This model has delivered major gains. Mortality rates among children under five in low-income countries, for example, fell by 19 percent between 2011 and 2019, from 1,837 deaths per 100,000 children to 1,485. ODA-funded institutions also underpinned collective responses to global crises, including the COVID-19 pandemic. But dependence on a small number of provider countries has become a structural vulnerability as shifts in their political and fiscal priorities reverberate across the entire system.

As a result, global health financing is at a turning point. In 2024, total ODA fell by more than US$15 billion. Funding is estimated to have fallen by another 9-17 percent in 2025, and cuts are expected to continue through 2027, placing $40-55 billion in development assistance at risk. Bilateral ODA for health is shrinking even faster, falling by 19-33 percent between 2023 and 2025 to below pre-pandemic levels.

The consequences for multilateral health institutions and the world’s poorest countries will be severe. Of the 34 members of the Organisation for Economic Development’s (OECD) Development Assistance Committee (DAC), 22 cut their aid budgets in 2024.

Agencies are already being forced to adjust. The Joint United Nations Programme on HIV/AIDS (UNAIDS) expects to halve its staff and scale back its operations from 75 countries to 36 following a sharp reduction in United States funding, while the World Health Organization has proposed a 14 percent cut to its core budget for 2026-27.

The impact will be felt most strongly in the world’s least developed countries. Bilateral ODA to the world’s least developed countries (LDCs) fell by an estimated 13-25 percent in 2025, following a 3 percent decline in 2024. In Sub-Saharan Africa, the projected cuts are even steeper, at 16-28 percent, potentially resulting in the loss of around one-quarter of total ODA in a single year. In the ten countries with the highest levels of extreme poverty, the top five donors provide 85 percent of ODA, with the US and the World Bank ranking among the top two in eight of them.

The decline in ODA reflects a structural shift rather than a cyclical shock. Between 2011 and 2024, health-related development assistance fell by roughly 24 percent as a share of global gross domestic product, despite a brief pandemic-driven surge. Over the same period, the rationale for health aid shifted away from solidarity and human development toward economic interests, national security and pandemic preparedness.