Opinion: Financing health for all requires bold moves away from aid

This article was first published on Devex on 28 April 2024.

As heads of state and senior global development leaders gather today for a Financing for Development meeting against a backdrop of falling global health funding, we urge for decisions now on rethinking how we can finance health for universal access to care.

Recent freezes and cuts in official development assistance threaten to thwart progress toward universal health coverage, or UHC, and health-related Sustainable Development Goal targets.

These decisions have already reduced access to essential health services — including for sexual and reproductive health, HIV, tuberculosis, and malaria — and endangered millions of lives.

These cuts could lead to an additional 15 million cases and 107,000 deaths from malaria this year, and more than 10 million cases and 3 million deaths from HIV. The measures will also have a ripple effect on many health conditions, including noncommunicable diseases. Ultimately, the burden will disproportionately fall on the most vulnerable — women, girls, adolescents, and children — exacerbating health inequities and undermining the foundational principles of UHC.

At the 2025 United Nations Economic and Social Council’s Forum on Financing for Development this week and within the discussion about the resolution on strengthening health financing globally at the 78th World Health Assembly, we urge governments on behalf of the Coalition of Partnerships for UHC and Global Health to rethink their approach to health financing to create more sustainable systems that foster healthy, equitable, and resilient communities.

By investing strategically in high-impact interventions and integrating them into essential benefits packages embedded in primary health care, governments can address inefficiencies, advance long-term health goals, and create financing systems that can deliver UHC while coping better with global shocks.

Several countries have already demonstrated that progress toward UHC is possible by optimizing allocations of limited resources:

• The HIV/AIDS funding crisis, which threatened the treatment of 1.5 million Nigerians, has catalyzed a push for greater self-sufficiency in essential medicine production. The government has mobilized emergency resources, strengthened supply chain oversight, and accelerated local pharmaceutical manufacturing efforts.
• Uganda’s Ministry of Health is integrating HIV/AIDS, malaria, tuberculosis and other health services into routine outpatient and chronic care services in hospitals and lower-level facilities and training health workers in integrated service delivery. 
• Rwanda has long used funding for HIV, malaria and tuberculosis to build broader health systems, highlighting the need for donor support to focus not only on disease-specific interventions but also on strengthening health systems to deliver services across multiple health issues.
• Ethiopia has integrated maternal, newborn, and child health into its primary health care program since 2003 in order to mitigate reliance on volatile donor funding.  The deployment of trained health extension workers to rural communities, delivering essential health services, including maternal, newborn and child care, has led to significant improvements: for instance, institutional delivery rates increased from 5% in 2000 to 26% in 2016, and antenatal care coverage rose from 27% to 62% over the same period.

These initiatives underscore the importance of strong political will and whole-of-government approaches to achieve health for all.

To cope with this and any future financing crises, we need decisive action that ensures the sustainability of health systems. Failure to act will result in millions of lives lost and communities left or further pushed behind. We recommend that governments:  

1. Mobilize domestic resources for health. Evidence shows that meaningful progress toward UHC is not possible when countries rely primarily on private spending. Governments must invest in health systems by allotting adequate and sustainable public resources, including for financial protection measures to shield people from impoverishing health costs which they pay out of their own pocket.
2. Increase taxes on health-harming products. Health taxes have the potential to generate government revenue while promoting healthier behaviors, leading to improved health outcomes. Over the next five years, increases in taxes on tobacco, alcohol, and sugar-sweetened beverages could generate an additional $3.7 trillion in government revenues globally — an average of $740 billion per year — with the largest share of these potential revenues going to low- and middle-income countries. Such measures would also lead to significant changes in consumption, such as a reduction of 25% for tobacco consumption, while reducing health care costs, alleviating pressure on health systems.
3. Improve alignment of international development cooperation for health. Official development assistance remains critical for many low- and lower-middle-income countries, but to be effective, it requires improved alignment with national health priorities and better coordinated and more predictable donor actions. The Lusaka Agenda provides a framework for enhanced coordination and alignment of external resources with country priorities and systems. This, in turn, helps strengthen well-integrated service delivery systems based on primary health care.
4. Mitigate the expected growth in debt servicing to increase fiscal space for health. Currently, 3.3 billion people live in countries where debt interest payments are greater than expenditure in health or education. Addressing the expected growth in public debt servicing will be critical to strengthening health systems, closing coverage gaps, and protecting the poor and vulnerable.

In the face of this global health financing emergency, governments must act boldly and decisively now to guarantee that every person, everywhere, can access quality health care without financial hardship. The resilience of our communities and economies depends on it.

By The Coalition of Partnerships for UHC and Global Health