By Rahul S Reddy Kadarpeta, Muluken Argaw, Samson Kuhora, Charlotte Muheki As traditional development aid declines sharply—with cuts exceeding 70% from major donors between 2021 and 2025—African and Asian countries are navigating an unprecedented transition that demands new approaches to achieving universal health coverage. This article examines how South-South collaboration and catalytic investment mechanisms are emerging as critical strategies for sustaining health system progress in the post-aid era. Drawing on global experiences, including from the Joint Learning Network for Universal Health Coverage (JLN) and its Joint Learning Fund (JLF), we share how countries are leveraging peer-to-peer learning to mobilize domestic resources, and innovative financing to build resilient, country-owned health systems that limit the dependence on unpredictable flows of external assistance. Key Words Universal Health Coverage, South-South collaboration, domestic resource mobilization, health financing, Joint Learning Network, aid transition, global health,  African health systems —————— For decades, international development has been defined by the flow of aid, resources and expertise moving from wealthier governments, multilaterals, banks, private foundations, and non-governmental organizations – typically in the Global North – to those in need – typically in the Global South.  The modern development model emerged as a post-colonial responsibility. After World War II and through the Cold War, it was used as a geopolitical tool by more dominant economic and political powers, including the United States, Western Europe, and the Soviet Union¹‚². However, this model has been changing as power, resources, and expertise have diversified—driven by the rise of middle-income countries, digital transformation, critiques of aid effectiveness, and stronger demands for locally led development.<3>  The traditional development aid model has been further disrupted recently given significant political shifts and cuts to Official Development Assistance budgets by major donor countries like France, Germany, the United Kingdom, and the United States, as well as the impact of large-scale events like COVID-19 and the ongoing war in Ukraine.<4>  According to a recent World Bank report, 80% of low-income countries and 40% of low- and middle-income countries are expected to face a decline in combined government and donor-health spending by 2030. Collectively, these forces have pushed the development ecosystem toward more partnership-based approaches and innovative funding models as many low- and middle-income countries have also begun proactively charting their own paths toward self-reliance, using shared learning and collaborative problem-solving, along with catalytic investments, to drive progress.  Across Africa, the aid transition is exposing both the fragility of donor-dependent health systems and the untapped potential for homegrown solutions. Countries across Africa face health crises driven by aid cuts, shifting demography, and infectious and environmental threats. Renewed public health strategies, smarter investment, and stronger surveillance can help, but reversing funding cuts is vital.<6> Countries like Nigeria have lost over $600 million in health funding—more than a fifth of their annual health budget—while dramatic reductions in funding from the United States government threaten decades of progress in HIV treatment, tuberculosis control, and maternal health services.<7>   Yet this crisis has catalyzed unprecedented political momentum, with the August 2025 Accra Health Sovereignty Summit marking a watershed moment where African heads of state committed to “health without aid” through domestic resource mobilization, pooled procurement, and regional pharmaceutical manufacturing. The challenge remains significant: only three African countries—Rwanda, Botswana, and Cabo Verde—consistently allocate 15% of national budgets to health.<8> Investing in health is one of the most powerful drivers of human capital formation, economic growth, and job creation. Each additional dollar, well-spent, will save lives and deliver outsized returns. More and better health spending will facilitate the expansion of core health services and bring countries closer to reaching their UHC goals.  — World Bank.<5> However, innovative financing mechanisms are emerging, from Ghana’s excise taxes on sugary drinks to Kenya’s restructured Social Health Insurance Fund, demonstrating that African countries are no longer waiting for external validation to chart their own paths.6  The shift from passive recipients to active architects of health systems requires not just more money, but strategic investments in primary healthcare, stronger health governance, and public-private partnerships that leverage Africa’s entrepreneurial spirit and digital innovation<9>. What we’re witnessing is not merely an adaptation to reduced aid, but a fundamental reimagining of health systems rooted in African agency, regional solidarity, and sustainable financing models. These transformations across the African continent represent one of the most important global trends today – particularly when it comes to global health and the advancement of universal health coverage (UHC) and the Sustainable Development Goals. Cross-Country Learning as a New Currency  While peer-to-peer learning is increasingly important to sustain and drive change, it is not a new concept. Over the years, multiple learning networks have emerged to support locally led health systems in strengthening and driving policy change and action globally, regionally, as well as sub-nationally. These include the Linked Immunization Action Network, Strategic Purchasing Africa Resource Center, and, of course, the Joint Learning Network for Universal Health Coverage (JLN)<10>. The idea of the JLN itself emerged from a side session on UHC in May 2009 at the World Health Assembly. Representatives from Ghana, India, Thailand, and Vietnam were invited to speak on their efforts by the Rockefeller Foundation and while their presentations highlighted several common challenges, it also was clear that each country was largely working on their own. As a result, the JLN was born to bring countries together so practitioners could work alongside each other in a more intensive, structured, and egalitarian manner to co-develop solutions grounded in their experience, helping address the persistent and difficult problems of moving towards UHC more efficiently and effectively<11>. As the development assistance landscape continues to shift, countries will be increasingly seeking ways to maintain momentum toward UHC without depending solely on traditional development models. Ultimately, this “post-aid” era may be defined by a new currency that emphasizes partnership, mutual accountability, and the exchange of ideas.  The model of joint or collaborative learning aligns directly with the new reality of decreasing development aid. Through South–South cooperation, countries can collectively generate and refine knowledge that can be immediately applied to their contexts. The value lies not