Frontline Lifelines: Putting Grassroots First In Global Health Aid

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We have heard this narrative before. So why now? Because the funding landscape is shifting . With major US foreign aid cuts and many bilateral donors pulling back, more funders are rethinking their roles, calling for trust in local leadership and multi-year, flexible grants .

We have seen promising initiatives like Singapore's ImpactCollab – backed by the Monetary Authority of Singapore and the Gates Foundation – set ambitious goals to move capital into vetted organisations across Asia.

These efforts matter. But if they stop short of reaching the small, unpolished clinics and networks we have walked alongside, they risk leaving the most urgent innovations invisible. Even well-intentioned“collective impact” models can end up concentrating power in a small circle of philanthropists, guided by boardroom visions that risk becoming prescriptive.

Real, lasting change rarely follows the boardroom script. It is slow, relational and deeply rooted – built on trust earned over years, not lost when a grant cycle ends. Too often, those visions arrive with conditions: metrics and data that risk missing the heart of the work.

When every interaction is framed in deliverables and data points, partners start performing for the metric rather than engaging for the mission. As such, the space for honesty, nuance and risk-taking shrinks. Communities translate their realities into funder-friendly language, sometimes at the expense of telling the full truth.

This is where trusted networks matter – not to abandon oversight, but to design accountability that reflects what is happening on the ground. Like a well, impact can be measured in liters drawn, but also in the trust it inspires in those who depend on it. As one health worker told me,“Sometimes, the best treatment is not a pill. It is being heard.”

Dr Cynthia knows this. Over tea, her hands wrapped around a warm cup, she spoke of pressure from some board members amid shrinking resources to prioritize high-profile partnerships to keep Mae Tao Clinic afloat.

She gently pushed back:“It is the smaller ones who need us,” she said, thinking of the makeshift clinics deep in the hills, run by young people with grit and community ties. Her conviction was clear: trust is built on the ground, not in boardrooms.

Walking with those at“ground zero” rarely comes with fanfare. It is easier to raise funds for an established name like Mae Tao Clinic than for an emerging clinic still proving itself. The question is not whether they already have a track record, but whether they have the vision, commitment and community trust to grow.

Many such solutions will never appear in a grant portal. Their leaders are busy doing the work, not packaging it for funders. They rarely fail for lack of relevance, but for lack of scaffolding – the technical, financial and network support needed.

We have seen this“messy middle” in a pharmacy that doubled as a schoolroom, and in a frontline clinic led by displaced health workers that kept going with no salaries for months – spaces that exist because people refused to wait for perfect conditions. Finding them takes proximity and translation so a funder in Singapore does not get to decide which part is“effective,”“transformative” or“fundable.”