Financing health amid global cutbacks: A call for smart investments in universal health coverage

On 29 April 2025, on the margins of the 2025 UN ECOSOC Financing for Development Forum, UHC2030, in collaboration with the co-chairs of the Group of Friends of Universal Health Coverage and Global Health (Georgia, Japan and Thailand), the World Health Organization (WHO), and the Coalition of Partnerships for Universal Health Coverage and Global Health, hosted a side event titled “Financing health amid global cutbacks: A call for smart investments in universal health coverage”.

In preparation for the upcoming Fourth International Conference on Financing for Development (FfD4) and against the backdrop of sharp reductions in official development assistance (ODA), the discussion emphasized the need for more sustainable health financing – recognizing health not as a cost, but as a critical investment and driver of economic growth and social equity.

• Mr. Werner Obermeyer, Director of the WHO Office at the UN, opened the event with an overview of WHO’s rapid assessment of the impact of suspensions and reductions in health ODA on health systems. The assessment was conducted in March 2025 in 108 WHO country offices, primarily in low- and lower-middle-income countries. The findings show that the nature and scale of service disruptions are comparable to those observed during the peak periods of the COVID-19 pandemic in some settings, with disruptions to at least one health system area reported by 80% of country offices, disruptions to health services reported by one third of country offices, and critical shortages in the availability of medicines and health products reported by one third of country offices. Health information systems have also been affected as data collection has been disrupted and job losses have been felt across the health workforce.
• The co-chairs of the Group of Friends of UHC and Global Health provided high-level opening remarks. H.E. Mr. Cherdchai Chaivaivid, Permanent Representative of Thailand to the UN, emphasized the need for a more strategic approach to health financing by leveraging domestic resources to achieve UHC and health security. He stressed the need to prioritize high-value investments and reorient health systems towards health promotion, quality of care, and effective health technologies. H.E. Mr. Mikanagi Tomohiro, Deputy Permanent Representative of Japan to the UN, shared Japan’s commitment to UHC since World War II. The country has expanded healthcare access to all citizens, reduced social inequality, and supported economic growth. While health spending in Japan—over 10% of GDP today—has grown due to an aging population, the rising burden of noncommunicable diseases (NCDs), and the expansion of health care infrastructure, alcohol taxes help fund the system. He noted that the upcoming UHC Knowledge Hub will be key in global discussions on these shared health financing challenges. Mr. David Abesadze, Deputy Permanent Representative of Georgia to the UN, emphasized the criticality of prioritizing health financing in domestic budgets and aligning international support with national health priorities. Georgia’s strategic health system reforms and investment in its UHC programme since 2013 have resulted in enhanced efficiencies and expansion of health coverage to over 90% of the population.

During the panel discussion, speakers reflected on the current global financing challenges and practical solutions for countries to transition to more sustainable models of funding health systems. 

• Ms. Mary Beth Goodman, Deputy Secretary-General of the OECD, warned that ODA cuts and global economic shocks—driven by inflation, rising sovereign debt, and shifting trade policies—are severely impacting health financing. She noted that ODA has already dropped by 9–17% this year, with further declines likely, especially due to uncertainty around U.S. contributions. She stressed that health must be recognized not just as a sector, but as essential to global security and stability. To address the financing gap, developing countries need stronger domestic resource mobilization, better governance, and financial protection for the poorest. Effective coordination between international and domestic financing, alignment with national plans, and use of blended finance and private sector contributions are crucial to building resilient health systems.
• Mr. Cesar Nunez, Director of the UNAIDS Office in New York, highlighted HIV response's heavy reliance on international funding—74% in low-income countries—making it highly vulnerable, especially with the sharp ODA decline in 2025. Key strategies to counter this reduction include integrating HIV efforts into national health plans, increasing domestic funding for stronger national ownership, and involving community systems. He noted that Sub-Saharan Africa faces especially tough choices amid economic stagnation and competing priorities. With historically weak domestic funding, the HIV response now requires a three-pronged approach: short-term financing options like targeted taxes, long-term reforms to strengthen the tax base and reduce illicit financial flows, and political coalitions to boost local and regional medicine production.
• Ms. Alison Cox, Director of Policy and Advocacy at the NCD Alliance, made the case that investing in health—especially for noncommunicable disease (NCD) prevention—is both moral and economic, with every $1 spent yielding up to $7–12 in returns through improved employment, economic growth, and financial welfare. While health spending is often deprioritized by finance departments, it is essential for achieving not just SDG 3 but all of the Sustainable Development Goals (SDGs), as poor health hinders overall progress.
• Dr. Mary-Ann Etiebet, President & CEO of Vital Strategies, highlighted that raising taxes on tobacco, alcohol and sugary drinks by 50% could save 50 million lives over 50 years and generate $2.1 trillion, significantly boosting health spending in low- and middle-income countries. Despite this potential, little progress has been made due to industry interference and political hesitancy. However, evidence shows such taxes do not harm employment or increase illicit trade, and that they protect the poor by reducing future health costs. What's more, public support is strong—up to 60%—when taxes are clearly linked to health benefits, underscoring the need for unified advocacy and inclusion of health taxes in global financing agendas.

The interactive discussion following the panel emphasized the need to better leverage existing in-country resources to support preventive health services. Speakers stressed the importance of addressing systemic barriers, such as industry interference and the broader food system, while engaging and educating communities to drive behavior change. Strong calls were made for health taxes and subsidies for healthy food, as well as for global financing strategies that are coherent, inclusive and aligned with national priorities. As international support becomes more constrained, there is an urgent need for greater country ownership through domestic resource mobilization, improved financial protection for vulnerable populations, and stronger community-based responses. 

Participants agreed on the importance of including meaningful health financing commitments in the FfD4 outcome document to serve as a foundation for long-term action. Accountability, coherence in fiscal policy, and alignment with the SDGs—especially from governments and multilateral development banks—were also key themes, along with the need for ongoing advocacy and follow-up beyond Sevilla.