Health systems in poor countries at risk amid cuts in official development assistance: WHO review

Health systems and services may take a massive hit amid suspesions and reductions in official development assistance (ODA) for health, the World Health Organization (WHO) warned April 10, 2025. ODA is government aid that promotes and specifically targets the economic development and welfare of developing countries.

The results emerged from a swift WHO evaluation of the present circumstances, highlighting serious and lasting impacts on global health systems and services. WHO carried out a rapid review with 108 of its country offices from March 7 to April 2, 2025. The global health organisation collected information from a selected group of WHO offices, primarily in lower and lower-middle income countries, territories, and regions receiving health ODA.

It was found that more than half (56 per cent) of responding WHO country offices reported moderate or severe suspension of health ODA. Around 80 per cent of WHO country offices reported at least one health system area disrupted. 

Health system areas most severely affected included humanitarian aid, health emergency preparedness and response, public health surveillance and service provision.

Service areas most severely affected included malaria, neglected tropical diseases, vaccination (clinic-based and outreach), tuberculosis and maternal and child health, sexually transmitted infections, family planning, outbreak detection and reporting. Of particular concern were the  disruptions for potentially life-saving emergency, critical and operative care.

Availability of health products such as medicines, medical devices (diagnostics, vaccines, assistive products) and others was also impacted. Over a third of WHO country offices reported shortage of medicines and health products for key diseases and conditions. 

Most severely affected products were vaccines (clinic-based and outreach), outbreak detection and reporting, non-communicable diseases, sexually transmitted infections and neglected tropical diseases. Shortages of products for potentially lifesaving emergency, critical and operative care were reported in 32 per cent of countries.

Regarding the impact on health and care workers, more than half (63 percent) of WHO country offices indicated job-related consequences for these workers. These effects encompassed job losses, temporary leave, salary suspension, and salary reductions. The next most frequently reported impact on healthcare workers was the interruption of their training.

Mitigation measures were taken for health financing, WHO noted. This included adjusting budget allocations among health programmes; increasing / reallocating funding from other donors; implementing cost cutting measures in health services; increasing domestic public funds for health; strengthened partnerships like private and philanthropic among others.

The magnitude of service disruptions due to current health ODA suspensions and reductions was close to (three-fourths) of the disruption level experienced at the peak of the COVID-19 pandemic, a majority of WHO country offices said.

“These results paint a worrying picture about the impact of the sudden and unplanned cuts to aid on the health of millions of people,” said Tedros Adhanom Ghebreyesus, WHO director-general. “Although these cuts are a shock, they are also driving an accelerated transition away from aid dependency to a more sustainable self-reliance based on domestic resources,” he said.The assessment aimed to determine the immediate assistance required by nations to prevent severe consequences on public health and to aid in tracking the swiftly changing circumstances.

US, the biggest health funder globally, has been tightening the purse strings since the beginning of President Donald Trump's second term. On January 20, 2025, US President Donald Trump signed an executive order imposing a 90-day freeze on foreign development assistance and launching a thorough scrutiny of every existing aid programme.

The Trump administrations action on foreign aid could dramatically shift the global health funding landscape and trigger a health financing crisis in many countries, experts pointed out. 

As many as 26 low- and middle-income countries, with a combined total population of 1.38 billion, are both highly exposed to US global health aid cuts and massively fiscally constrained. Thus, they are the least capable of responding adequately.

Further, in February 2025, the United Kingdom government announced cuts to ODA, dragging it down to the lowest share in 25 years.