independent and diverse voices of civil society contribute context-specific knowledge that enriches development policy processes.

Strengthening Germany as a Centre for Science and Industry

Collaboration between the scientific community and bilateral development cooperation offers significant potential to increase the efficiency and relevance of both sectors, supporting independent research and reinforcing Germany’s position as a hub for science. In addition, the industrial health sector is a major pillar of the national economy, with an annual turnover of over 100 billion euros, more than one million employees, and a share of around nine per cent of total German exports.

Many companies have been operating in partner countries for years through programmes such as develoPPP and the Integrated Healthcare Initiative AYA. These efforts strengthen health systems in low- and middle-income countries while opening up new markets — a strategically important factor given current global challenges. Germany’s leadership is reflected in the visibility, quality and effectiveness of its development cooperation. Bilateral programmes support partner countries and address their needs while strengthening German implementing organisations, such as GIZ and KfW, as well as companies, research institutions and civil society actors.

The signatory organisations and individuals, many of whom are members of the Global Health Hub Germany, emphasise the ongoing need for, and relevance of, bilateral development cooperation in the health sector. A one-sided shift in focus towards multilateral cooperation could undermine established structures and partnerships. Therefore, a balanced and strategically oriented combination of multilateral, bilateral and civil society engagement is considered essential for achieving effective, equitable and sustainable global health.

Public sources:

Zivilgesellschaftliche Organisationen: Stärkung der vielfältigen Ansätze der gesundheitsbezogenen Entwicklungszusammenarbeit (Link)

Picture designed by Freepik