Global health is facing a funding cliff. Major donors announced sharp reductions in official development assistance (ODA) for 2025-27; if these trends persist, ODA for health in 2027 could fall below 2020 levels. In parallel, domestic health spending is flat or falling in many LMICs, and out-of-pocket (OOP) payments remain the primary source of health financing in 30 countries, pushing families into poverty. These realities framed PMNCH’s September 2025 webinar on how to safeguard and sustain investments in women’s, children’s and adolescents’ health (WCAH).
Watch the recording here:
Countdown to 2030 researchers and partners were prominent in the discussion, including Dr Mary Kinney (University of the Western Cape), who presented findings from the Global Health Action (GHA) special series, Global Financing Facility for Women, Children, And Adolescents: Examining national priorities, processes, and investments, collection of papers co-led with Countdown’s Health Policy & Systems data & analysis center.
A call to re-prioritize
Opening the event, PMNCH Executive Director Rajat Khosla highlighted the human stakes: based on recent modeling, the world could see 14 million additional preventable deaths by 2030, including 4.5 million children under five, if today’s abrupt cuts are not reversed. He also underscored a second trend, declining domestic spend and rising OOPs, warning that “a single medical emergency can push the entire family into destitution.”
Dr. Khosla urged budgets to put WCAH at the center, pointing to the Lancet Commission on Investing in Health (CIH 3.0) as fresh evidence that prioritizing maternal, newborn and child health in national plans yields outsized mortality and economic gains.
What countries are doing: Ethiopia’s experience
Dr. Solomon Worku, senior adviser to Ethiopia’s Ministry of Health, described how Ethiopia has positioned reproductive, maternal, newborn, child and adolescent health (RMNCAH) as essential health services, adopted a health-care financing strategy, and introduced costed implementation plans, including a family planning compact that matches donor funds with government allocations. Ethiopia also piloted a social business model to generate private-sector revenue that is reinvested into WCAH, prioritizing marginalized populations. The aim: shifting donors from “programmatic gap-filling” to gap-closing strategies while strengthening cross-ministerial dialogue with Finance and Parliament. Dr. Worku also stressed efficiency and the need to “speak the language of economics and health” in negotiations about public budgets—an approach that created space for RMNCAH even amid ODA cuts.
What this means for health budgets
From the global financing vantage point, Dr. Agnès Soucat of Agence Française de Développement argued that “development aid as we’ve known it is a thing of the past.” The focus now should be mobilizing collective action and financing, local, national, regional, and global, to strengthen domestic systems and avoid aid substituting for national budgets. She also called for investment in the “pipes” of delivery: human resources, institutions, and social protection systems, and for health taxes that both improve health and raise fair revenue.
Dr. Kalipso Chalkidou of the World Health Organization set out the macroeconomic squeeze: pandemic borrowing, rising interest rates, and surging debt-service costs are crowding out domestic health spending, with billions living in countries now paying more in interest than on health or education. The result: over reliance on OOPs and volatile aid for primary care and WCAH in many low-income settings. She urged governments to strengthen fiscal capacity, improve priority-setting and public financial management, and ensure aid supports, not replaces, core government functions.
Evidence to guide investments: the GHA-GFF collection and CIH 3.0
Presenting the GHA special series on the GFF, Dr. Mary Kinney explained that this external review of the Global Financing Facility (GFF) reviewed GFF country documents from 28 countries (24 investment cases and 30 World Bank project appraisal documents). This work resulted in nine academic papers, including four in-depth country case studies (Burkina Faso, Mozambique, Tanzania, Uganda), as well as an editorial and three commentaries. Dr. Kinney highlighted several major findings:
- Visibility and alignment: The GFF has elevated WCAH in national plans, consolidating fragmented RMNCAN+N policies into single investment cases in several contexts.
- Scale of financing: Mapping of the World Bank project documents showed that US$14.5 billion was mobilized through GFF-linked World Bank projects in 2015–22; the GFF grant share was only about 4%, catalyzing government and concessional lending. Many stakeholders were unclear that GFF grants were tied to loans.
- Ownership and politics: Country ownership was uneven; while investment cases were often broad and inclusive, linked World Bank projects addressed fewer priorities and were shaped mainly by the Bank, governments, and GFF teams. Civil society, youth, and private sector actors were sometimes sidelined, though evidence from Tanzania shows engagement improving over time.
- Adaptation and learning: Although early GFF projects lacked measures of impact, quality, and equity, the GFF has invested in stronger data platforms and monitoring systems and has shown a willingness to adapt in response to evidence and feedback.
She concluded that in today’s financing climate, the future trajectory of the GFF is even more critical saying, “Now is the time to accelerate efforts to strengthen country capacity to lead through inclusive platforms and address power imbalances, secure fair long-term financing, and ensure independent accountability.”
Prof. Gavin Yamey of Duke University presented findings from the CIH 3.0, which laid out a pragmatic path to “50 by 50”, halving the probability of premature death by 2050, through focused investments in 15 priority conditions, eight of which are WCAH (including maternal conditions, neonatal disorders, common infectious diseases). In many low and middle income countries (LMICs), premature mortality is concentrated in children under five, making investments in child and maternal health central to progress. Looking ahead, the Commission will examine what it would take to achieve “50 by 50” for under-5 mortality specifically, and is exploring innovative subsidy mechanisms to make essential commodities more affordable.
Practice and the path forward
In the final panel, Luc Laviolette, the head of the GFF Secretariat, emphasized the GFF as a country-led partnership and catalytic financing mechanism. To date, the GFF has mobilized about US$2.6B in donor grants from 17 donors, using grants to incentivize ministers of finance to allocate World Bank IDA and domestic budget toward WCAH priorities; a Joint Financing Framework now lets other donors co-finance World Bank projects, improving alignment and reducing fragmentation. He acknowledged that country leadership is variable, which shapes how inclusive and visible GFF processes are, but stressed that GFF’s 2026–30 strategy will further sharpen this approach, with greater focus on domestic resource mobilization, stronger data systems, and and equity-focused investments, ensuring external funding strengthens national priorities rather than bypassing them.
This emphasis was echoed by Dr Joël Kiendrébéogo from the Ministry of Health in Burkina Faso who underscored that sustainable financing depends on national ownership and alignment with domestic strategies. In Burkina Faso, this has meant prioritizing interventions for WCAH within the national health development plan, using tools like digitized action plans and dynamic resource mapping to improve efficiency and accountability. He argued that external support must reinforce, not replace these national expenditure frameworks, and that long-term impact requires governments to manage resources effectively while ensuring that external partners remain accountable to national priorities.
For Countdown’s community of researchers, advocates, and policymakers, three immediate takeaways stand out:
- Use evidence to defend budgets now. The PMNCH, GFF/GHA series, and CIH 3.0 together provide a compelling, quantified case that WCAH is both vital and high-return. This is the language Finance Ministries and Parliaments need to hear.
- Push for alignment and transparency. Investment cases must translate into funded priorities, with public resource mapping that shows who is financing which commitments, and whether equity, quality, and impact are measured.
- Champion sustainable systems. Countries and partners should protect primary care and health workers, deploy health taxes where sensible, and ensure aid strengthens national systems rather than substitutes for them.
As we head into the next United Nations General Assembly (UNGA80), the message from this webinar is clear: it’s not only “more money for health,” it’s more and better financing for WCAH, anchored in country leadership, aligned behind one plan, measured for equity and impact, and protected from the shocks that have derailed progress. The costs of inaction are measured in lives; the solutions are already on the table.