Interview with Supriya Madhavan , Senior Health Specialist at the Global Financing Facility (GFF). She works to provide technical assistance on analytical and operational work to advance the demographic dividend and improve quality of care around reproductive, maternal, newborn, child, and adolescent health. Before joining the GFF, Supriya worked at USAID to promote implementation research and delivery science to support maternal child health service delivery in lower- and middle-income countries. She has extensive experience working in Central, South, and Southeast Asia; the Balkans; and Sub-Saharan Africa.
1/The ongoing crisis in Sudan – where famine conditions are spreading and millions face acute malnutrition– underscores the need for stronger, more coordinated responses. What does this crisis reveal about current partnership gaps, and how can international actors better align to deliver effective, integrated nutrition responses in fragile contexts?
From an operational perspective, many of the barriers to delivering nutrition services in fragile, conflict-affected, and violence-affected (FCV) settings are the same as those faced in non-FCV countries. Weak health systems remain a major challenge: inadequate financing, weak supply chains, shortages of commodities, limited human resources for health, and poor data systems all constrain the delivery of nutrition services.
However, FCV settings add another layer of complexity: insecurity. Conflict directly affects the ability of health systems to physically deliver services. Not only are recipients of nutrition services affected, but health workers themselves are also exposed to significant risks. Since the majority of health workers globally, and especially community health worker, are women, they face additional vulnerabilities in FCV contexts. Recruiting and retaining female health workers becomes particularly difficult, especially when mobility and security are compromised.
Community health workers are especially critical in nutrition programming, yet they often lack the protections and enabling conditions needed to do their jobs safely. At the same time, governments in FCV settings face competing priorities, having to allocate limited resources between health and nutrition services on the one hand and defense and security on the other. This creates additional pressure that is less pronounced in more stable settings.
Another major challenge is fragmentation. Humanitarian actors and basic service delivery systems often operate in parallel rather than in coordination. In the nutrition space especially, this creates inefficiencies, duplication, and gaps in coverage. There is a significant missed opportunity to better align humanitarian and development resources to improve coverage and maximize the impact of limited funding.
The Global Financing Facility (GFF) has tried to address some of these challenges through its partnership with the World Bank. Around 40% of the 37 countries supported by the GFF are FCV countries, many of them in sub-Saharan Africa. Interestingly, some GFF-supported FCV countries have achieved better health outcomes than non-FCV countries, in part because of the ability to leverage World Bank financing instruments effectively. One important mechanism is performance-based financing, which helps channel resources directly to frontline service delivery points, including primary healthcare facilities and community health platforms, while maintaining accountability. Through this approach, the GFF is also able to focus on quality of care, coverage, equity, and the specific nutrition needs of vulnerable populations, particularly pregnant women and children under five.
A key pillar of the GFF’s model is alignment and government stewardship. In FCV contexts, strengthening government leadership is essential to ensure that humanitarian and development actors coordinate around nationally defined priorities rather than operating in silos. Governments need to be supported to identify clear priorities, finance them appropriately, and align partners behind a shared agenda.
This becomes even more important in a context of shrinking fiscal space and declining aid budgets. One promising approach has been resource mapping and expenditure tracking across both humanitarian and development sectors. For example, in Afghanistan, joint resource mapping revealed major overlaps and duplication between actors, while also identifying areas of the country receiving little or no coverage. Nutrition is particularly vulnerable to duplication because multiple humanitarian actors—including UN agencies, donors, and implementing partners—operate simultaneously in the same space.
Without a comprehensive understanding of where resources are being spent, it is very difficult to improve efficiency or close coverage gaps. Better coordination, stronger government stewardship, and integrated planning between humanitarian and development actors are therefore essential to delivering effective nutrition responses in fragile settings.
2/How can partnerships—including with IFIs, the private sector, and local actors—be better structured to scale up nutrition responses?
Strengthening nutrition responses in FCV settings requires partnerships that are both locally grounded and strategically coordinated. One important lesson is that financing alone is not enough; partnerships must also invest in systems, governance, and the frontline workforce. The majority of frontline health and nutrition services are delivered by women, both within national health systems and among humanitarian actors. In many contexts—particularly conservative settings such as parts of the Sahel—women and children are more likely to access care when services are delivered by female providers. Supporting female health workers therefore becomes central to scaling nutrition services effectively.
The GFF’s new 2026–2030 strategy places gender at the center of its approach. This includes creating enabling environments for female health workers through both financial and non-financial support measures. Examples include ensuring fair compensation, providing safe transportation, offering secure accommodation near health facilities, and strengthening security protections for frontline workers.
Partnerships also need to support advocacy and policy engagement. A recent example comes from Afghanistan, where the Taliban interim government announced restrictions on women’s participation in medical training. In response, the GFF rapidly worked with gender partners and the World Bank to model the projected health impacts of reducing the female health workforce. The analysis demonstrated the likely increase in deaths among women and children under five if female health workers were no longer trained and entering the system. This evidence was then shared with donors, UN agencies, and diplomatic actors through Afghanistan’s coordination platforms to strengthen collective advocacy efforts. The experience demonstrated the importance of partnerships that combine financing, technical expertise, data, and diplomatic engagement.
At country level, strong coordination platforms are also essential. The GFF works to strengthen government stewardship so that countries themselves can lead alignment between humanitarian actors, development partners, bilateral donors, NGOs, and financial institutions. Where governments are unable to directly deliver services due to insecurity, alternative delivery mechanisms become critical.
In countries such as Afghanistan, Myanmar, the Central African Republic, Mali, and Burkina Faso, the World Bank and partners have supported contracting arrangements with NGOs and non-state actors to deliver services in areas inaccessible to governments. These partnerships can be highly effective when contracts are well designed and responsive to the needs of women and children.
Burkina Faso offers an example of how strong national leadership can make a significant difference even in highly insecure contexts. Despite repeated political instability and growing insecurity in parts of the country, Burkina Faso has achieved relatively strong health outcomes compared to many other FCV settings. This has been driven in part by strong stewardship from the Ministry of Health, which has prioritized nutrition, strengthened community health systems, and institutionalized tools such as resource mapping and expenditure tracking to guide policy and investment decisions.
Ultimately, partnerships are most effective when they are aligned around country-led priorities, grounded in strong data systems, and focused on strengthening long-term resilience rather than only responding to immediate crises.
3/What are the key conditions for ensuring that such partnerships deliver sustainable reductions in malnutrition?
Sustainable reductions in malnutrition require long-term investment in resilient systems, strong government stewardship, and sustained political commitment. The GFF does not see itself primarily as a humanitarian actor. Rather, its comparative advantage lies in strengthening systems and institutions that can improve resilience over time. This systems-based approach focuses on areas such as the health workforce, supply chains, data systems, financing mechanisms, and community health platforms. Strengthening these systems benefits both routine service delivery and emergency response capacity. This is increasingly important as countries face multiple and overlapping shocks, including conflict, climate change, food insecurity, and future pandemics. Resilient systems are essential for countries to absorb and respond to these pressures effectively.
Government stewardship is also fundamental. In most contexts, GFF support is delivered through governments because state institutions remain central to long-term sustainability. Even where humanitarian needs are acute, investing in national systems helps build the foundations for future resilience and continuity of care. At the same time, partnerships must remain people-centered and grounded in humanitarian principles. This includes protecting health workers—especially women—and ensuring safe access to services for vulnerable populations. Strong and coordinated advocacy from international partners, including the EU, remains essential in contexts where women’s rights, humanitarian access, or health services are under threat.
The EU has played an important role in several FCV contexts, including Afghanistan, by acting as a strong advocate for women, adolescents, and children. More broadly, there is a need for a more unified international voice in support of nutrition and health services in fragile settings, particularly in situations where governments themselves may not prioritize these populations.
Finally, sustainable progress requires countries to gradually increase domestic investment in health and nutrition services. External partners can support this process collectively through financing, technical assistance, and coordination, but long-term resilience ultimately depends on countries being able to invest in services for their own populations. Despite shrinking aid budgets and declining political attention globally, strengthening systems and building resilience remain the only viable long-term path to reducing malnutrition in fragile and conflict-affected settings.
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