Restructuring global health – WHO faces major challenges as foreign aid reductions take toll
Last week, global leaders gathered for the World Health Assembly in Geneva to address the reality that the global health landscape is being reshaped by dramatic shifts in funding, priorities, and leadership.
Chief among these is the United States' decision to slash foreign aid and withdraw from the World Health Organization (WHO). Despite spending only 0.24% of its gross national income on foreign aid, the United States has been the largest donor to global health programmes, providing one-third of the international assistance in global health. This is not just a US issue – other countries have also signalled reductions in foreign health aid, and Argentina also recently announced it will withdraw from the WHO.
These dramatic shifts have forced the WHO to plan a reduction in staff by nearly 50%, triggering massive restructuring. Non-government organisations (NGOs) are laying off large numbers of staff worldwide. While other donors and philanthropies are stepping in, they cannot fill the void alone.
Meanwhile, the shock to the system is already resulting in lives lost. According to the WHO, countries such as Haiti, Kenya, Lesotho, South Sudan, Burkina Faso and Nigeria may run out of HIV antiretroviral medications within months.
The Africa CDC's director-general, Dr Jean Kaseya, warned in March that 'two to four million additional Africans are likely to die annually' as a result of the aid cuts. T
The continent now faces a $12-billion shortfall in healthcare financing. Substantial impacts will be felt across the globe, from Afghanistan to Lao PDR, in many low- and middle-income countries.
While the immediate effects of these cuts are being felt primarily by the Global South, the associated risks extend globally. When countries become overwhelmed by preventable infections, they will lose the ability to detect and contain pathogens with epidemic potential that could cross borders in days. The current situation carries serious implications for global security as well as health.
A new era needs to begin with a roadmap for sustainable domestic funding by individual nations, a strategic view of the role of WHO, and a coordinated plan among major donors. Governments must take the lead in reshaping their health budgets to reflect urgent needs while navigating competing priorities. Donors, NGOs, and multilaterals can support this shift if they embrace flexible, trust-based funding models tailored to local strategies.
African health financing
The desire to create long-term sustainability is apparent in the Africa CDC's strategic plan to transform health financing, which focuses on domestic resource mobilisation, diversifying funding sources, optimising health fund management and using evidence-based data for efficient resource allocation. The plan calls for member countries to meet the Abuja Declaration target of spending at least 15% of national budgets on health and explores innovative ideas such as solidarity levies and mobilising Africa's $95-billion in annual diaspora remittances. Nigeria's Basic Health Care Provision Fund, which dedicates 1% of revenue (about $150-million annually) to primary care, is a promising example.
Any effort to reform global health infrastructure must prioritise resilient, widely accessible primary healthcare. Since the Alma-Ata declaration of 1978, we've known that primary care is the foundation of 'Health for All'. Doing so will not only reduce the impact of chronic and endemic infectious diseases, but also serve to enable systems that quickly identify when infectious disease outbreaks of concern appear.
As the WHO recalibrates, it must assess realistically the current situation and focus on its most important core functions for the future: setting global standards, responding to emergencies and coordinating transnational responses. Routine programme implementation should be handled by individual countries, NGOs, and the private sector.
The WHO can no longer afford to take on the management of basic health functions within countries. Instead, it needs to focus on maintaining surge capacity to meet needs during health emergencies and facilitate cooperation in transboundary issues. The WHO needs to prioritise doing fewer things better.
Now is also the time for new global coalitions, agreements and leadership among non-government actors. The Gates Foundation has reaffirmed its commitment to address emerging challenges. Philanthropies must align their efforts to successfully cooperate, identify priorities and gaps, reduce duplication and maximise impact. Meanwhile, the private sector has a vital role to play in connecting national health priorities to new markets, innovations and partnerships.
Global health needs a multisector coalition of the willing right now that is felicitous, innovative, able to learn from past mistakes and adapt to meet the world's current needs and prevent future crises. The time for action is now – the consequences of inaction are too great, and the lives lost are both predictable and preventable. DM
Mitchell Wolfe is Senior Associate at the Center for Strategic Studies, Washington, DC; Nahid Bhadelia is Associate Professor at the Boston University School of Medicine; and Wilmot James is Professor and Strategic Advisor to the Pandemic Center at Brown University's School of Public Health and a former Member of Parliament (South Africa).
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