The State and Future of Health Financing amid Uncertainty in External Funding

Résumé

The global health financing landscape is entering a period of profound uncertainty as external donor priorities shift and overall development assistance declines. For decades, external funding has been central to financing lifesaving interventions across Africa, contributing to major gains such as reductions in under-five mortality and expanded access to HIV treatment through initiatives like PEPFAR. However, recent geopolitical and policy changes—particularly among major donors—combined with a broader downward trend in global health funding, threaten to reverse these hard-won achievements. This funding contraction coincides with a rising burden of public health emergencies across Africa, increasing pressure on already fragile health systems.

Using Zambia as a case in point, this article highlights the risks posed by heavy reliance on external financing and underscores the urgency of rethinking health financing strategies. It argues that declining donor support, while challenging, presents an opportunity to build more resilient and sustainable health systems. The article calls for strengthened multilateral collaboration, prioritisation of high-impact and evidence-informed interventions, and the adoption of innovative domestic financing mechanisms. Together, these actions are essential to safeguard public health security and ensure equitable access to quality healthcare in an increasingly uncertain global environment.