Contingency and future scenarios for global health aid

What does IDA Foundation do? IDA Foundation is a not-for-profit supplier of essential medicines and medical products. It supplies low- and middle-income countries (LMICs) worldwide so that healthcare providers and their patients have access to quality products at affordable prices. Key partners and clients include international and national aid organisations, large donor organisations, ministries of health and public healthcare institutions.

Short-term shocks and structural uncertainty call for sharp choices At the start of 2025 the playing field changed abruptly. The announced cuts to USAID and other international aid flows under the Trump administration put the global health-aid landscape under immediate pressure. For IDA Foundation this meant it had to think quickly about possible impact on clients, funding and its own organisation.

At the same time, more is going on than that short-term shock. Even beyond Trump, the landscape is changing structurally: from shifts from multilateral to bilateral aid, to stronger local ecosystems that may be able to take over tasks from Western parties such as IDA Foundation, to digitalisation and changing health needs. Those developments are uncertain, interconnected, and call for a strategy that gives direction without pretending the future is predictable.

From contingency scenarios to strategic choices As Jester Strategy we supported IDA Foundation in exploring both acute and structural uncertainties. First, contingency scenarios were developed around the possible consequences of the USAID cuts and the degree to which other funders might step in. From these emerged intervention packages: concrete measures that can be rolled out per scenario.

Next, broader future scenarios were developed for the global health-aid landscape towards 2033. Those scenarios provided no forecast, but a shared frame of reference and testing framework. They helped management to discuss, test and prioritise strategic options: which choices are robust, which fit specific scenarios, and where does IDA Foundation need to keep monitoring closely?

What did it produce? The trajectory led to a sharp strategic focus: a combination of robust growth directions and scenario-dependent emphases. These strategies were then translated with the OGSM method by various IDA Foundation staff into concrete objectives, actions and KPIs that sit under the strategic choices. Scenario thinking thereby became not only a way to understand uncertainty, but also a practical instrument to make choices, create ownership and organise execution.