Across global health and development, a long-standing question has new urgency: how can social and development sector leaders move beyond fragmented programs to build more durable, locally rooted pathways to scale?

Recent aid contractions have made the stakes stark. Preliminary 2025 data from the Organisation for Economic Co-operation and Development show official development assistance falling by 23.1 percent, the largest annual contraction on record. Meanwhile, an analysis in The Lancet Global Health estimated that even a mild defunding scenario—defined as a continuation of current downward trends—could result in 9.4 million additional deaths through 2030, including 2.5 million children under the age of 5.

The immediate consequences have been severe. Clinics have closed, frontline workers have fewer resources, and programs in immunization, nutrition, clean water, HIV treatment and prevention, and education have been disrupted. Urgent funding is needed to protect these critical services and prevent further harm. But the crisis has also exposed a deeper vulnerability: too many health and development efforts remain dependent on fragmented programs, priorities set far from the communities they affect, and political decisions made outside countries responsible for sustaining the work.

Where public institutions can play a meaningful role, philanthropy has an opportunity to work more deliberately with government. One of its distinctive contributions is flexible, risk-tolerant capital that can generate evidence, develop and test innovations, and strengthen the policies, programs, capabilities, and systems needed to sustain outcomes at a population scale. Drawing on The Bridgespan Group’s research and conversations with funders, nonprofit leaders, and practitioners, we see five recurring pathways for this work:

• Generating evidence and offering technical advice
• Designing and testing programs, solutions, and platforms
• Helping governments manage programs at scale
• Building public-sector capacity
• Strengthening connections between communities and public systems

These pathways are not a formula; government partnerships are not always possible or appropriate. Governments are not monoliths, and their capacity varies widely across ministries, states, districts, and departments. In some countries, funders and social-sector organizations can work closely with government. In other contexts, particularly in conflict-affected regions or in places where public institutions are unstable, under-resourced, or unable to reach parts of the population, this kind of partnership may not be possible in the near term. In these scenarios, funders may need to support humanitarian assistance and essential service delivery, strengthen civil society and community-based organizations, preserve local and institutional capacity, or work with non-state actors until conditions shift. The goal is to sustain essential services and locally rooted institutions while remaining alert to opportunities for closer public-sector engagement as conditions change.

Together, the pathways offer funders practical ways to consider how they can support organizations not only by contributing directly but also by sharing relationships and expertise to help organizations work more effectively with public systems.

Why Collaboration with Government Is Newly Urgent

Many philanthropies, NGOs, and social-sector organizations have worked with government for decades, contributing to gains in health, education, livelihoods, and other areas. Now, the work has taken on new urgency. A growing number of experts have brought renewed attention to it. Kevin Starr, CEO of the Mulago Foundation, argued that nonprofits seeking exponential impact often need to shift from delivering services themselves to helping governments and other “doers at scale” adopt and deliver effective solutions. Rakesh Rajani and Tim Hanstad, president of JustSystems and chief program officer at King Philanthropies, respectively, have similarly called on NGOs and funders to make a “big shift” toward placing government systems at the center of their work.

Bridgespan’s research on government-philanthropy collaboration in India highlights the potential of these partnerships, where government accounts for roughly 95 percent of social-sector spending. Public services also rely on vast infrastructure and human resources, including more than one million Accredited Social Health Activists, or ASHA workers, and more than 30,000 primary health centers.

At a Skoll World Forum session this past April co-hosted by Bridgespan and the Gates Foundation, with leaders from ELMA Philanthropies, Emerging Public Leaders, DIV Fund, Piramal Foundation, and The END Fund, the conversation repeatedly returned to a common point: partnerships with government are essential for durable scale, but they are also complex and relational, and they often don’t unfold in neat, linear timelines. What, then, does effective partnership look like in practice?

Five Pathways for Partnering with Government

Government partnerships can begin in different ways. Some begin with a new policy that creates an opportunity for action. Others with a proven intervention that could reach more people through public systems, a gap in government capacity, a need raised by communities, or a public priority that an experienced nonprofit is well positioned to support.

Funders do not need to pursue these pathways directly. For those new to a country or region, a more effective role may be to support locally rooted, regional, or global organizations that have spent years building the relationships, knowledge, and capabilities to work with public systems. A potential partner’s experience working with government, as well as its ability to navigate political, administrative, and community dynamics, can be an important consideration when funders select grantees, intermediaries, or collaborative funding vehicles.

During a session at the Skoll World Forum, Bernadette Moffat, executive director of ELMA Philanthropies, emphasized that effective partnership begins with a clear understanding that government is the lead actor, with philanthropy aligning its funding and support behind public priorities. The Beginnings Fund—whose founding donors include ELMA Philanthropies and the Gates Foundation—offers a valuable example of this principle in practice. Across 10 African countries, the fund pools multiyear funding and aligns its investments with country plans jointly developed with ministries of health, maternal and newborn health specialists, and other stakeholders.

The five pathways that follow describe capabilities funders may develop or support through organizations already equipped to provide them. These pathways offer distinct lenses on work that often overlaps. We feature illustrative examples under each, while recognizing that many organizations—including those we have mentioned—work across several pathways at once.

Generating evidence and offering technical advice

Funders and social-sector organizations can help governments make better-informed policy and investment decisions by helping to generate evidence, conduct research, elevate issues in public discourse, offer technical inputs, and share lessons from other contexts. This role is especially important when governments face difficult choices about which interventions work, as well as which are affordable, implementable, and likely to deliver results at scale.

The DIV Fund illustrates this pathway. Its work focuses on identifying global development innovations from early pilots through rigorous testing and large-scale expansion, and it calibrates its support to the strength of the evidence and results. It also provides technical assistance to governments, bilateral agencies, multilaterals, and philanthropies seeking to design and implement evidence-driven innovation tools. Across this work, the fund focuses on identifying approaches that can measurably improve people’s lives while delivering strong value for money and durable scale.

As Sasha Gallant, CEO and co-founder of the DIV Fund, shared at the Skoll World Forum session, “Government is the largest distribution network in the world. If you want to reach people with something that will improve their lives, going through government will be necessary. At the same time, governments have limited resources and need to ensure they are spent as effectively as possible.” Philanthropy can help meet this need by funding the evidence generation, cost analysis, and experimentation needed to help government identify which solutions merit investment and assess how such solutions can be adopted within the systems and budgets that will have to sustain them.

Designing and testing programs, solutions, and platforms

Funders and social-sector organizations can help governments design and adapt sector strategies, programs, solutions, and platforms. This can include shaping plans, developing products such as vaccines or digital platforms, and testing new ways to deliver services. Working with government throughout can help ensure that these new approaches reflect public priorities and can be integrated into public programs, systems, and budgets.

With this broader role, investing in innovation is one of philanthropy’s core distinctive contributions. Flexible, risk-tolerant funding can support research and development, proofs of concept, and promising ideas that governments may be limited in their ability to fund, or that are unlikely to attract private investment. Funders and their implementation partners can test whether these ideas are effective, affordable, and practical, laying the groundwork for governments to adopt and deliver successful approaches at scale.

The END Fund’s work on neglected tropical diseases (NTDs) shows what it can look like to design for public-system adoption from the start. In 2025, The END Fund partnered with the Africa Centres for Disease Control and Prevention, the African Union Commission, and the World Health Organization on a continent-wide plan for eliminating NTDs—one designed to track resource allocation, advocate for sustainable financing, and support locally led solutions.

For people living with or at risk of these diseases, this kind of integration can mean more reliable access to prevention and treatment over time. Dr. Solomon Zewdu, former CEO of The END Fund, shared at the Skoll World Forum that in his experience, “Working with government is a trust-based exercise.” In practice, this has meant aligning around one plan, one budget, and one evidence mechanism, so that countries and partners can test, adapt, finance, and sustain solutions through the systems governments already use.

Helping governments manage programs at scale

Funders and social-sector organizations can help governments translate policy commitments into programs that work. This may include planning implementation, coordinating across ministries and delivery partners, developing monitoring systems, adapting programs as conditions change, and strengthening the capabilities for government to manage programs over time. This work is often less visible but essential to building effective programs.

Living Goods illustrates this pathway through its work with governments to strengthen the management of community health systems. Working through government systems, its approach combines digital tools with clear performance targets, supplies and training, supportive supervision, and compensation for community health workers. Digital workflows help health workers prioritize tasks and deliver care, while near-real-time dashboards allow supervisors to monitor performance, identify gaps, and direct support where it is most needed.

Living Goods works with governments to adapt and apply these practices within publicly led community health systems, rather than operating them solely through a parallel NGO structure. By helping governments establish stronger management routines, supervision systems, and ways to use frontline data, the organization aims to improve the quality and consistency of community-based care. The experience shows how social-sector organizations can support governments in launching programs at scale and building the day-to-day management capabilities required to sustain and improve them.

Building public-sector capacity

Effective government partnerships depend on capable people and institutions on both sides. Funders and social sector organizations can help strengthen the capabilities public systems need by training staff, building leadership pipelines, developing peer-learning platforms, and creating tools that help public servants and frontline workers do their jobs.

Emerging Public Leaders (EPL) focuses on attracting talent into professional civil service roles and building a new cadre of civil servant leaders. Founded in 2009 by former President of Liberia Ellen Johnson Sirleaf and Betsy Williams, EPL works across Liberia, Kenya, Ghana, Malawi, and Sierra Leone. Its fellows are placed inside government ministries with mentorship and professional support, and most go on to meaningful careers in public service.

At the Skoll World Forum, EPL fellows and alumni were described as the “doers”: the people government leaders turn to when something needs to be implemented. In one example, an EPL fellow helped create a dashboard for a government school-feeding program, making it easier to match food supply to schools’ needs and identify gaps. By investing in the people within public institutions, philanthropy can help governments lead and innovate over time, respond more effectively during crises, and expand equitable access to high-quality public services.

Strengthening connections between communities and public systems

Civil society organizations often serve as the critical link between communities and government. They can help public officials understand communities’ needs and priorities, improve uptake of public programs, and build feedback loops that make services more responsive. For many funders, this may mean supporting work both inside and outside public institutions: building champions and capacity within government while strengthening grassroots organizations, community voice, and public accountability.

Piramal Foundation’s work in India underscores the importance of connecting public systems with the communities they serve. The foundation aims to help 70 million people move out of multidimensional poverty—an outcome it believes cannot be achieved without the government’s mandate, reach, and delivery infrastructure.

Piramal seeks to complement that reach by making information within public systems more visible and useful. As Aditya Natraj, CEO of Piramal Foundation, shared at the Skoll World Forum session: “Our role is really about making the information streams within public health systems more visible to citizens, administrators, finance departments, and frontline health care workers.” Without that visibility, he noted, “These systems can be completely opaque even to those working inside them.” With better information, frontline workers, administrators, finance departments, and communities can see needs and system constraints more clearly. By helping to strengthen these connections, philanthropy can support public systems to become more informed and responsive.

Across these pathways, the common thread is that philanthropy and social-sector organizations are working alongside government, paying close attention to local context, government capacity, and public ownership.

What Funders Can Do Now

Philanthropy cannot replace lost aid. However, funders can be more deliberate about the scale they hope to achieve and the systems required to sustain it. Funders beginning to explore government partnership can start by clarifying why such a partnership matters before deciding to pursue it. What role does government play in the change you seek? Where could partnerships increase reach, legitimacy, sustainability, or responsiveness? What is the capacity of the relevant public institutions? And is there appetite for longer time horizons, nonlinear progress, shared ownership, and sustained relationship-building?

Funders also do not need to navigate the complexities alone or build government-partnership expertise from scratch. Those unfamiliar with a country, region, or public system can begin by supporting locally rooted organizations, experienced NGOs, and intermediaries, or funding collaboratives that have already established the relationships and capabilities this work requires.

Funders already partnering with government can deepen their work by using flexible capital to develop and test innovations with a pathway to public-system adoption, shifting from individual programs to system-strengthening agendas, investing in public-sector capacity and community feedback loops, planning earlier for public ownership and financing, bringing other funders into aligned collaboratives, and sharing practical learning with the field.

In a constrained funding environment, the opportunity (and the challenge) is not simply to do more with less. It is to help public systems and civil society do more, for more people, for longer.

Edited by Robyn Porteous 

This article was developed with support from the Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect the positions or policies of the Gates Foundation.