WHO issues guidance to address drastic global health financing cuts

• The announcement by the government of the United States in January 2025 to suddenly pause and then dramatically reduce foreign aid was then compounded by announcements of reductions from other donor countries.

• While the impact of the US reductions is by far the largest, at least 10 other countries of the Organisation for Economic Co-operation and Development’s (OECD) Development Assistance Committee have also announced reductions in aid for health. 

• Many countries are faced with difficult choices following the sudden, large reduction in external funding for their health systems. 

• In response to this immediate shock, countries are also rethinking their longer-term vision for financing health systems built on domestic resources.

• External health aid is projected to drop by 30 per cent to 40 per cent in 2025 compared with 2023, causing immediate and severe disruption to health services in low and middle-income countries (LMICs). 

• WHO survey data from 108 LMICs collected in March 2025 indicate that funding cuts have reduced critical services — including maternal care, vaccination, health emergency preparedness and response, and disease surveillance — by up to 70 per cent in some countries. 

• More than 50 countries have reported job losses among health and care workers, along with major disruptions to health worker training programmes.

• This year’s funding cuts have compounded years of persistent health financing challenges for countries, including rising debt burdens, inflation, economic uncertainty, high out-of-pocket spending, systemic budget underfunding and heavy reliance on external aid.

• The World Health Organisation (WHO) released new guidance on November 3 for countries on ways to counter the immediate and long-term effects of sudden and severe cuts to external funding, which are disrupting the delivery of essential health services in many countries.

Immediate health financing measures

• WHO’s new guidance urges policy-makers to make health a political and fiscal priority in government budgets even during times of crisis, seeing health spending as not merely a cost to be contained, but an investment in social stability, human dignity, and economic resilience. 

• The guidance emphasizes the need for countries to cushion the immediate impact of reductions in foreign assistance for health, and to adapt to a new era of reduced assistance. 

Key policy recommendations include:

i) Prioritise the health services accessed by the poorest.

ii) Protect health budgets and essential health services.

iii) Improve efficiency through better procurement, reduced overheads and strategic purchasing.

iv) Integrate externally-funded or disease-specific services into comprehensive primary healthcare-based delivery models.

v) Use health technology assessments to prioritise services and products that have the greatest health impact per dollar spent.

Country leadership and global solidarity are critical

• Several countries have already taken decisive action to strengthen their health systems and protect essential health services.

• Kenya, Nigeria and South Africa have allocated additional budget funds to health, or are awaiting parliamentary approval for increases.

• Nigeria increased its health budget by $200 million to offset aid shortfalls, with increased allocations for immunisation, epidemic response, and priority programmes.

• Ghana lifted the cap on excise tax earmarked for its national health insurance agency, resulting in a 60 per cent budget increase. The country also launched “the Accra Reset”, a bold framework to reimagine global governance, financing and partnerships in health and development.

• Uganda has outlined a clear policy agenda for integration of health services and programmes, aiming to improve efficiency and sustain service delivery.

Way forward

• In the face of uncertainty and an ever-evolving health financing landscape, this guidance provides a set of actions and associated analytics that can be taken now to promote sustainable and equitable access to quality health services with financial protection. 

• All of these require prioritisation, careful sequencing and tailoring based on specific country needs and issues.

• Critically, they also form the basis of a learning and capacity-building agenda around health financing reform and policies and their complex linkages with services, people and overall health.