A new paradigm for global health financing

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Global health financing has long reflected good intentions but flawed incentives, with donor countries setting priorities and recipient governments learning to follow them. But this decades-old arrangement is now collapsing, giving us a rare opportunity to transform how we finance health nationally, regionally and globally. More countries are already articulating a vision in which health financing would build on national resources, answer to domestic priorities and remain accountable to their own citizens. Health would be seen not as a cost but as an investment that drives growth and builds resilience, and the international system would become more closely aligned with national ambitions. Countries would collaborate where interests converge, with everyone recognizing that stronger national capacities ultimately strengthen collective preparedness and global stability. Those calling for a change do not deny that global health financing has delivered real gains. Development assistance for health grew from $15 billion to $50 billion between 2000 and 2019, and with it came procurement systems, financing mechanisms and collaborative infrastructure, proving what concerted global health cooperation can achieve. The system saved lives, improved health and contributed to major development milestones. But the same arrangements also entrenched dependency and concentrated power, consistently rewarding short-term outputs over long-term capacity. Accountability ran upward to donors, not downward to citizens. Then came the 2025 disruptions to aid flows, multilateral institutions and the assumptions underpinning them. What has followed is an overdue reckoning and, with it, the question of how to develop something better. The answer must include three distinct but mutually reinforcing elements. First, domestic........

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