Vital Supply Chain: Building a Fellowship for a New Era in Global Health

"The world is changed. I feel it in the water, I feel it in the earth, I smell it in the air."
— J.R.R. Tolkien, The Lord of the Rings‍

Tolkien’s words resonate deeply in today’s world of global development. And for good reason: we are living through a moment of massive transition. Not just policy shifts or budget adjustments, but a fundamental reshaping of how health and humanitarian systems operate.

For those of us who have worked in this space, the change is nearly inescapable. It’s not just a professional pivot; it’s a profound emotional and operational shift.

The fallout: When donors disappear

Many of us recently re-entering the job market are witnessing these changes first-hand. Donor-funded programs have been scaled back or shuttered entirely. Communities that once relied on stable commodity flows are now uncertain of their next shipment. Former implementing partners have closed shop. Staff and consultants—some with decades of institutional knowledge—are grappling with abrupt ends to careers and missions.

If you're reading this, you likely know or are someone directly affected by these changes. Senior program officers, project directors, technical advisors who managed hundreds of millions in health investments just months ago are now rebuilding their professional identities.

These are not abstract numbers. These are real people, families, futures. The departure of a major funder like USAID leaves a void that risks reversing decades of progress.

The need: Why countries are seeking help

Governments still need to deliver the seven rights of health supply chains: the right product, in the right quantity, quality, price, place, time, and to the right client. Meeting all seven—every time—is a colossal challenge. Historically, donors helped fill gaps with funding, commodities, and expertise. Now, countries face these same expectations, with a fraction of the support.

During the COVID-19 pandemic, many donor dependent countries demonstrated resilience. They innovated. They coordinated across public and private sectors. They adapted. But even then, the cracks showed: fragmented supply chains, limited local manufacturing, over-reliance on international consultants.

The opportunity: A smarter, leaner, more equitable model

That resilience during a crisis shows what's possible when systems adapt. Even as we mourn what’s lost, we must be clear-eyed about the opportunity before us. USAID was transformative, but imperfect. Its model, like many others in global development, created a system that rewarded scale over impact, favored large players, and often sidelined smaller, local actors. Costs ballooned. Innovation slowed. Accountability fragmented.

Foreign assistance has also been criticized for perpetuating dependency, undermining local resilience, disrupting local markets, and being top-down project focused to the point they are more accountable to donors than local communities.

Now, with fewer resources, we are forced to rethink everything. What if we could design a system from the ground up—one that is agile, inclusive, tech-forward, and driven by the needs of local clients and communities? What if we could encourage greater use of local talent? What if this crisis became a catalyst for a better future?

A new fellowship for a new era

These questions brought a few of us together, from different countries and diverse backgrounds: consultants, public servants, logisticians, strategists, and technologists. Like the Fellowship of the Ring, we were an unlikely group united by necessity and, in our case, a shared recognition: the old ways aren't coming back, so we need to build something new, something better.

Companies like Crosscut, which makes geospatial mapping accessible to health workers without technical training, and other organizations like LifeBank have joined this broader conversation about reimagining technical assistance for a post-USAID world.

Over many conversations, we realized that the future of technical assistance (TA) wouldn’t look like the past. It couldn’t. TA must be smaller, faster, more modular, and more affordable. And it must be underpinned by technology, especially AI, not just to do the same work faster—but to be more strategic about what (and how) work gets done.

How we're rethinking expertise and technology

Thousands of health and development experts are now displaced. They carry valuable skills—but traditional consulting models no longer fit. They’re too expensive, too rigid, too slow, and lack the contracting mechanisms to engage with countries directly.

So we asked: Can we deliver expertise differently? On demand? By the hour, not the week? Can we automate some tasks using AI to make TA more affordable? Can we retrain experts to become AI-savvy, to advise governments not just on what’s needed—but how AI can solve it faster and cheaper?

Vital supply chain’s vision

Vital Supply Chain is our answer to those questions. We're building a new kind of platform—one that:

• Seeks to establish sustainable networks
• Establishes clear performance targets
• Offers modular, flexible TA packages that clients can purchase affordably
• Connects governments and NGOs to vetted experts, many recently displaced
• Equips those experts with AI tools that amplify their impact
• Upholds trust, security, ethics, and equity at every step
• Partners with local and established providers like Crosscut and LifeBank

Visualizing the community with LifeBank

This is not just a tech solution. It’s a systems-level reimagining of how support flows, how people are empowered, and how outcomes are delivered.

The fellowship grows

Can we really make expertise more accessible while making it more effective, even amid such upheaval? Early indicators suggest the answer is yes. Governments are actively seeking  new solutions. Experts are ready to retool and re-engage. AI startups are exploring ways to adapt their tools to the realities of LMICs, prioritizing ethics and usability.

We are building a coalition—of clients, funders, thinkers, and doers—ready to experiment, learn, and scale. The fellowship keeps growing, but there's still room for more. If you see yourself in this story, we invite you to join us.

Vital Supply Chain exists to ensure that the health systems of tomorrow are more resilient, inclusive, and equitable than those of yesterday.** Let’s build that future together.

Complete this form if you are interested in joining the Vital Supply Chain Fellowship!

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About the Author

David J. Sarley brings over two decades of global public health leadership to addressing complex health challenges. As a former Senior Program Officer at the Bill & Melinda Gates Foundation (2012-2025), he managed $250 million in health innovation portfolios, investing in AI/ML technologies, digital health platforms, and supply chain solutions across Africa and globally. His work spanned vaccine delivery, women's health innovation, and primary care strengthening in partnership with WHO, UNFPA, UNICEF, GAVI, and other major international organizations.

David co-chaired the WHO's Decade of Vaccines Innovation working group and has extensive experience building coalitions across UN organizations, philanthropic foundations, and the private sector. Prior to Gates Foundation, he directed USAID's $150 million DELIVER project at John Snow Inc., strengthening health supply chains in over 25 countries and managing global procurement systems for essential medicines.

David holds degrees in Economics and Econometrics from the University of Hull and Southampton, with additional credentials in supply chain management and design thinking from MIT and RIT.

Currently Director of Vital Supply Chain LLC, David continues to provide strategic consulting on global health innovation and coalition building.