The global health system, particularly in Africa, faces a critical juncture following significant US aid cuts, urging a fundamental shift from disease-specific responses to comprehensive, integrated healthcare systems. This shift aims to build a more resilient and equitable global health compact, less vulnerable to the political fortunes of a single nation.

• US global health funding, once valued at some US$12 billion annually, has seen steep cuts due to an "America First" agenda.
• The US President’s Emergency Plan for Aids Relief (Pepfar), created in 2003, was the largest-ever bilateral program to combat a single disease, leading to significant African dependence on US aid.
• The new global health compact proposes that African governments design robust health systems, focusing on primary care, health promotion, and long-term care, with international assistance from behind.