When a public health emergency strikes, the success of the response does not hinge on policy decisions or logistics alone. Various dimensions of trust are critical factors.
Time and again, whether navigating the fear of the Ebola outbreak in the Democratic Republic of the Congo or building vaccine confidence during the COVID-19 pandemic, we are reminded that purely technical interventions that fail to engage key stakeholders, especially those managing the crises, often stall at the community level. When biomedical guidance collides with local culture, the results are all too predictable: fear, skepticism, and resistance. Instead, engaging local faith, traditional, and community-based actors in dialogue and in developing solutions is essential.
Countless local faith actors, alongside other community health partners, have been doing the work of trust-building for health interventions with communities over decades of global health funding. Global health has relied on this often unseen and under-appreciated work. Yet recent shifts in funding threaten to erode this basis of trust, with serious short and long term ramifications.
While we work on the Georgetown-Lancet Commission on Faith, Trust, and Health, we have reflected on the vital position of local faith actors in navigating trust dynamics with communities in global health programming. At a recent Strategic Religious Engagement and Global Health Roundtable hosted by the Georgetown University Berkley Center for Religion, Peace, and World Affairs and the Initiative on Faith, Trust, and Health at the Georgetown University Global Health Institute, we spoke with faith-based organizations, advocates, and researchers in the faith and global health space to also reflect on recent changes.
Local faith actors, ranging from neighborhood religious leaders to community-based religious committees, or more formalized local faith-based organizations and services, are not peripheral to global health and development. They are at the center of community trust and social cohesion in many parts of the world. In some places, public health facilities and government institutions are sparse, underfunded, and not necessarily trusted. Faith-based health care can fill an important gap providing services in rural and hard-to-reach areas. For example, the Churches Health Association of Zambia (CHAZ) accounts for 50% of healthcare in rural areas in the country. We are reminded that religious social networks and services long predated modern facilities and will likely remain long after international donors leave.
Those who lead religious communities—clerics but also peer leaders—hold relational authority and, consequently, trust from deep, daily connections grounded in shared beliefs and practices. The need for this type of trust was demonstrated during the COVID-19 pandemic: faith actors were called upon throughout the pandemic to promote health messaging and address concerns among their respective communities, but this left some of them feeling instrumentalized by health partners. The Berkley Center published a repository of information about how different faith actors responded to the COVID-19 pandemic and broader emergencies.
Localizing international aid—long promised—requires moving beyond viewing faith actors as simply "subcontractors" tasked with delivering well-cooked messages from on high. Real community engagement means recognizing local faith actors as strategic co-creators of health interventions.
Previous Support for Local Faith Actors in Global Health
Across previous administrations, we have witnessed a growing consensus on the need to engage more purposefully with local communities, including specifically with local faith communities. The U.S. President's Emergency Plan for AIDS Relief—or PEPFAR—is a prominent example of faith community integration in U.S. foreign assistance in health, and has set an important precedent for faith-health partnerships around the world. Authorized in 2003 by then-President George W. Bush, PEPFAR has been estimated to have saved 26 million lives worldwide, preventing millions of new HIV infections, particularly among children. Examples of faith-related health activities funded by PEPFAR include faith-engaged community posts for HIV testing and treatment, “baby showers” held in churches and mosques that include testing and health assessments for pregnant women, and advocacy efforts from “faith champions” to raise awareness for increased access to HIV care and treatment.
While there have been debates and critiques centered on religious influences on PEPFAR (notably its focus on abstinence education), PEPFAR has represented a broadly bipartisan initiative, with large-scale results, and complementary secular and faith-based support and implementation. PEPFAR has experienced various cuts and exemptions in the last 18 months, frozen entirely for a period after January 2025. Recent reporting indicates that some PEPFAR programs have survived cuts, but the statistics demonstrate that HIV testing, diagnoses and prevention efforts declined sharply over the last year. PEPFAR-supported HIV testing fell by more than 17%, while new HIV diagnoses dropped by nearly 16%. Calls now focus on a shift to country-level programs and co-financing, with locally and nationally-located faith-based models as a central part of that approach.
Impacts of Recent Cuts on Local Faith Actors
International Faith Based Organizations (FBOs) have received substantial U.S. government (USG) global health financing over the decades, and many subgrant to smaller local faith actors to deliver health services. Since January 2025, FBOs carrying out global health programs, such as World Relief and World Vision, have reported significant effects from foreign aid cuts, with downstream, and rapidly felt, impacts both within their organizations (with staff layoffs and furloughs) as well as on their implementing partners.
Early reports in February 2025 pointed to drastic effects across several of the most well-known FBOs, with two of USAID’s twelve most funded recipients being faith-based (Catholic Relief Services and World Vision), both organizations that also support local faith actors in communities around the world. In November 2025, a conference in Nairobi that brought together African health-related national and local FBOs from across the continent featured a detailed discussion of where external funding continued but also where cuts had imperiled community engagement work in particular.
Navigating the New Landscape
Organizations in the humanitarian and development sector have long grappled with issues of sustainability and calls for transitions to local ownership. A recent Lancet Commission calls for a deep-rooted overhaul of the humanitarian system, shifting “power toward affected communities and locally legitimate actors.” This highlights the well-established premise to include local actors more proactively in humanitarian planning and diversify decision-making authority, including through changes to funding mechanisms.
The trust that faith actors, especially those that are part of local communities, have earned and built has often benefitted from programs supported by external partners, such as USAID and the State Department. Cuts have damaged the reservoirs of trust. They have also undermined the diplomatic soft power that was bolstered by U.S. support for global health programs around the world. Reversing the damage of funding cuts will be difficult, and will require time to rebuild broken relationships, establish new ones, and co-develop new solutions and strategies with key stakeholders to meet the needs of their communities.
The U.S. State Department recently announced more than $240 million for a “trusted and vetted” partner, Catholic Relief Services, stating that this “demonstrates the Administration’s commitment to partnering with faith-based organizations.” This new development substantiates the announced prioritization of FBOs in the America First Global Health strategy. The U.S. government has also been negotiating Memorandum of Understanding (MOU)s with national governments around funding aligned with the “America First” strategy. How the strategy’s focus on FBOs will play out in real-world examples is only now developing. Some wrangling has occurred about the types of faith actors that may be preferred. Nigeria’s chief government spokesperson critiqued a focus on Christian faith-based healthcare providers alone. These discussions seem to be happening at bilateral levels between governments, however, and local faith actors will only understand the full results and impacts on their work in due course.
Questions remain as to how diverse faith actors will navigate this new and evolving landscape. In response so far, there are some, including FBOs, who are wary of this focus, while others embrace it. Health responses requiring a whole-of-society and multisectoral approach need faith engagement, but not only faith engagement. It is clear that if the international health and development sectors are serious about localizing aid, they must treat community engagement not as a tactical checkbox for project evaluations, but as the starting point, with local faith actors necessary partners in the work. By integrating the insights, influence, and trusted reach of local faith actors, global health responses can shift from top-down mandates to genuinely collaborative, resilient, and life-saving partnerships. Local faith actors are essential to the community engagement that is a critical part of effective health promotion and response strategies everywhere.
