Fixing global health financing as cuts begin to bite

by Anil Soni, CEO WHO Foundation

The situation we face is nothing short of an emergency. It’s not only the US that has cut health spending: 11 OECD country members have announced reductions in overseas development aid. This month’s Fourth International Conference on Financing for Development confirmed a $4 trillion financing gap to meet the SDGs by 2030. At a panel I moderated for the G20/G7-aligned H20 (Health20) summit recently, the panelists shared some sobering data. Dr. Kalipso Chalkidou, Director, Health Financing and Economics at WHO reported that aid for health has shrunk by more than a third, a roughly US $10 billion reduction since 2023. These aid cuts hit the least wealthy hardest. The withdrawal of USAID health spending alone is expected to shave 1 percent from Malawi’s GDP, she added. These cuts will push more people to spend out of pocket on healthcare, the least equitable or sustainable way of financing health. The Center for Global Development estimates that 1 million lives a year are at risk because of cuts to health spending. Added to this are the stark differences in global spending power: as His Excellency Matthew Wilson, Permanent Representative and Ambassador of Barbados to the United Nations office at Geneva, memorably noted: people in Europe spend more each year on facial fillers than on investing in emerging infectious diseases.

Human cost

The human cost is real. Measles cases have been surging in the past four years. Measles is entirely preventable. In some places, children have died simply because routine immunization services couldn’t reach them in time. People are dying of HIV because they can no longer get the treatment they relied on. It’s a grim throwback to a time of even greater health inequity. Dr Ricardo Baptista Leita, CEO of HealthAI, put it bluntly, “We’ve been punched in the face in the global health community.”

This shock is not only the result of a funding failure. It’s also a system failure, and it’s one we must fix.

Why fix global health?

Investing in health is an investment in a stable society and in health security. As Jeremy Farrar, WHO’s Assistant Director General for Health Promotion, Disease Prevention & Control, put it, health investment is, ‘an amplifier of the society we want’. Improving health equity is also a contributor to a more just world. The direction is clear: we must build resilient systems that are locally owned, equitably funded, and future-ready. The Lusaka Agenda  is a commitment towards this goal.

Key to the arguments for reform are that global health initiatives should:

• Support one national health plan in each country
• Support the goal of increasing domestic health spending in countries
• Strengthen partnerships including public-private and private-not-for-profit partnerships
• Scale up health solutions to achieve efficiencies
• Prioritize production of health products and services, with regional manufacturing where needed.

Time for bold action

It’s obvious that overseas development aid is neither sufficient to meet health goals including those of the Lusaka Agenda, nor is it sustainable. But highly-indebted countries, many of whom spend more on servicing their debt than on health or education, still need assistance by way of aid, concessional financing, and other instruments. 

This is where WHO’s role as a normative global health body is vital. WHO can work with financial institutions such as the World Bank and multilateral banks, pension funds, and sovereign wealth funds to advise which health investments offer the greatest health benefits for the people who need it most. They have the scientific expertise and the country-level knowledge to educate potential investors on the health needs, focus on evidence-based outcomes, and confirm returns on the investment to the economy and society at large. The health taxonomy report from the G7/G20 is a good resource from which to learn more.

Attract the investment

The WHO Foundation acts as a bridge between WHO and other health initiatives and private and philanthropic finance. I’m highly conscious that low and middle income countries not only lack access to financing but miss out on affordable medical and healthcare products because investors don’t see the potential in those markets. So I was delighted to hear from Zina Affas Besse, the deputy health director at Axa Investment Managers at the same H20 panel, who argued strongly for investment in healthcare products and services – from pharmaceuticals, and diagnostics to AI tools – that are affordable enough to “bring to the whole world.”With Dr Ricardo Baptista Leita reporting a potential half trillion dollar market in AI for healthcare, the potential is there for investors to invest in both traditional healthcare products, in AI, digital health and beyond.

WHO as expert adviser

Much of what I’ve touched upon here will require a shift in mindset, and in some cases a change in the way that investors and financial institutions view both healthcare and lower-income countries. The incentives for public investment and private investment need to be agreed and aligned. At the WHO Foundation, we believe our role is to help accelerate that shift—to mobilize new partners and new capital, yes—but also to build the trust and tools required to unlock sustainable, equitable financing for health. Absolutely key to these relationships is a robust, independent WHO which can act as expert adviser, advocate for health for all in service of member states. As we look toward the next G20 and G7 cycles, my takeaway is this: the world doesn’t just need more money for health. It needs smarter financial flows, targeted investment in products and services, and the courage to fund health as the foundation of a just society.