Tax capacity—the policy, institutional, and technical capabilities to collect tax revenue—is part of a deeper process of state building that is essential for achieving the sustainable development goals. This Staff Discussion Note shows that developing countries have made some progress in revenue... mobilization during the past decades, but that much more is needed. It finds that a staggering 9 percentage-point increase in the tax-to-GDP ratio is feasible through a combination of tax system reform and institutional capacity building. Achieving this calls for a holistic and institution-based approach that focuses on improving policy, administration, and legal implementation of core taxes. The note offers practical lessons and guidance, based on IMF capacity-building experience in this area.
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To meet our Strategy objectives and get within reach
of the 2030 SDG 3 target related to the three diseases,
the Global Fund needs to raise US$18 billion for the
Eighth Replenishment. That sum is essential to drive the
required pace of progress in the fight against HIV, TB
and malaria, and to m...aintain the necessary investments
in health and community systems.
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To deliver on the Global Fund Strategy milestones
for 2028 and ensure we keep the SDG 3 target
within reach, we need to raise US$18 billion to
fund the Global Fund’s next three-year grant cycle.
The Global Health Expenditure Report delves into the intricate landscape of global economies and health systems. This year, it focuses on health spending in 2022, the third year of the COVID-19 pandemic. It shows how countries around the world responded to the health and economic shocks of the pande...mic from a financial perspective. It also considers what the future may hold as countries emerge from the pandemic. Although it is still too early to gauge whether the COVID-19 pandemic has altered long-term trends in health spending, spending appears to have peaked and is now at or below its long-term rising trend in most country income groups. Additionally, to mark the 25th anniversary of the World Health Organization’s (WHO) Health Expenditure Tracking Program, the report reviews the program’s achievements and envisions a path forward. As the program’s lead technical agency, WHO is committed to working closely with partners to support countries in tracking health spending and sustaining the Global Health Expenditure Database and the Global Health Expenditure Report as global public goods.
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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 ...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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We investigate whether and to what extent Chinese development finance affects infant mortality, combining 92 demographic and health surveys (DHS) for a maximum of 53 countries and almost 55,000 sub-national locations over the 2002-2014 period. We address causality by instrumenting aid with a set of ...interacted variables. Variation over
time results from indicators that measure the availability of funding in a given year. Cross-sectional variation results from a sub-national region’s “probability to receive aid.” Controlled for this probability in tandem with fixed effects for country-years and provinces, the interactions of these variables form powerful and excludable instruments. Our results show that Chinese aid increases infant mortality at sub-national scales, but decreases mortality at the countrylevel. In several tests, we show that this stark contrast likely results from aid being fungible within recipient countries.
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Insufficient funding is hindering the achievement of malaria elimination targets in Africa, despite the pressing need for increased investment in malaria control. While Western donors attribute their inaction to financial constraints, the global health community has limited knowledge of China’s ex...panding role in malaria prevention. This knowledge gap arises from the fact that China does not consistently report its foreign development assistance activities to established aid transparency initiatives. Our work focuses on identifying Chinese-funded malaria control projects throughout Africa and linking them to official data on malaria prevalence. By doing so, we aim to shed light on China’s contributions to malaria control efforts, analysing their investments and assessing their impact. This would provide valuable insights into the development of effective financing mechanisms for future malaria control in Africa.
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The relative priority received by issues
in global health agendas is subjected to impressionistic
claims in the absence of objective methods of assessment
of priority. To build an approach for conducting structured
assessments of comparative priority health issues receive,
we expand the public ...arenas model (2021) and offer a
framework for future assessments of health issue priority
in global and national health agendas.
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The key tools and governance approaches for
international cooperation for sustainable development
(hereafter, international cooperation) were set up in a
markedly different time and age. International
cooperation – with official development assistance
(ODA) as the dominant means of implementa...tion –
remains key, despite being generally considered as no
longer adequate for addressing today’s common and
collective challenges.
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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 ...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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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.
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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...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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There has never been a more critical moment to invest in WHO, and strengthen the unique role it plays in global health. Now is the time to sustainably finance WHO and invest in a healthy return for all.
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.
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Children with disabilities are particularly vulnerable in humanitarian settings, yet they are often not able to access the services and protection they need. While multiple factors create these barriers, a major cause is how data about children with disabilities is collected and mapped. Data collect...ion processes often exclude or underrepresent the views of children with disabilities and thier caretakers. When the experiences of children with disabilities and their caretakers are not defined and collected, they become excluded from mainstreamed protective services, which are meant to serve all children. Children with disabilities also do not get the specialised interventions they need.
This guidance note explores how to use qualitative methods to create more robust assessment processes to ensure more effective programming and services for children with disabilities. This note provides promising practices for engaging with children with disabilities and includes sample tools that can be tailored to fit the needs of a particular assessment process. The note also explores the importance of thoughtful cross-sectoral responses so that children with disabilities, and their families, are carefully considered in areas like water, sanitation, and hygiene (WASH), education, health, and nutrition, and therefore receive the holistic support they need and deserve.
This note is intended for a broad audience of relevant child protection actors, including practitioners, coordination groups, researchers, and donors. The information is not limited to one type of humanitarian setting, geographic region, or culture. As a result, the practices and guidance should be adapted to each specific context, ideally in partnership with well-informed local actors, such as representatives from local organisations for persons with disabilities.
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