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Multi-country outbreak of cholera External Situation Report # 23, published 20 February 2025
With the COVID-19 pandemic and the ensuing energy and cost-of-living crises, many OECD countries have had to face significant economic and societal challenges over the last five years. The succession of crises has had important implications for health systems and the available resources allocated to
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health. This policy brief examines the recent trends in health spending and discusses what is driving the latest spending trajectory.
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The role of evidence in the journey towards universal health coverage is paramount. Financial risk protection monitoring, the major focus of this report, informs where the WHO African Region stands in reducing the financial hardship people face due to health expenses. This report details the status
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of financial risk protection and related trends, the drivers of out-of-pocket (OOP) payments and the impact of the COVID-19 pandemic on financial risk protection. As such, it provides evidence coutries can draw on to develop health financing systems and reforms that mitigate financial barriers to accessing health services. Through analysis of country data, cross-country learning and drawing on the published literature, this report proposes recommendations that countries may adapt to their contexts.
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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”. Its purpose is to contribute to the
debate of the Mozambican Ministry of Health’s draft Health
Sector Financing Strategy (HSFS) 2025 – 2034
Each year since 2007, G-FINDER has provided policy-makers, donors, researchers and industry with a comprehensive analysis of global investment into research and development of new products to
prevent, diagnose, control or cure neglected diseases in low- and middle-income countries, making it the go
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ld standard in tracking and reporting global funding for neglected disease R&D. This year’s report, the sixteenth overall, focuses on investments made in participants’ 2022 financial year (‘FY2022’) and, for the first time, adds comprehensive coverage of the product pipeline in each disease area.
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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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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
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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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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
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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.
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Pillar 3 of the Global technical strategy for malaria 2016–2030 calls for the transformation of malaria surveillance into a core intervention in all malaria-endemic countries, as well as in countries which have eliminated malaria but remain susceptible to re-establishment of transmission. This ref
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erence manual covers subjects that are relevant to both settings.
The target readership of this manual includes staff working in ministries of health, national malaria programmes and health information systems; partners involved in malaria surveillance; and WHO technical officers who advise countries on malaria surveillance.
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Getting back on track to cutting malaria by 90% could boost African economies by $127bn by 2030. This important new report shows we can save lives, boost economies and trade, creating a healthier world
This toolkit is a comprehensive set of practical tools and resources designed to support country-level risk communication and community engagement (RCCE) practitioners, decision-makers and partners to plan and implement readiness and response activities for Ebola disease outbreaks. The toolkit conta
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ins: information about Ebola disease; RCCE considerations on how to approach key issues during Ebola disease outbreaks; tools for understanding the context in which Ebola disease outbreaks occur; methods for collecting data to inform strategy development and bring evidence into the planning and implementation of activities; guidance to support prevention and response interventions; and links to existing RCCE tools and training. It is one of a suite of toolkits on RCCE readiness and response to a range of disease and response areas.
more
This toolkit is a comprehensive set of practical tools and resources designed to support country-level risk communication and community engagement (RCCE) practitioners, decision-makers, and partners to plan and implement readiness and response activities for yellow fever outbreaks. The toolkit conta
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ins: information about yellow fever; RCCE considerations for how to approach key issues during yellow fever outbreaks; tools for understanding the context in which yellow fever outbreaks occur; methods for collecting data to inform strategy development and bring evidence into planning and implementation of activities; guidance to support vector control and immunization campaigns; and links to existing RCCE tools and training. It is one of a suite of toolkits on RCCE readiness and response to a range of disease and response areas.
more
This toolkit is a comprehensive set of practical tools and resources designed to support country-level risk communication and community engagement (RCCE) practitioners, decision-makers, and partners to plan and implement readiness and response activities for yellow fever outbreaks. The toolkit conta
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ins: information about yellow fever; RCCE considerations for how to approach key issues during yellow fever outbreaks; tools for understanding the context in which yellow fever outbreaks occur; methods for collecting data to inform strategy development and bring evidence into planning and implementation of activities; guidance to support vector control and immunization campaigns; and links to existing RCCE tools and training. It is one of a suite of toolkits on RCCE readiness and response to a range of disease and response areas.
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The 2024 edition reviews more than 50 health-related indicators from the Sustainable Development Goals and WHO’s Thirteenth General Programme of Work. It also highlights the findings from the Global health estimates 2021, notably the impact of the COVID-19 pandemic on life expectancy and healthy l
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ife expectancy.
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This document on logistics management information systems (LMIS) was developed to address the increasing need for harmonization and standardization of core indicators for managing medicines and health products for neglected tropical diseases (NTDs) at country level (i.e. for last-mile logistics). It
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thereby responds to requests from Members States, pharmaceutical groups, financial donors and implementing partners for guidance from the World Health Organization (WHO) for a transparent, standardized reporting mechanism and key indicators for in-country logistics. More importantly, this document will also guide the last-mile logistics process and is relevant for the health workforce working at different levels of national health information systems. It can be adapted and used for any health products depending on the needs of the country or health programmes.
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Non-Communicable Diseases (NCDs) have emerged as conditions of great public health concern in Kenya accounting for 39% of deaths annually. The Ministry of Health through the Department of Non-Communicable Diseases has adopted the vision of achieving a nation free from preventable burden of NCDs. Fur
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ther, the mission of this strategy is to halt and reverse the rising burden of NCDs through effective multisectoral collaboration and partnerships by ensuring Kenyans receive the highest attainable standard of NCD continuum of care that is accessible, affordable, quality, equitable and sustainable thus alleviating suffering, disease and death for their well-being and socio-economic development.
The scope of NCDs covered by this strategy include; cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, mental health conditions, violence and injuries, hemoglobinopathies, haemophilia and other bleeding disorders, auto immune diseases, chronic renal diseases, epilepsy and other neurological disorders, chronic skin conditions and oral diseases and conditions. It equally addresses seven risk factors; tobacco use, harmful use of alcohol, unhealthy diets and toxins, physical inactivity, indoor air pollution, environmental pollutants and toxins and stress.
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Public health challenges over the past decade have highlighted the importance of approaching health through a holistic lens of human, animal, and environmental sectors, recognizing the need for a collaborative response against shared threats. Zoonotic diseases, transmitted between humans and animals
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through their shared environment, are at the forefront of the threats requiring collaborations that span human health, natural ecosystems, and food systems.
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The global cholera statistics for 2024, showing an increase in both the number of people who fell sick and died from the disease.
Reported cholera cases rose by 5% and deaths by 50% in 2024 compared to 2023, with more than 6000 people dying from a disease that is both preventable and treatable. Whi
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le these numbers are themselves alarming, they are underestimates of the true burden of cholera.
Weekly epidemiological record WER No 36, 2025, 100, 347–364
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On Global Handwashing Day, WHO and UNICEF have released the first-ever global Guidelines on Hand Hygiene in Community Settings to support governments and practitioners in promoting effective hand hygiene outside health care – across households, public spaces and institutions. Framing hand hygiene
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as a public good and a government responsibility, the Guidelines translate evidence into ready-to-adopt actions that enable sustainable access to effective hygiene services. This will reduce diarrhoeal disease, acute respiratory infections and other preventable illnesses, strengthening routine public health where people live, work, visit and study, and emergency preparedness, including outbreaks like cholera.
Despite clear benefits, 1.7 billion people still lacked basic hand hygiene services at home in 2024, including 611 million with no facility at all. Meeting the 2030 target will require accelerated progress – about a doubling in the global rate, and much faster in specific settings (up to 11-fold in least-developed countries and 8-fold in fragile contexts). Hand hygiene remains one of the most cost-effective health investments, reducing diarrhoea by 30% and acute respiratory infections by 17%, with large, measurable gains for population health.
“Clean hands save lives, but results at scale require policy, financing and accountability,” said Dr Ruediger Krech, Director a.i, Department of Environment, Climate Change, One Health & Migration at the World Health Organization. “These Guidelines help countries move beyond fragmented projects to government-led systems that make soap, water, and conditions conducive to everyday hand hygiene the norm.”
“Children and young people pay the highest price when basic hygiene is out of reach,” said Cecilia Scharp, Director, Water Sanitation and Hygiene (WASH) Team, Programme Group, UNICEF. “These Guidelines provide practical steps to ensure facilities are accessible when they need to be – in homes, schools, markets, and transport hubs – so every child can learn, play and thrive with dignity.”
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The WHO handbook “Epidemiological Data Analysis for the Early Warning Alert and Response Network (EWARN) in Humanitarian Emergencies” explains how to collect, analyse, interpret, and share health data during crises such as conflicts or natural disasters. It is a practical guide for health and su
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rveillance officers to detect disease outbreaks early and guide quick public health responses. The document outlines steps for managing data at different levels (local, regional, national), analysing disease trends by time, place, and person, and using indicators to monitor outbreak risks. It also provides methods for interpreting and communicating results clearly to decision-makers to support effective health interventions in emergencies.
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