Despite significant progress against individual diseases like polio, malaria and HIV/AIDS, and increasing coverage of specific interventions like vaccines, more than 4.5 billion people still lack access to basic health services, with progress stagnating since 2015. One in four people globally face financial hardship due to health costs.
The Covid-19 pandemic exposed the fragility of the global health system and of global solidarity. The World Health Organization (WHO) estimated 14.83 million excess deaths globally in 2020-2021 alone. The pandemic led to cumulative economic losses of US$13.8 trillion, according to the International Monetary Fund. And it revealed the power imbalances that underpin global health, illustrated by stark disparities across research, development and manufacturing for tests, treatments and vaccines, which fostered lasting distrust across nations.
Financing projections are concerning too. Of 177 countries around the world, domestic health finance over the coming years is expected to contract in 41 and stagnate in 69 low- and middle-income countries compared to pre-pandemic levels.
There’s also less money to spend on health due to slow growth. Pressures from rising energy and food costs, climate damage and escalating debts services have added to this. After a sustained spotlight on health during the pandemic, many countries have turned to competing priorities.
And while many health ministers are under pressure to cut spending, demands increase. The need for strong and resilient health systems that can adapt to emerging threats such as climate change and conflict, while also maintaining coverage for existing health needs, is growing.
Strengthening these health systems requires every dollar to be used as effectively, efficiently and equitably as possible. But we continue to see highly fragmented international health financing.
Many parallel funding streams exist that continue to focus on single diseases, rather than creating the most effective system. This creates high transaction costs, reduces overall efficiency and places unsustainable burdens on countries. It poses challenges to integrated service delivery and country ownership. Money is too often channeled towards priorities based on donor interests rather than country needs.
Together this means that global health funding isn’t as effective, efficient and equitable as it should be.
In response, marking the culmination of a 14-month multi-stakeholder process, the Lusaka Agenda proposed coordinated action to speed up progress towards domestically-financed health systems and universal health coverage that leaves no one behind.
Since its launch, the Lusaka Agenda has gained increasing traction at country, regional and global levels, leading to positive shifts in alignment and coordination of global health funds that could translate to the much-needed enhanced efficiency and impact in countries.
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