The global health funding crisis – what’s at stake?
We are seeing a health funding crisis unfold worldwide in the wake of abrupt cuts of more than USD 12 billion in US aid. At the same time, global health initiatives like the Global Vaccine Alliance (Gavi) and the Global Fund to Fight AIDS, TB, and Malaria (GFATM) are facing increasing uncertainty about future funding.
Lower and middle-income Southeast Asian countries have long relied on donor funding and donor-funded implementers to deliver essential health services. In Myanmar, for example, Gavi, GFATM and US aid funding represent around 15% of current health expenditure, while in Lao PDR and Cambodia, the same donor allocations represent more than 10% of current health expenditure123.
If urgent action is not taken to mitigate the impacts of these sudden cuts and transform health systems for the future, many lives will be at risk. For example:
- HIV – Without the President’s Emergency Plan for AIDS Relief (PEPFAR), over 20 million people living with HIV will lose access to services and over 4 million people will lose access to treatment commodities4.
- Women’s Health – Without US funding, 48 million women and couples will be left without contraceptive care, resulting in an estimated 17 million unintended pregnancies and 34,000 women and girls dying from pregnancy-related deaths annually5.
- Child health – USG cuts to Gavi and child health projected can result in 2-3 million additional deaths annually and an 89% increase in incidence in vaccine preventable diseases among children in the best-case scenario6.
The opportunity at hand – radical and sustainable health system transformation
This upheaval will not be easy to navigate. However, the situation also provides a rare opportunity for governments to enact radical, sustainable, nationally-led reforms. There is no more urgent time for governments to take stock of the gaps that have been left and ask not how to go back to the way things were, but instead how to do things differently and better. This means grappling with questions like: What and who should we prioritize? How does our health system need to change? How can we do more with less?
These are not easy questions to answer. The Clinton Health Access Initiative (CHAI) provides deep technical assistance to ministries of health around the world. We’ve spent the past three months rapidly reorienting this support through ‘Technical Support Units’ (TSUs) in 9 sub-Saharan countries so far to support Ministries of Health in figuring their answers out. These teams are providing embedded technical support to Ministries on everything from rapid gap assessments and prioritising resources to highest impact areas to helping governments mobilize more funding for health, and catalysing longer-term systems reforms.
We don’t yet know what the future holds. Our support will likely evolve over time, as governments shift from immediate crisis response to longer-term system transformation, and as we learn from these early efforts.
Writing Southeast Asia’s next chapter – what you can do to guarantee a healthier future for all
CHAI is now working to set up Technical Support Units in Southeast Asia, in response to strong government demand and continued foreign aid reductions. However, this first step will not be enough to set health systems in the region on a stable path forward. Donor involvement is very much still needed, but ideally on radically different terms – ones that prioritise country needs, government ownership, and system efficiencies.
CHAI is now calling for those interested in writing Southeast Asia’s next chapter. Here are 3 ways for those interested, to start working towards a healthier future for all:
- Lead by being led: Ask governments and communities what their health needs and system-level priorities are, and invest accordingly – don’t assume you know in advance what is most important.
- Be patient: Invest in system transformation and expect that change will take time – parallel, program-specific systems may deliver quicker results in the short-term, but sustained impact requires ownership by strong local institutions.
- Offer your expertise and platform: Support governments as they explore alternative financing instruments like debt-for-health swaps and use your voice to advocate for new funding.
If you are interested in learning more about CHAI’s work in reducing the burden of disease in low- and middle-income countries within Southeast Asia and globally, reach out to Corina Milic from CHAI at [email protected]
1 WHO Expenditure Database 2022
2 Global Fund Allocations 2023-2025
3 OECD CRS data (ODA in 2022 and ODA in 2023)
4 CHAI analysis and PEPFAR Fact Sheet (Dec 2024)
5 Guttmacher Institute (based on 2024 funding and targets)
6 USAID. March 04, 2025. Info Memo for the USAID Administrator and Deputy Administrator.
