Global Health Financing Needs A Reset
With major donor countries slashing their foreign-aid budgets, the financial foundations of global health have come under strain, revealing structural weaknesses long masked by steady public funding. The solution lies in building a more resilient system that combines grants, concessional loans, and private capital.
The impact will be felt most strongly in the world’s least developed countries. Bilateral ODA to LDCs fell by an estimated 13-25% in 2025, ing a 3% decline in 2024. In Sub-Saharan Africa, the projected cuts are even steeper, at 16-28%, potentially resulting in the loss of around one-quarter of total ODA in a single year. In the ten countries with the highest levels of extreme poverty, the top five donors provide 85% of ODA, with the United States and the World Bank ranking among the top two in eight of them.
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The decline in ODA reflects a structural shift rather than a cyclical shock. Between 2011 and 2024, health-related development assistance fell by roughly 24% as a of global GDP, despite a brief pandemic-driven surge. Over the same period, the rationale for health aid shifted away from solidarity and human development toward economic interests, national security, and pandemic preparedness.
Meanwhile, the development-finance landscape has become increasingly crowded and complex. BRICS+ (China, Russia, and India in particular) and emerging regional powers collectively have been providing over $100 billion in development funding since 2022. Roughly 80% of these funds come from China and are primarily delivered through loans and other non-grant instruments.
The 11 BRICS+ countries, which account for 27% of global GDP, are widely expected to overtake the G7 by 2050, enabling them to exert growing influence over both the volume and direction of development finance. These newer providers often favor bilateral, project-based approaches, loans over grants, and infrastructure-heavy investments. Their investment patterns are driven by geopolitical interests, concentrating resources in strategically important regions while leaving others, including parts of Sub-Saharan Africa, underserved.
Private and impact investors are also playing a more prominent role. Across Africa and Asia, health-care-focused private equity and impact funds are providing patient capital and innovative financing structures, creating space for investments that deliver both financial returns and measurable health benefits.
But not all health projects are suitable for this type of capital. A detailed analysis of Côte d’Ivoire and Uganda’s health-security action plans shows that only 25-30% of budgeted projects combine direct, measurable health impact with predictable cash flows and clear revenue models. These are typically infrastructure investments, such as oncology centers and specialized institutes, that can generate service revenues and position countries as regional hubs. By contrast, core public goods such as disease surveillance and health-system planning continue to rely on grants and highly concessional financing.
More broadly, the Boston Consulting Group estimates that projects representing roughly 20% of national health spending, and potentially up to 30% of global portfolios, could attract return-seeking investors. To this end, such projects should be viewed through an investment lens, with clearer business models, cash flows, and risk-return profiles.
Unlocking that potential requires making health outcomes legible to investors. While public donors focus on traditional indicators such as lives d and mortality reduction, private and impact investors often look for quantitative frameworks that link investments to the Sustainable Development Goals and to portfolio-level performance. A prime example is the SDG Blue rating system. Developed by Blue an Orange Sustainable Capital, it assigns each investment a score from zero to ten based on its contribution to selected SDGs.
We need more such models, because the latest wave of ODA cuts underscores the need to rethink how global health is financed. National and global portfolios should be broken down into distinct project types, each matched to the form of financing most suitable for its risk profile. Government grants and highly concessional loans should remain focused on low-income countries, vulnerable populations, and essential public goods, while infrastructure-heavy and service-based initiatives with clear revenue models can be structured to attract private and impact capital. Blended arrangements can bridge these two extremes, aligning public, philanthropic, and private resources.
Achieving such a reset will depend on how effectively governments, multilateral institutions, and development partners structure financing, sort projects by risk, and engage investors. By recognizing that impact and financial returns can be mutually reinforcing, the world can move toward a more resilient and diversified financing model that protects and builds on hard-won gains, even as public budgets become increasingly constrained.
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