Following massive cuts in foreign health aid, should we expect greater global sickness and suffering?
Mukesh Kapila – 13 March 2026
Published 13 March at The National News
Following massive cuts in foreign aid by the US and its exit from the World Health Organisation, should we expect greater global sickness and suffering?
President Donald Trump’s disappointing decision was long previewed and should not have shocked anyone. That it did – and disrupted many life-saving programmes – reflects head-in-the-sand complacency in an unprepared aid system. Global health providers have been at the forefront of the panic, thereby making objective scrutiny of health financing surprisingly difficult for such a science-centred discipline.
That is because health agencies passionately advocate for their cause while maximising their own roles. Their combined functions to assess needs, appeal for and channel funds, deliver services, and evaluate their own results generate conflicts-of-interest. When that mixes with donors’ political ideologies, transparency and trust inevitably suffer.
Under this scenario, the most reliable data come from the Institute of Health Metrics and Evaluation because it does not have its own aid projects to colour judgement. It reports that global health assistance for low- and-middle-income countries (LMICs) fell to US$36 billion in 2025 from around $50 billion annually since 2015, discounting the short-lived peak of $80 billion during the Covid-19 pandemic.
The cuts in health development assistance were led by the US which historically made about a third of global health contributions. Most other donors followed suit while UAE, China, and the Gates Foundation stayed steady and Australia, Japan, South Korea and Canada gave a little more.
How significant is the overall 28 per cent reduction in global health aid? It is trivial for most of the Asia-Pacific region and Latin America where foreign health aid constitutes less than 5 per cent of national health expenditure. Such modest shortfalls are easily compensated for by efficiency gains and increased domestic spending in the predominantly middle-income countries. As these also include the more populous nations, the effect of aid cuts on aggregate global health indicators is not worrisome.
However, there are exceptions. Small economies, especially small-island Pacific states, need external health aid. So too do volatile or fragile states such as Afghanistan, Haiti, Syria and Yemen. But this is classified as humanitarian aid because there is insufficient stability to consider development assistance.
Thus, development health aid cuts matter mostly to sub-Saharan Africa. Even there, it is marginal to countries where foreign health aid is less than 10 per cent of national health expenditures. It is significant only in the 12-15 states that depend on foreign assistance for more than 20 per cent of their health budgets. Even so, middle-income countries like Kenya, South Africa, Nigeria, Angola and Tanzania can afford topping-up budgets to the $56 per capita annual investment necessary for essential healthcare provision.
More commendably, low-income countries such as Rwanda and Uganda are also boosting domestic healthcare spending, as are Ethiopia and Eritrea – two states beset by conflict. Thus, boosting health sectors is not simply a function of poverty but a question of political will. Nearly all African countries can do so despite weak governance and institutions, and periodic or persistent pockets of violence.
Of course, African populations in generalised conflict – as in Sudan and the Sahel – require humanitarian health support. But the case for development health financing applies only to a diminishing list of states, such as Somalia and South Sudan, that totter between crises but show development potential.
There is a counter argument that aid cuts reverse progress. Past official development assistance Past official development assistance (ODA) is credited with reducing mortality by 23 per cent including steep declines in HIV/AIDS, tuberculosis and other communicable and neglected tropical diseases. Various future defunding scenarios postulate 9-22 million additional deaths. However, such studies give insufficient recognition to states’ self-advancement, with much of that coming from broader strategies beyond health. Foreign aid has helped but whether that was decisive to progress is disputable.
What is the future of global health aid? Geopolitical and economic trends show fraying international solidarity, and expenditures shifting towards defence and other priorities. So, ODA will continue drifting downwards from the already reduced $180 billion estimated in 2025. Although the picture is somewhat brightened by the US reversing some earlier cuts through a $9.4 billion package under a new America First Global Health Strategy that supports much of the same priorities as before.
Meanwhile, low-and-middle-income countries must spend $371 billion annually by 2030 to achieve the health goal of the faltering Sustainable Development Goals. Happily, 85 per cent of that is achievable from domestic resources. The political choice of sovereign states not doing so may be deplored but it must be respected and not undermined by kind but fickle donors jumping in.
The remaining annual financing gap of about $55 billion for health development can be feasibly bridged by shrinking global health aid that will continue from donors but expected to flatline around $40 billion. The rest can be made up by private philanthropy and enterprise, diaspora remittances and new concessional loans from multilateral development banks.
In short, panic around global health financing is overblown. Additional funds can be released by reforming bloated global health architecture, correcting overlaps between several large agencies and eliminating activities rendered unnecessary as nations became more capable. The residual work that is best done globally and multilaterally can be streamlined with responsible agencies downsized, merged and shifted to locations cheaper than Geneva and New York.
The WHO is providing an example of such a shift. That has necessitated trimming more than a third of its budgets, programmes and staff. But what is left still amounts to more than $4 billion in 2026-27 for core WHO activities, three quarters of which has already been funded.
Although the political implications of America’s withdrawal from the WHO will emerge over time, the financial fallout is an immediate opportunity to strengthen critical functions that a global health body must discharge – that is, to protect us from disease risks that do not stop at borders.
That is global health in its truest sense as a shared common good achieved through facilitating voluntary cooperation among nations including via agreed international health regulations and treaties. This should have first call on shrinking global aid funds. Along with WHO-led provision of normative technical advice to countries on impartial, scientifically-informed policies and strategies that control disease vectors and maximise health outcomes.
But implementation must be a national, not global, responsibility. Yes, the WHO provides valued “gap filling” services including in emergency contexts like Gaza but with other international and local actors capable of more efficient provision, these could be shifted to them without overall diminution in the global health assistance effort.
However, this bargain requires a more thoughtful donor role. They should resist the temptation of shifting their own job and associated overheads to multilateral health agencies when channelling large funds through the WHO and similar technical bodies not constructed for that purpose. International financial institutions, such as the World Bank and regional development banks, make better funding conduits.
Multilateral agencies should not become tools or sub-contractors of donors. In that context, the bilateralisation of renewed US health aid to 14 low-income African countries may not be so bad, if associated conditionality delivers better results and accountability – not just American control.
At a time of considerable geopolitical turmoil, global health efforts face many risks. However, financing does not have to be one of them if the economies and efficiencies forced by ongoing changes are used as opportunities to help countries stand on their own feet.
That global health development assistance – distinct from emergency humanitarian health support – is becoming less of the lifeline that it was previously should be a cause for celebration not concern.
1 Comment
This is one of the best pieces on the aid cuts I have read and I will post it everywhere to counteract the hysterical pearl clutching of now-unemployed Lords of Poverty.
Dr EJ Brearley, author Aid Inferno