The scale and sudden timing of the withdrawal of the USAID, in addition to the Official Development Assistance cuts from many European countries, including the UK, has left global health funding in peril and an urgent need to look for alternative funding for health in low- and middle-income countries. In response, the future of global health will require new international cooperation and partnerships to strengthen health systems to enable access of technologies like vaccines and digital health innovations.
IDS researcher Dr Gerry Bloom, who specialises in health systems and global health governance, argues that in the short-term leaders of aid-recipient countries, the traditional donors and large middle-income countries will need to take joint responsibility to fill these gaps. In the long-term Bloom explains that it is critical to build resilient health infrastructures for future preparedness and that global leaders need to work towards this by forging new long-term partnerships, helping leaders of lower-income countries build their capacity to finance and manage their own health systems.
The short-term impacts
Many countries transitioning toward domestic financing of health systems, are often unprepared to fill the sudden funding gaps due to reductions in external funding—particularly from longstanding partners such as the US and UK. These risks reversing hard-won gains in health equity, access, and outcomes, particularly in fragile and conflict-affected states.
The recent announcement of the annual report from the Foreign, Commonwealth & Development Office (FCDO) for the Overseas Development Assistance (ODA) budget for 2024-25 shows the health budget will be reduced by millions, including a £500 million cut to the Health Institutions & Health Security Department. Funding to Africa will fall by 12% to £1.37 billion, affecting key programmes on women’s health, health systems strengthening and emergency response in countries such as the Democratic Republic of Congo (DRC), Mozambique, Zimbabwe and Ethiopia. Nutrition, WASH, and child health interventions will also face reductions.
The UK Government’s Equality Impact Assessment for the 2025–26 ODA allocations warns that cuts to health programmes could lead to increased mortality and disproportionate harm to women, children, people with disabilities and those living in poverty.
Moving forward with support from the UK
In regard to what action needs to be taken by governments of high, middle and low-income countries in response to the new funding landscape for global health, Gerry Bloom, Research Fellow at the Institute of Development Studies said:
“The decision by the US Government to halt its funding for health services in developing countries, has illustrated the serious risks of aid-dependency. In the short-term, it will be important for the UK to help mitigate the harms caused by this decision. In the longer term, it can help governments and other stakeholders in these countries build their capacity to finance and manage their own health system.
“The announcement that the UK wants to be seen as a partner and investor in developing countries, rather than as a traditional aid donor is welcome. The challenge for government will be to ensure that it becomes a good partner.
“As countries become increasingly responsible for financing their own health services, other issues need attention. They will need access to drugs, vaccines and diagnostic devices at an affordable cost, and, where possible, to produce them locally. They will also need access to the benefits of digital technologies and to the vaccines and drugs needed to deal with major outbreaks of infectious disease.
“The UK can play an important role in making this possible through involvement of the NHS, centres of research excellence and private companies, but only if priority is given to the creation of partnerships that are mutually beneficial, rather than to the generation of short-term financial gains. This will involve major changes to the way many private companies behave in these markets. China, India and other middle-income countries have a rapidly growing presence in these markets.
“It will be important for the UK to collaborate with the governments of these countries to put in place appropriate global rules of engagement. In the absence of this kind of collaboration, there is a risk that health systems will become increasingly fragmented and unequal with serious negative consequences for public health.”
For more analysis on the future of global health read ‘Global health governance in transition: A time for new leadership, new ideas, new partnerships.’
