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Toolboxes
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In contrast to bilateral aid, aid disbursed from
multilateral institutions increased significantly at the onset
of the COVID-19 pandemic. Yet, at a time when a coherent
and effective multilateral response is needed most, the
COVID-19 pandemic revealed a shifting landscape of donor
agencies that
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struggle with basic functions, such as crossnational coordination. While multilaterals are uniquely
positioned to transcend national priorities and respond
to pandemics, functionally we find official development
assistance (ODA) from these entities may increasingly
mimic the attributes of bilateral aid. We explore three
important, but not comprehensive, attributes of aid leading
up to and during the COVID-19 pandemic: (1) earmarking,
(2) donor concentration and (3) aid modality.
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One approach to development assistance for health, or health aid, emphasizes the ex ante selection of cost-effective health interventions, an approach that began with the World Development Report (1993) on Investing in Health and has since been adopted by the Effective Altruism community. But just h
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ow much of health aid is cost-effective? In this paper, we examine projects in the Organisation for Economic Co-operation and Development (OECD) Creditor Reporting System, the standard dataset that measures and characterizes development assistance for health, for the
years 2019 to 2021, and count the number of projects that refer to interventions from a list of highly cost-effective interventions as defined by the Disease Control Priorities Project, third edition. This exploratory quantitative analysis indicates that 61% of projects used a key word/phrase of a costeffective intervention. There were 11.9 interventions mapped per project on average. There is little evidence that donors tailor the set of interventions to country income levels by cost-effectiveness.
Policymakers may benefit from reviewing the full portfolio of interventions covered by domestic and external resources.
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In the last three decades, health financialization has surged in
several creative ways, yet this growing phenomenon remains surprisingly
unknown, and neglected, in the global health arena. Financialization in the
health domain could be described as the uncontrolled expansion of finance along vari
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ous lines of healthcare provision. Health has been intentionally transformed into a commodity as private for-profit actors have been allowed freedom to operate - and ultimately play with people’s fundamental right to health - for their vested financial interests, nationally and internationally. Health financialization is thrivingly pursued today for example through the institutionalization of medical knowledge monopolies, the expansion of markets and of financial techniques applied to healthcare insurance schemes, the soaring digitalization of global health interventions and the booming data industry.
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Development Finance at a Turning Point: Effects and Policy Recommendations
Berensmann K., Laudage Teles S., Sommer C., et al.
German Institute of Development and Sustainability (IDOS)
(2023)
CC
Development finance is at a turning point, as the macroeconomic environment has changed profoundly and the financing gap for low- and middle-income countries has widened. The events that led to this new situation are the multiple crises that the global economy is facing, such as the climate crisis,
...
the COVID-19 crisis and the war in Ukraine. As a
result, interest rates have risen sharply over the past year and are not expected to decline anytime soon. High interest rates further restrict low- and middle-income countries’ access to international financial markets by making borrowing more expensive. At the same time, debt
levels in several countries are rising to levels that are almost impossible to repay. Poorer countries find themselves in a trap where financing the Sustainable Development Goals (SDGs) becomes a distant goal for them.
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The “Declaration for Accelerated Malaria Mortality Reduction in Africa” is a statement signed by African health ministers reaffirming their commitment to reducing malaria-related mortality. It pledges strengthened leadership, increased domestic financing for malaria control programs, and the imp
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lementation of current technical guidelines. The ministers emphasize the need to invest in data technologies, enhance cross-sector collaboration, and build partnerships for financing, research, and innovation in order to intensify malaria control efforts at both national and subnational levels.
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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 vulnerabilities. This collapse is placing immense pressure on Africa’s already fragile health systems as ODA
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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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The Council was established in late 2020 by Dr Tedros Adhanom
Ghebreyesus (Director-General, WHO) to provide new economic thinking – reassessing how health and wellbeing are valued, produced and distributed across the economy. An all-female group of 10 distinguished economists and area experts, t
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he Council has focused on reimagining how to put Health for All at the heart of government decision-making and private sector collaboration at regional, national and international levels.
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Most foreign aid comes in one of two forms: either we pay a person or an institution today in exchange for delivering some beneficial activity in the future, or we observe something bad happen to them and then give them support to recover from it. This kind of aid is simple to design and deliver,
b
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ut in the former case has limits in how sharply it incentivizes success and effort from a range of actors and in the latter case leads to the inefficient and undignified “begging bowl” approach to humanitarian financing. In what follows, I identify a broad family of alternative approaches, which
can loosely be grouped together as “contractually contingent financing,” and explain why they are still relatively underused.
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The COVID-19 pandemic exposed critical gaps in the global response to health crises, particularly in the financing of pandemic prevention, preparedness, response, recovery, and reconstruction. This chapter presents a comprehensive framework for pandemic financing that spans the entire pandemic cycle
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, emphasizing the need for timely, adequate, and effective financial resources. The framework is designed to support
policymakers in both low- and middle-income countries (LMICs) and high-income nations, providing a guide to appropriate financing tools for each stage of a pandemic, from prevention and preparedness to response and recovery. Key economic concepts such as global public goods, time preference, and incentives are explored to underscore the complexities of pandemic financing.
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In 2019, the Task Force on Fiscal Policy for Health concluded that taxes on tobacco, alcohol, and sugar-sweetened beverages were a highly effective but greatly underused policy tool to reduce consumption, save lives, and raise domestic resources. The Task Force estimated that if all countries increa
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sed their excise taxes to raise prices by 50 percent, over 50 million premature deaths could be averted worldwide over the next 50 years while
raising over USD 20 trillion of additional revenue. Since the Task Force first convened, the world has faced a “polycrisis,” including a global pandemic, an economic recession, and the outbreak of wars in Europe and the Middle East. Against this backdrop, the world has also experienced prolonged health and fiscal crises. Health systems, weakened by the COVID-19 pandemic, lack sufficient financing to rebuild and respond to the surging noncommunicable diseases epidemic caused by uncontrolled risk factors such as tobacco, alcohol, and sugar consumption. Opportunities to raise domestic resources are limited and debt burdens have squeezed budgets. The period from 2019 to 2027 risks becoming a “lost decade” for health and social policies, with 110 countries facing little prospect of any
ability to raise government revenues beyond current levels. In this paper, we describe the current health and fiscal crises and review the contribution that health taxes could make in turning around this dire situation. We conclude that taxes on tobacco, alcohol, and
sugar-sweetened beverages are an ideal policy solution—good for the budget and good for health. These taxes are relatively quick to implement, and, unlike other taxes, do not put economic growth at risk—a vital benefit in the current era.
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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 concrete evidence, recognition and integration of political economy issues within
health financing, and
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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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The world is facing a sustainable development crisis. The 2024 Financing for Sustainable Development Report: Financing for Development at a Crossroads finds that financing challenges are at the heart of the crisis and imperil the SDGs and climate action. The window to rescue the SDGs and prevent a c
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limate catastrophe is still open but closing rapidly. Financing gaps for sustainable development are large and growing – the estimates by international organizations and others are coalescing around $4 trillion additional investment needed annually for developing countries. This represents a more than 50% increase over the pre-pandemic estimates. Meanwhile, the finance divide has not been bridged, with developing countries paying around twice as much on average in interest on their total sovereign debt stock as developed countries. Many countries lack access to affordable finance or are in debt distress. Weak enabling environments are preventing progress. Average global growth has declined, while policy and regulatory frameworks still do not set appropriate incentives. Public budgets and spending is not fully aligned with SDGs. Private investors are not incentivised to invest enough in SDGs and climate action. The world is at a crossroads. This is the last chance to correct course if we want to achieve the SDGs by the 2030 deadline. Only an urgent, large-scale and sustainable investment push can help us achieve our global goals. Next year’s Fourth International Conference on Financing for Development in 2025 will be a once in 80-year opportunity to support coherent transformation of financing.
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National Strategic Plan: Malaria Elimination 2023-27
National Centre for Vector Borne Disease Control (NCVBDC)
Ministry of Health and Family Welfare (MoHFW) - India
(2023)
C2
The National Strategic Plan for Malaria Elimination in India (2023-2027) focuses on achieving malaria elimination by 2030, in alignment with the Global Technical Strategy. The document outlines the strategies, targets, and goals for malaria elimination, aiming for zero indigenous malaria cases by 20
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27. It emphasizes district-based planning, robust surveillance systems, and enhancing case management and vector control. The plan stresses the importance of universal access to treatment, prevention, and data-driven decision-making. Furthermore, it encourages innovation and research in malaria elimination efforts, fostering multisectoral coordination and community engagement.
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The guidelines are primarily intended for health-care professionals working in first- or second-level health-care facilities, including emergency, inpatient and outpatient services. They are also directed at policy-makers, health-care planners and programme managers, academic institutions, non-gover
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nmental and civil society organizations to inform capacity-building, teaching and research agendas.
Web annex A provides the quantitative evidence reports, Web annex B summarizes the qualitative and economic evidence and Web annex C presents the Evidence-to-Decision frameworks.
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The objectives of this guideline are the same as those of the 2011 edition, namely to provide evidence-based normative guidance on interventions to improve adolescent morbidity and mortality by reducing the chances of early pregnancy and its resulting poor health outcomes. The specific objectives of
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the guideline were to: 1. identify effective interventions to prevent early pregnancy by influencing factors such as early marriage, coerced sex, unsafe abortion, access to contraceptives and access to maternal health services by adolescents; and 2. provide an analytical framework for policy-makers and programme managers to use when selecting evidence-based interventions to prevent early pregnancy and negative health outcomes when they occur that are most appropriate for the needs of their countries and context. The recommendations and best practice statements described in this document aim to enable evidence-based decision-making with respect to preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income country contexts.
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This publication provides a problem analysis of the U.S. cuts in global health and derives concrete recommendations for action for medical actors. The focus is on analyzing the direct effects on health-specific development cooperation.
This document is for public health specialists, health emergency responders, clinicians, health facility managers, health and care workers and IPC practitioners including but not limited to those working in primary care clinics, sexual health clinics, emergency departments, dental practices, infecti
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ous diseases clinics, genitourinary clinics, maternity services, paediatrics, obstetrics and gynaecology and acute care facilities that provide care for patients with suspected or confirmed mpox.
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2nd edition. This second edition builds on the experience of more than 10 years of SMC deployment, and reflects changes introduced in the WHO guidelines for malaria, 3 June 2022. The goal of this publication is to share these best practices to improve SMC implementation, coverage, and monitoring and
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evaluation. Examples of materials and tools as well as links to resources are included to support managers and health workers in their efforts to conduct successful SMC activities and prevent malaria among vulnerable children.
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The document outlines essential steps and provides guidance to countries on the adoption and deployment of c-IPTp so that it is integrated into the existing health system. It draws upon best practices and lessons learned from pilot implementation experiences in eight African countries and targets st
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akeholders at the national level that are involved in the provision of maternal and child services, including national and local policymakers and implementers of malaria, maternal health, child health, reproductive health and community health programmes, and nongovernmental and other organizations.
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