An action agenda on global health financing
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Article summary
Notes from the CSPF session titled An action agenda on global health financing on 16 October 2025. This panel offered a discussion among diverse stakeholders about priorities for global health financing moving forward. It follows an April meeting when civil society groups held a global consultation on expanding global health financing through ODA, domestic resources, international financing institutions and the private sector. The consultation led to a report.
Moderator
- Chris Collins, President & CEO, Friends of the Global Fight
Panellists
- Ndidi Okonkwo Nwuneli, President & CEO, ONE Campaign
- Rosemary Mburu, Executive Director, WACI Health
- Agnes Couffinhal, Global Program Lead for Health Financing, WBG
- Bonanza Taihitu, Senior Advisor to the Minister of Health, Indonesia Ministry of Health
A video recording from this session can be found here.
Chris: We need additionality, new financing in the global health space, and we need a ‘do no harm’ approach to investments. There are proposals such as debt for health swaps, health insurance schemes, blended finance, debt relief, de-risking of private sector investment, more use of Special Drawing Rights (SDRs). Global health people and finance people don’t talk enough.
We need information between stakeholders, and more investment in health overall. Policy makers have discussed transition healthcare focus to national leaders. I want to understand what our panelists see as two or three things that should happen in the next year. How do we scale financing that is working well?
Ndidi: We need to see improvement in the quality of healthcare, it’s not just about increased financing. We need eco-systems approaches: access to basic healthcare as a fundamental right. The health sector must be seen as a driver of economic growth, a creator of jobs. Finance and health ministers don’t sit together and often health ministers feel like they’re coming with a begging bowl. Commitment to domestic resource mobilisation, effectiveness in health spending to ensure every dollar goes where it’s supposed to go, reducing debt distress. One Campaign just issued a letter on this, signed by Stiglitz. We should demand our financial institutions on a local and regional level also invest in health. We need to focus on diaspora communities and their spending. The World Bank has done good work on remittances, but there’s interest in pushing that along on a private sector solution and a government-enabling environment. We need to hold governments accountable on this values-based social contract.
Rosemary: I work with communities and CSOs in the African region. As we look at these proposals, it is a critical time being in an environment where we see governments struggling to balance things. They are experiencing debt distress. It’s also at a time where we haven’t seen as many scientific breakthroughs as we have in the last decade. The field is making progress, but we are struggling in terms of scaling up financing. The challenge for low- and middle-income countries is the challenge of equity, when do you get access to health products? Are we the last in the queue? It is important to look at financing when we are at a critical juncture. I would like to see us thinking about aligning financing with national and regional health financing frameworks. Countries have made progress in terms of health financing reforms. We have the regional framework, the African blueprint, on investing in health – the ALM framework. It’s not just about more money, but also some metrics to measure more things. It looks at whether money is additional – are we seeing impact and better outcomes due to investment? it also looks at governance and who makes decisions about resources, and tracking equity.
Bonanza: We are building long term security and resilience. We have a ‘transformation of health’ agenda. The plan aligns our national health priorities with broader development goals, and addresses funding gaps. In Indonesia, we identified a funding gap of $4.2 billion. We’re taking an approach of public and private investment, as well as ODA. We are facing the issue of tuberculosis. As we see the decline of global TB funding, we have to act strategically. We identified actions: enhancing domestic financing, strengthening international support and partnership, and leveraging innovative financing such as PPPs. We look to the WBG for loan support and engagement, and private sector engagement. Strong economies don’t mean anything unless care is also provided to everyone.
Agnes: We’ve been playing closer attention to monitoring health spending in real time. We’re about to release our next report, these are some findings. LICs, in order to provide basic healthcare services, need around $60 per capita. As of 2024, they had $17. Half of this comes from ODA. By 2030, given ODA declines, this number will likely drop to $16 dollars. This is bleak. What do we need? Economic growth, for domestic resource mobilisation to improve. A recent IMF report: tax system reforms could allow a good increase in tax per GDP on average. Therefore it’s about improving the ability to tax. It will help contain the amount of spending that is required. Tobacco taxes represent a fiscal gap of 1.1% of GDP. The political choice to increase the share of spending. Looking at reality, it’s not happening. The share of health in government spending has stagnated. Yet one in three LMICs have the fiscal space to increase the priority of health spending.
Didi: African governments must come together. There are new players and initiatives. I am a big believer in saying we need to work together rather than making new initiatives. In Senegal, there is a crisis due to debt. Debt for health swaps is a big focus, then a big diaspora – cost of remittances is high and 14% goes to health. How do we unlock that? We need accountability on all sides.
Chris: What’s the next step in alignment?
Rosemary: Agreeing with Didi, it has to be country specific in terms of models that work. If the players can be guided by principles…we want to see impact. If partners can make sure principles around additionality, impact, financing being protected.
Agnes: We have designed mechanisms to support governments. They are to support and leverage public financing. Budgets are aligned with government priorities. It’s about making fiscal space and combining it with additional money in the government programmes. Fragmentation creates inefficiency, so it’s about pooling resources at the national level rather than creating new schemes.
Questions and answers
Unknown: it’s overwhelming coming from advocacy to understanding the financing landscape. I would like to hear from panelists recognising there’s no one size fits all solution but where should we as advocates focus our energy? It’s a fraught space when politics get involved: planned global gag rule, US involvement. How do we work together when there’s a divisive political landscape setting us apart?
Ndidi: Unified voice is so important at this time. We need to be focused on the most vulnerable. We have a common enemy: disease, poverty, debt. Let’s reaffirm our values. We need candid closed-door messages. It will take merging, it will take commitment to working ourselves out of a job. This has to come to the country level. Donors need to stop ramming down our throats what we prioritise, we at the country level should decide.
Linda, from Oxfam: How are you embedding accountability in financing methods? We work a lot on safeguards in blended healthcare financing. How can you ensure profit maximisation doesn’t impact people?
Unknown: What is the Bank’s role in this ‘new money’ aspect?
Bonzana: When we designed the proposed MDB loan, the proposals touch on principles of equity that means we want the populations of Indonesia to have good access to healthcare. Zooming into village level, then moving to city level, then up to central level.
Agnes: Spending decreased after covid, we’ve been trying to fight internally at the WBG. The change needs to start with ourselves. It’s for us in the health sector to advocate for more IDA funding to go to health, it’s about making the case that health is an economic investment. We are discussing with some foundations and we will make an announcement about financing, hoping for others to pitch in and finance.
