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6
2
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.
more
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
...
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.
more
Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries (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.
more
Development assistance for health (DAH)
plays a vital role in supporting health programmes in lowand middle-income countries. While DAH has historically
focused on infectious diseases and maternal and child
health, there is a lack of comprehensive analysis of DAH
trends, strategic shifts and the
...
ir impact on health systems
and outcomes. This study aims to provide a comprehensive
review of DAH from 1990 to 2022, examining its evolution
and funding allocation shifts.
more
Zambia is facing a severe economic crisis marked by high inflation, increasing poverty and a heavy debt burden that is straining both its fiscal stability and progress in health outcomes. By 2020, the country's external debt reached United States dollars (USD) 12.7 billion, representing 108% of the
...
country's gross domestic product (GDP). In 2020, Zambia sought assistance through the G20 Common Framework and the International Monetary Fund (IMF) Extended Credit Facility (ECF), securing a USD 1.7 billion loan over 5 years. IMF loans, however, come with austerity measures that prioritise fiscal discipline but could potentially exacerbate social inequalities. These measures, which include increasing consumer taxes on goods and services (value added taxes - VATs), electricity tariffs and fuel prices, disproportionately impact vulnerable populations, raising concerns about their long-term effects on essential services, especially accessible and good quality healthcare services.
more
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
...
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.
more
There is growing pressure on PEPFAR, the U.S. global HIV program, to increase its planning for sustainability, including through domestic resource mobilization and, ultimately, transitioning financing at
least in part to recipient countries. While this is connected to a broader push in global healt
...
h and development, driven by a constrained financing environment and desire to promote more countryownership of programs and services, there are specific questions facing PEPFAR’s future. A National Academy report from 2017, for example, recommended that PEPFAR look toward phasing down its spending and supporting countries in their transition from bilateral aid to domestic financing for HIV. At a
Senate hearing last year, PEPFAR was asked how it was working to increase domestic resources and under what conditions would it need less resources to accomplish its goals. Recent challenges in securing a five-year reauthorization of the program have only served to heighten the focus on
sustainability and domestic resource mobilization. How PEPFAR does this, however, remains an ongoing question.
more
For this report, the Task Force commissioned
additional background papers on health taxes to
update the evidence, assess short-term revenue
potential, and understand the role of health taxes
in the current era of multiple crises. We find that
health taxes continue to be underutilized despite th
...
e
powerful impact they have in reducing preventable
death and disease — a particularly glaring act of
neglect in a world that has experienced a massive
pandemic.
more
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
...
, 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.
more
Frequent efforts to revise the official development assistance (ODA) accounting rules have raised important questions about the integrity and relevance of what currently “counts” as ODA spending. In this note, we outline a brief history of the evolution of the ODA accounting rules to date, highl
...
ighting how—and why—the ODA concept has changed since it emerged in 1969. Doing so provides a starting point for considering whether the current concept of ODA remains “fit for purpose” and whether, or how, the concept could reform to better meet current needs.
more
The Malaria Ministerial Conference, co-hosted by WHO and the Government of Cameroon on 6 March 2024, brought together more than 400 stakeholders, including Ministers of Health and senior representatives from the African countries hardest hit by malaria, global health leaders, scientists, civil socie
...
ty and other partners. The pivotal meeting sought to leverage political commitment, scientific innovation and community engagement to reshape the trajectory of malaria control in high burden African countries, and beyond.
At the end of the meeting and in the weeks that followed, Ministers of Health from the 11 “High Burden High Impact” African countries (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, Uganda and United Republic of Tanzania) signed the Yaoundé Declaration, pledging their “unwavering commitment” to the principle that “no one should die from malaria given the tools and systems available.” Success in reducing malaria morbidity and mortality will hinge on efforts by countries to translate this political commitment into actions and resources that will save lives.
more
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 publication uses graphics to explain the importance of development cooperation in general and for health in particular. Financial contributions in the context of development cooperation have proven to be indispensable, effective, affordable and responsible in recent decades.
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
...
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.
more
The Regional Child Protection Operational Note has been developed by IOM and UNICEF’s Regional and Country Offices in North, West and Central Africa as a collaborative inter-agency and cross-regional endeavour within the framework of the sixth phase of the IOM Regional Development and Protection P
...
rogramme (RDPP) for North Africa, a regional initiative funded by the European Union through the Directorate‑General for Migration and Home Affairs and the Italian Ministry of Interior.
more
ith a view to support the monitoring and reporting on the denial of humanitarian access against children, the Office of the Special Representative of the Secretary-General for Children and Armed Conflict and UNICEF publish today* a guidance note offering new tools to practitioners to better address
...
this violation of children's rights in conflict situations. The Denial of Humanitarian Access (DHA) is one of six grave violations against children monitored by the United Nations in the framework of its Children and Armed Conflict (CAAC
more
The Strategic Malaria Communication Guide for Central America is intended to facilitate the shift from malaria control to elimination by strengthening communication and advocacy initiatives throughout the region. Based on interviews and a review of literature, the guide offers National Malaria Progr
...
ammes (NMPs) recommendations on messaging, target audiences, communication channels and advocacy strategies. The guide's primary goals are to raise awareness of malaria elimination, encourage long-term commitment from decision-makers and mobilise sustainable resources. The guide outlines two strategic objectives: (1) creating a shared understanding of the long-term requirements for malaria elimination, including funding, surveillance and multi-sectoral engagement, and (2) expanding support among public, private and cross-sectoral stakeholders. With malaria cases having already reduced by 88% since 2000, the guide emphasises the importance of maintaining focus and investment in order to fully eliminate the disease and prevent its re-establishment in Central America.
Accessed on 10/06/2025.
more
This chapter of the AMP LLIN Mass Campaign Toolkit outlines the strategic communication approaches that are essential before, during and after long-lasting insecticide-treated net (LLIN) distribution campaigns. It emphasises the importance of setting up a national communications sub-committee under
...
the leadership of the National Malaria Control Programme (NMCP) and the Ministry of Health (MoH) to coordinate advocacy, social mobilisation and behaviour change communication (BCC). The aim of these three components is to secure political and financial support, mobilise communities, and promote sustained net use through tailored, multi-channel messaging. Effective coordination and planning are critical for successful malaria prevention efforts.
more
Cette note d'information souligne l'importance d'intégrer une approche sensible au genre dans les efforts de lutte contre le paludisme dans le monde entier. Il montre que la prise en compte des vulnérabilités et des besoins spécifiques à chaque sexe - en particulier ceux des femmes et des enfan
...
ts - peut produire un « double dividende » en améliorant les résultats sanitaires et en faisant progresser l'égalité entre les sexes
more
Relapsing malaria caused by Plasmodium vivax parasites poses a significant challenge to global malaria elimination efforts. About one third of the population remains at risk of contracting P. vivax malaria, and 85% of P. vivax infections stem from reactivated latent parasites, leading to chronic ana
...
emia and increased morbidity and mortality. In addition to diagnostic tools that can detect the acute, blood-stage of P. vivax, new tools are needed to detect the dormant infections before they reactivate and contribute to morbidity and onwards transmission
more
