In the densely populated informal settlements of Mumbai, a local waste-for-food initiative led by 27-year-old social entrepreneur Shakti Yadav is combining environmental cleanup efforts with food distribution in communities affected by poor sanitation and limited access to nutrition.

Yadav, founder of the “Buy Food with Plastic” initiative, operates a system in which residents exchange discarded plastic bottles for prepared meals. According to the programme’s operating model, 20 plastic bottles are accepted in return for one hot meal.The initiative, launched in 2020, has so far distributed more than 42,000 meals, supported approximately 4,500 people and conducted sustainability awareness activities involving over 1,000 students, according to figures cited in the report.

Yadav said the project was shaped by his own experience growing up in a Mumbai slum, where seasonal flooding and poor waste management created recurring public health risks.“During the monsoons, sewage water would flood the streets,” he said. “People had to wade through it because discarded plastic choked the drains.”

According to Yadav, blocked drainage systems contributed to repeated outbreaks of mosquito-borne diseases, including dengue and malaria, in vulnerable neighbourhoods. His initiative was designed to address what he described as two interconnected urban challenges: unmanaged plastic waste and food insecurity.The programme operates through a circular collection and redistribution model.

Plastic bottles collected from participating residents are transferred to recycling facilities, where some workers are recruited from the same communities supplying the waste. The recycled material is then repurposed into products including flowerpots and tea coasters, which are later sold to companies, including international corporations.

Mumbai, India’s financial capital and one of the country’s most densely populated cities, generates thousands of tonnes of municipal solid waste daily. Plastic waste management has remained a major challenge for urban authorities, particularly during monsoon periods when clogged drainage infrastructure increases flood risks in low-income settlements.

Yadav said the project was inspired by a similar initiative operating in the United States. He contacted the founder of that programme and developed his own local adaptation focused on conditions in Mumbai’s informal settlements.An MBA graduate and the first member of his family to pursue higher education, Yadav initially managed the project while working in a corporate job.

He later left full-time employment to focus entirely on expanding the initiative.The transition initially faced resistance within his family. According to the report, Yadav’s mother questioned the sustainability of non-profit work and believed such efforts were generally undertaken by financially secure individuals or organizations.Yadav said he eventually persuaded her by demonstrating how the programme could simultaneously reduce waste accumulation and improve food access in underserved communities.

The meals distributed through the initiative are intended to support residents in slum areas where access to affordable and nutritious food remains inconsistent. By linking food distribution with waste collection, the programme also attempts to incentivize recycling participation among residents who may otherwise lack formal waste disposal options.

Environmental awareness has become another component of the initiative’s outreach strategy. Yadav and his team regularly visit schools and residential communities to conduct educational sessions focused on sustainability and waste disposal practices.“Previously, nobody told me that throwing plastic away was harmful,” Yadav said, describing the lack of environmental education during his childhood.

The awareness campaigns target younger audiences in particular, with organizers seeking to promote behavioural changes related to littering, recycling and environmental responsibility.The initiative’s visibility has expanded beyond Mumbai in recent years. According to the report, Yadav represented India in Germany during a programme focused on sustainability and climate change research.

He was also awarded the 2023 Cross-Cultural Program Fellowship.The project currently operates in selected slum clusters across Mumbai, although Yadav said he intends to expand its reach across additional parts of the city.Urban policy experts have increasingly emphasized the relationship between waste management, flooding and public health risks in Indian metropolitan regions.

During annual monsoon periods, low-income settlements often experience disproportionate exposure to waterlogging and sanitation failures due to inadequate drainage systems and high concentrations of unmanaged waste.

Plastic waste has become a central issue in municipal governance discussions across India, particularly after several state governments introduced restrictions on single-use plastics and expanded recycling regulations in recent years. Enforcement and waste segregation, however, remain inconsistent across many urban districts.

Programmes such as “Buy Food with Plastic” operate outside formal municipal systems but increasingly form part of localized efforts aimed at combining environmental management with social welfare objectives.The initiative also reflects a growing trend among younger social entrepreneurs in India seeking hybrid solutions that combine recycling, employment generation and food distribution.

By connecting waste collection with direct community incentives, such models attempt to address both environmental and economic pressures simultaneously.Yadav said his long-term objective remains focused on improving conditions within communities similar to the one where he was raised.

“My goal is to eradicate both plastic waste and hunger,” he said.

The United States is restructuring how it delivers life-saving medical supplies for HIV and malaria to low-income countries, a shift that officials and health experts warn could disrupt treatment access across parts of Africa and Asia.

The changes centre on winding down the Global Health Supply Chain Program – Procurement and Supply Management, a U.S.-funded initiative run by Chemonics, which has coordinated the delivery of critical medicines and prevention tools since 2016. According to internal communications and multiple sources familiar with the matter, U.S. officials have been instructed to begin halting implementation of the programme by May 30.

From its inception through 2024, the programme distributed more than $5 billion worth of HIV and malaria-related commodities to 90 countries, with a primary focus on sub-Saharan Africa and parts of Asia. The supplies included antiretroviral drugs, malaria treatments and insecticide-treated bed nets, forming a key component of global disease control efforts.The restructuring follows broader changes to U.S.

foreign aid policy under the administration of Donald Trump, which has prioritised reducing reliance on contractors, cutting budgets and shifting toward direct agreements with recipient governments. The overhaul also comes after the dismantling of the United States Agency for International Development, which had previously overseen much of Washington’s development assistance.

Five sources familiar with the transition said the pace of the changes risks creating supply gaps for essential medicines, particularly in countries with fragile health systems. An internal email reviewed by Reuters warned that accelerating the transition without a clear implementation plan could jeopardise continuity of services.

The communication, sent by the U.S. State Department to staff in 17 African countries and Haiti, directed country teams to prepare for the end of programme operations while outlining potential risks. It did not provide a detailed roadmap for replacement mechanisms, instead asking local offices to identify vulnerabilities and report back to Washington.

A State Department spokesperson said the agency had not issued technical instructions for Chemonics to cease operations by May 30, though the contract is set to expire on September 30 in line with other USAID awards. The official end date is listed as November.

The uncertainty has revived concerns stemming from earlier disruptions. In January last year, a freeze on international aid left millions of dollars’ worth of medical supplies stranded in ports and warehouses worldwide, including HIV drugs and malaria prevention tools. Distribution resumed only after waivers were granted for life-saving interventions.

Six sources said the United States has been in discussions with the Global Fund to Fight AIDS, Tuberculosis and Malaria about potentially using its procurement and distribution systems to replace the existing programme. The Geneva-based institution already manages approximately $2 billion in annual purchases for HIV, tuberculosis and malaria programmes through partnerships with national governments and implementing agencies.

However, two sources said earlier plans had envisaged a transition timeline extending to November 2027, allowing sufficient time for procurement cycles and logistical adjustments. Compressing this timeline into a matter of months could create operational bottlenecks, they said, noting that delivering medical supplies to remote areas can take up to a year from order to distribution.

The Global Fund declined to comment on the discussions. The State Department did not directly confirm the talks but said it would rely on pooled procurement mechanisms to secure supplies at competitive prices from private manufacturers.The policy shift is part of a broader “America First” approach to global health funding, which aims to reduce what officials describe as inefficiencies in the existing system.

A strategy document released in September argued that contractor-led programmes had contributed to waste and inflated costs, and emphasised direct funding for frontline services and national governments.

Under the new approach, Washington has signed 28 bilateral health agreements with partner countries and is increasingly channeling funds directly to national authorities. It also plans to use private logistics firms to handle distribution rather than relying on large development contractors.

Recent agreements with countries such as Kenya, Rwanda and Uganda include commitments to increase domestic health spending alongside U.S. funding. However, implementation has encountered obstacles. In Kenya, a proposed deal faces legal challenges from activists concerned about data privacy, while negotiations with Zambia have been delayed as officials seek to safeguard national interests.

Health experts and aid practitioners say the transition risks compounding existing vulnerabilities in global disease control programmes. Previous disruptions linked to funding changes have already contributed to shortages of malaria treatments for children and gaps in HIV prevention services in several countries.

The State Department defended the overhaul, describing the current system as outdated and inefficient. A spokesperson said the new model would prioritise value for American taxpayers while maintaining support for critical health interventions.

Despite those assurances, several sources involved in programme delivery said the lack of a detailed transition plan remains a central concern. They warned that without clear coordination between donors, governments and implementing partners, the shift could interrupt supply chains that millions depend on for survival.

Speaking at a Reuters Newsmaker event in New York, Gates said the world was at a crossroads, with millions of children at risk of dying if funding drops too steeply.

The Gates Foundation’s pledge matches its donation in 2022. That was the last time the Global Fund, a Geneva-based independent nonprofit, raised money on its three-year budget cycle. The announcement follows deep aid cuts from governments around the world, led by the United States.

“A kid born in northern Nigeria has a 15% chance of dying before the age of 5. You can either be part of improving that or act like that doesn’t matter,” Gates said in an interview before the foundation’s annual Goalkeepers event in New York on Monday.

The event celebrates and seeks to accelerate progress on United Nations global development goals set for 2030, including improving health and ending poverty.

“I am not capable of making up what the government cuts, and I don’t want to create an illusion of that,” he said about his pledge.

The Gates Foundation, the philanthropy started by the Microsoft co-founder and his then-wife in 2000, is one of the world’s biggest funders of global health initiatives, with a particular focus on ending preventable deaths of mothers and babies, tackling infectious diseases and lifting millions out of poverty.

Earlier this year, Gates pledged to give away almost his entire $200 billion fortune by 2045, more quickly than planned because of the urgent need worldwide.

Millions More Could Be Saved

According to the U.S.-based Institute for Health Metrics and Evaluation, global development assistance fell by 21% between 2024 and 2025 and is now at a 15-year low.

That could still change, said Gates, with organizations like the Global Fund trying to raise money before the end of the year. But if the trajectory remains the same, progress that cut child mortality in half since 2000, saving 5 million lives a year, could be in jeopardy, he said in a statement.

Gates said that there was still an opportunity to save millions of lives and end some of the deadliest childhood diseases by the time he will have donated the rest of his fortune in 2045.

That would require maintaining funding for institutions like the Global Fund as well as Gavi, the Vaccine Alliance, prioritizing primary healthcare and rolling out innovations – such as the long-acting HIV prevention drug lenacapavir – quickly.

“What’s happening to the health of the world’s children is worse than most people realize, but our long-term prospects are better than most people can imagine,” Gates said in a statement.

At the Goalkeepers event, the foundation gave Spanish Prime Minister Pedro Sánchez its annual Global Goalkeeper Award. While other countries reduced global health support, Spain increased its donations to the Global Fund this year by 12% and Gavi by 30%.

The Goalkeepers event usually involves publication of a progress report on the U.N. sustainable development goals, originally adopted in 2015. But that has been delayed until an event in Abu Dhabi in December, when global health funding will be clearer, the foundation said.