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This report summarizes the findings of the Health Financing Progress Matrix assessment for Zambia. Recognizing the remarkable progress towards UHC made by the country over the past twenty years, the
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report also highlights weaknesses in the current health financing system and, extending from this, those priority issues to be addressed in order to further accelerate Zambia’s progress towards universal health coverage (UHC).
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This study aims to provide an overview of health financing in Africa and to examine the impact of the reemergence of mpox on health
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financing in the region.
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As part of the project ‘Equitable health financing for a strong health system in Mozambique’, N’weti and Wemos developed this policy brief wi
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th actionable policy recommendations for the Mozambican government and international organizations on how to increase resources for health in a sustainable and equitable manner. With global cooperation and adequate fiscal reforms, Mozambique can secure quality healthcare for its population and move toward a more self-reliant and healthy future.
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This paper was commissioned by N´weti and Wemos as part
of the project “Equitable health financing for a strong health
system in Mozambique”
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. Its purpose is to contribute to the
debate of the Mozambican Ministry of Health’s draft Health
Sector Financing Strategy (HSFS) 2025 – 2034
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The COVID-19 pandemic demonstrated that
the world was not well prepared to respond
to an infectious disease threat of this magnitude. Countries across all socioeconomic and development categories have struggled
to implement effective national responses. Substantial amounts of additional investmen
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t are required to support the development of country capacities to prevent, detect and respond to both existing and emerging
infectious disease threats. Prior research efforts have estimated that between US$96 and $204billion is required, globally, to
advance country-level health security capacities, with US$63–131billion needed over a 3-year period. Given the substantial costs
of ongoing COVID-19 response, estimated to
be over US$12.5trillion through 2024, and an estimated 12.1–22.7million excess deaths, globally, due to COVID-19 as of January 2022,
the importance and potential return on investment of such upfront investments in capacity building are more evident than ever before.
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Countries that are reforming their health systems to progress towards Universal Health Coverage (UHC) need to consider total resource requirements over the long term to plan for the implementation a
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nd sustainable financing of UHC. However, there is a lack of detailed conceptualization as to how the current health financing mechanisms interplay across health system elements. Thus, we aimed to generate evidence on how to utilize resources from different sources of funds in Africa.
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In 2021, global life expectancy at birth was 74 years whereas in sub-Saharan Africa it was 66 years. Yet in that same year, $92 per person was spent on health in sub- Saharan Africa, which is roughly one fifth of what the next lowest geographic regi
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on—North Africa and Middle East—spent ($379). The challenges to healthy lives in sub-Saharan Africa are many while health spending remains low. This study uses gross domestic product, government, and health spending data to give a more complete picture of the patterns of future health spending in sub-Saharan Africa. We analyzed trends in growth in gross domestic product, government health spending, development assistance for health and the prioritization of health in national spending to compare countries within sub-Saharan Africa and globally.
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Financing Global Health 2023: The Future of Health Financing in the Post-Pandemic Era
Apeagyei A.E., Dieleman J.L., Leach-Kemon K., et al.
Institute for Health Metrics and Evaluation (IHME)
(2024)
CC
IHME’s Financing Global Health report provides an overview of health spending around the world, with a special focus on investments in
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health in low- and middle-income countries. The report examines how this funding for health is changing each year and forecasts how it may change in the future. Financing Global Health examines where money for health originates and what health issues it funds.
This year, Financing Global Health 2023 looks at how interest payments on loans that many countries took out during the COVID-19 pandemic to keep their economies afloat and their people protected are now straining health budgets. It also details how development partners’ investments in health in low- and middle-income countries – development assistance for health – have changed since reaching historic levels during the COVID-19 pandemic, dropping by $19.4 billion between 2021 and 2023, from $84.0 billion to $64.6 billion.
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As a recognized win–win-win approach to international debt relief, Debt-to-Health(D2H)has successfully translated debt repayments into investments in health-related projects. Although D2H has expe
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rienced modifications and periodic suspension, it has been playing an increasingly important role in resource mobilization in public health, particularly for low-and middle-income countries deep in debt.
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Nearly 90 years after Simon Kuznets first introduced Gross Domestic Product (GDP) for the limited purpose of measuring economic growth (by measuring the monetary value of all local goods and services within a given period of time), calls continue to mount for decision-makers to stop using GDP and it
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s derivate, Gross National Income (GNI), for purposes far beyond their original design. This is particularly true in the case of the development assistance architecture, where these indicators are used as proxies to measure a nation’s overall well-being and, in some cases, eligibility for external funding. The GNI-based classification system has recently even been suggested by some Member States as a criterion to access to medicines in the new WHO Pandemic Agreement.
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The document is part of the Financing Global Health 2023 series by the Institute for Health Metrics and Evaluation (IHME) and focuses specifically
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on malaria. It provides a concise overview of global and regional trends in malaria-related health spending, including development assistance, government spending, and out-of-pocket costs. The profile highlights funding gaps, shifts in donor contributions, and the need for sustainable financing to support malaria control and elimination efforts in the post-pandemic era.
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Africa’s health sector is facing an unprecedented financing crisis, driven by a sharp decline of 70% in Official Development Assistance (ODA) from 2021 to 2025 and deep-rooted structural vulnerabi
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lities. This collapse is placing immense pressure on Africa’s already fragile health systems as ODA is seen as the backbone of critical health programs: pandemic preparedness, maternal and child health services, disease control programs are all at
risk, threatening Sustainable Development Goal 3 and Universal Health Coverage. Compounding this is Africa’s spiraling debt, with countries expected to service USD 81 billion by 2025—surpassing anticipated external financing inflows—further eroding fiscal space for health investments. Level of domestic resources is low. TThe Abuja Declaration of 2001, a pivotal commitment made by African Union (AU) member states, aimed to reverse this trend by pledging to allocate at least 15% of national budgets to the health sector. However, more than two decades later, only three countries—Rwanda, Botswana, and Cabo Verde—have
consistently met or exceeded this target (WHO, 2023). In contrast, over 30 AU member states remain well below the 10% benchmark, with some allocating as little as 5–7% of their national budgets to health.
In addition, only 16 (29%) of African countries currently have updated versions of National Health Development Plan (NHDP) supported by a National Health Financing Plan (NHFP). These two documents play a critical role in driving internal resource mobilisation. At the same time, public health emergencies are surging, rising 41%—from 152 in 2022 to
213 in 2024—exposing severe under-resourcing of health infrastructure and workforce. Recurring outbreaks (Mpox, Ebola, cholera, measles, Marburg…) alongside effects of climate change and humanitarian crises in Eastern DRC, the Sahel, and Sudan, are overwhelming systems stretched by chronic underfunding. The situation is worsened by Africa’s heavy dependency with over 90% of vaccines, medicines, and diagnostics being externally sourced—leaving countries vulnerable to global supply chain shocks. Health worker shortages persist, with only 2.3 professionals
per 1,000 people (below the WHO’s recommended 4.45), and fewer than 30% of systems are digitized, undermining disease surveillance and early warning. Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face 2 to 4 million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within. Furthermore, 39 million more
Africans could be pushed into poverty by 2030 due to intertwined health and economic shocks. This is not just a sectoral crisis—it is an existential threat to Africa’s political, social, and economic resilience, and global stability. In response, African leaders, under Africa CDC’s stewardship, are advancing a comprehensive three-pillar strategy centered on domestic resource mobilization, innovative financing, and blended finance.
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Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income co
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untries (LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal
space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation.
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This article provides an in-depth analysis of the Global Fund's strategic initiatives in resource mobilization and recovery amid global economic fluctuations and geopolitical challenges. It highlights the Fund's successful conversion of pledges and innovative
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financing models that ensure sustainable funding for combating HIV, tuberculosis, and malaria. The discussion extends to the Fund's rigorous recovery processes and advocacy efforts to bolster its visibility on international platforms. Additionally, it explores the impact of economic constraints on health funding and the potential of emerging markets and technologies. Performance metrics and health impact assessments underscore the Global Fund's critical role in advancing global health objectives. This analysis offers stakeholders valuable insights into the complexities of global health financing and the Global Fund's adaptive strategies in response.
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This comprehensive HPFM report thoroughly explores Kenya’s health financing landscape. It provides an in-depth analysis of the current state of affairs and sheds light on required strategic change
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s in health financing. The report points out the need to improve public financial management within the health sector, for more efficient financial systems. It focuses on better resourceraising and utilization mechanisms. The matrix highlights the need for consolidation of fragmented health financing arrangements, for a more efficient health system. It also emphasizes the need for enhancing strategic purchasing of health services, to improve the overall efficiency and quality of care. Additionally, the report stresses the critical
role of leveraging data and information systems for more evidence-based informed decision-making. These recommendations are crucial for advancing Kenya’s health financing system and moving closer to the UHC goal.
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Conditioned domestic financing policy, referring to the domestic financing of health projects, programs, and national responses conditioned by glob
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al health funding agencies and recipient country governments, is one mechanism to promote sustainability and country ownership. We aim to understand how the concept is defined and operationalized by agencies and how such policies relate to overall health spending patterns.
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Over the past few decades, the world has witnessed considerable progress in women’s, children’s and adolescents’ health (WCAH) and the Sustainable Development Goals (SDGs). Yet deep inequities remain between and within countries. This scoping
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review aims to map financing interventions and measures to improve equity in WCAH in low- and middle-income countries (LMICs).
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This Guide is part of WHO’s overall programme of work on Political Economy of Health Financing Reform: Analysis and Strategy to Support UHC. The impetus for this work came from demands for more co
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ncrete evidence, recognition and integration of political economy issues within
health financing, and overall system, reform design and implementation processes. This Guide is complementary to WHO’s Health Financing Progress Matrix assessment, as well as Health Financing Strategy development guidance. In this way, it promotes an embedded political
economy analysis approach that can be used in conjunction with other health financing assessments and guidance. The political economy framework can also be extended and easily adapted to broader health policy reforms.
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International financing for health has been high on the political and global health agenda since COVID-19. The recent launch of the Pandemic Fund r
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epresents the first consolidated effort of the international community to mobilise additional voluntary financial resources for the purpose of strengthening global efforts in pandemic prevention, preparedness and response (PPR). Against such a dynamic landscape, building on recent critiques and new policy proposals, we propose a new generation of more equitable, effective and coordinated financing arrangements for pandemic PPR and for global health and development more broadly: lessons that could be applied in the ongoing endeavour of the Pandemic Fund.
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