Dear Unlock Aid community,
We have big news, and it comes at a pivotal moment. The State Department will provide a $150,000,000 pay-for-results grant to work with Zipline in five countries over the next three years to modernize health supply chains. The agreement – supporting health systems in Africa, including Rwanda, Nigeria, Kenya, and Côte d’Ivoire, serving up to 130 million people – represents one of the first major U.S. global health commitments since the release of the agency’s new global health strategy. Zipline is one of Unlock Aid’s founding organizations.
Jeremy Lewin, undersecretary of state for foreign assistance, said, “This partnership is an example of the innovative, results-driven partnership at the core of the America First foreign assistance agenda.”
Zipline’s work is grounded in a simple idea: lifesaving medical products should reach patients in minutes, not hours or days. By using drone technology to deliver blood, medicines, vaccines, and other health products to last-mile communities, Zipline has transformed health outcomes where it operates. For example:
University of Pennsylvania researchers found that Zipline’s interventions reduced maternal mortality by 51% at hospitals serviced by Zipline in Rwanda.
IDInsight found that Zipline’s integration increased the diversity of stocked medical products, reduced days without essential supplies and vaccines, and reduced the number of patients turned away due to stockouts.
A study published in Vaccine found that immunization rates increased by 13–37 percentage points in Zipline-serviced districts in Ghana.
As part of the agreement, the U.S. government will cover the upfront infrastructure costs, such as building new “nests” to launch drones, and will release funds after countries commit to sustaining ongoing operations, with further payments tied to results. The goal is to build the infrastructure now so that, as unit costs fall, domestic budgets – not donors – carry the model forward over time. Countries like Rwanda and Nigeria already pay for Zipline through their national budgets, Rwanda making its first such investment nearly a decade ago. This agreement now provides additional capital to scale that impact.
The agreement also represents one of the first real signals that the system we’ve been pushing for is starting to take shape. Our recent Builders Report, drawing on input from more than 50 social innovators, makes clear that a new generation of organizations has already proven high-impact, financially sustainable, scalable models – many built outside the traditional aid ecosystem. The moment now is to align public resources with what’s already proven to work.
A bigger opportunity
This moment is exciting – and it’s also bigger than Zipline alone. This investment signals an appetite to fund the kind of evidence-backed, cost-effective, and financially-sustainable innovation that countries need now, especially amid major shifts in global development.
That’s why we’re launching the Solutions Index: to ensure funders can quickly identify the most impactful innovations ready for scale right now. The organizations we’ll feature operate models that are high-impact, scalable, financially sustainable, and accountable to the countries they serve.
While inclusion in the Index does not guarantee funding from the State Department or any other institution, visibility matters right now, especially as bilateral and multilateral donors, national governments, philanthropies, and investors look for proven partners.
(If you’re a health-sector innovator, submit your organization for the Solutions Index: Health Edition by December 2.)
Other major developments
The news of this $150 million investment also comes alongside three other significant global health announcements made by the U.S. State Department in recent weeks:
1. The United States will contribute $4.6 billion to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
The Global Fund has been one of the most effective vehicles for reducing deaths from HIV, TB, and malaria over the past two decades, and this commitment represents a major down payment toward sustaining that progress.
2. The State Department released its new America First global health strategy.
Importantly, the strategy reflects many of the recommendations we developed after running ReimagineAid.org, where more than 20 experts and 600 participants rank-voted the reforms most needed to modernize U.S. international investing. We published the resulting summary of recommendations earlier this year.
The global health strategy commits to time-bound investments to end HIV, malaria, TB, and polio; strengthen pandemic preparedness; and adopt a more transparent, results-driven approach. More specifically, we support the strategy’s calls for:
Shifting more to country-to-country agreements, private-sector partnerships, and collaboration with locally-embedded faith communities and frontline health providers
Increasing investments in innovation, science, and technology
Breaking down funding silos between disease programs
Paying for results using clear, verifiable metrics
Investing in community health and frontline workers
Accelerating transitions to locally-owned health systems
3. The State Department is partnering with Gilead to expand access to lenacapavir.
Lenacapavir requires only two injections per year and reduces HIV transmission risk by nearly 99%. Scaled rapidly and responsibly, this “breakthrough” drug could change the trajectory of the HIV epidemic. The State Department has committed investments to reach up to 2 million people with the drug by 2028.
But as with any new medical innovation, the hardest part often isn’t discovery alone – it’s also ensuring that lifesaving treatments actually reach the most vulnerable, hardest-to-access communities. That’s why investments in modern global health logistics and delivery systems are now just as critical as the drug itself.
Where this leaves us
Taken together, these developments signal meaningful, positive movement during a year of profound transition. Institutions are being reshaped, roles are shifting, and new models are emerging quickly. Our task, alongside our community, is to make sure these shifts translate into durable, measurable health gains – and that investments can be designed and sustained by the communities they’re meant to serve.
To Progress,
Unlock Aid
P.S. If you’re building a health innovation ready for scale, we encourage you to apply to the Solutions Index: Health Edition by December 2.