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Pathways to progress: a multi-level approach to strengthening health systems

Samuels, F., Amaya, A.B., Rodríguez Pose, R. and Balabanova, D. Overseas Development Institute (2014) C1

Findings on maternal and child health in Nepal, Mozambique and Rwanda, and neglected tropical diseases in Cambodia and Sierra Leone | This report synthesises findings from five country case studies from the ... more

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Africa’s Health Financing in a New Era

Africa Centres for Disease Control and Prevention (Africa CDC) (2025) CC

Africa’s health sector is facing an unprecedented financing crisis, driven by a sharp decline of 70% in Official Development Assistance (ODA) from 2021 to 2025 and deep-rooted structural vulnerabilities. This collapse is placing immense pressure o ... n Africa’s already fragile health systems as ODA is seen as the backbone of critical health programs: pandemic preparedness, maternal and child health services, disease control programs are all at risk, threatening Sustainable Development Goal 3 and Universal Health Coverage. Compounding this is Africa’s spiraling debt, with countries expected to service USD 81 billion by 2025—surpassing anticipated external financing inflows—further eroding fiscal space for health investments. Level of domestic resources is low. TThe Abuja Declaration of 2001, a pivotal commitment made by African Union (AU) member states, aimed to reverse this trend by pledging to allocate at least 15% of national budgets to the health sector. However, more than two decades later, only three countries—Rwanda, Botswana, and Cabo Verde—have consistently met or exceeded this target (WHO, 2023). In contrast, over 30 AU member states remain well below the 10% benchmark, with some allocating as little as 5–7% of their national budgets to health. In addition, only 16 (29%) of African countries currently have updated versions of National Health Development Plan (NHDP) supported by a National Health Financing Plan (NHFP). These two documents play a critical role in driving internal resource mobilisation. At the same time, public health emergencies are surging, rising 41%—from 152 in 2022 to 213 in 2024—exposing severe under-resourcing of health infrastructure and workforce. Recurring outbreaks (Mpox, Ebola, cholera, measles, Marburg…) alongside effects of climate change and humanitarian crises in Eastern DRC, the Sahel, and Sudan, are overwhelming systems stretched by chronic underfunding. The situation is worsened by Africa’s heavy dependency with over 90% of vaccines, medicines, and diagnostics being externally sourced—leaving countries vulnerable to global supply chain shocks. Health worker shortages persist, with only 2.3 professionals per 1,000 people (below the WHO’s recommended 4.45), and fewer than 30% of systems are digitized, undermining disease surveillance and early warning. Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face 2 to 4 million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within. Furthermore, 39 million more Africans could be pushed into poverty by 2030 due to intertwined health and economic shocks. This is not just a sectoral crisis—it is an existential threat to Africa’s political, social, and economic resilience, and global stability. In response, African leaders, under Africa CDC’s stewardship, are advancing a comprehensive three-pillar strategy centered on domestic resource mobilization, innovative financing, and blended finance. more

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National spending on health by source for 184 countries between 2013 and 2040

Dieleman, J.; Templin, T.; Sadat, N. et al. (2016) CC

A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these change ... s vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. Methods We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. Findings Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending. Interpretation Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action. Funding Bill & Melinda Gates Foundation. more

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Acute Chagas Disease: New Global Challenges for an Old Neglected Disease

Andrade, D.; Gollob, K.; Dutra, W. PLoS Neglected Tropical diseases (2015) CC

Abstract: Chagas disease is caused by infection with the protozoan Trypanosoma cruzi, and although over 100 years have passed since the discovery of Chagas disease, it still presents an increasing problem for global public ... more

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Toward Harmonization: Community Health Policy and Program Trends

USAID, JSI Research & Training Institute, fhi360 (2020) CC

The Community Health Systems (CHS) Catalog is a resource that provides information on community health program workers, and interventions for the 25 countries deemed priority by USAID’s Of of Pop ... more

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Understanding China’s shifting priorities and priority-setting processes in development assistance for health

Guo B.; Fan V.; Strange A. et al. Health Policy and Planning (2024) CC

Over the past two decades, China has become a distinctive and increasingly important donor of development assistance for health (DAH). However, little is known about what factors influence China’s priority-setting for DAH. In this study, we provid ... more

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Translating Community Research Into Global Policy Reform For National Action

S. Dilmitis; A. Welbourn; F. Anam; et al. ICW Latina; ICW WA; UNAIDS; et al. (2018) C2

Translating Community Research Into Global Policy Reform For National Action: A Checklist For Community Engagement To Implement The WHO Consolidated Guideline On The Sexual And Reproductive Health A ... more

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The 2022 Europe report of the Lancet Countdown on health and climate change: towards a climate resilient future
recommended

Daalen, K.R. van; M. Romanello, J. Rocklöv, et al. The Lancet (2022) C1

Lancet Public Health 2022 Published Online October 25, 2022 https://doi.org/10.1016/S2468-2667(22)00197-9 Executive summary In the past few decades, major public health advances have happened in E ... more

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AMR Fact Sheet Health Professionals

ReAct, Ecumenical Pharmaceutical Network (2019) C2

Antimicrobial Resistance (AMR) occurs when organisms that cause disease are no longer susceptible/responsive to antimicrobial agents that previously were effective in combating them. AMR is a global problem with particularly dire consequences for ... more

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Clinician mental health, nursing shortages and the COVID-19 pandemic: Crises within crises

Turale S., Nantsupawat A. (2021) CC

Around the world, nurses are working under enormous pressure providing care to sick and dying patients during the pandemic. Many are faced with increased stress, and other negative effects on their mental health. They are also faced with the possibi ... more

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2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas

Campbell, N.R.C.; Burnens, M.P.; Whelton, P.K. et al. The Lancet Regional Health - Americas (2022) CC

Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World ... more

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Panorama Global Humanitario 2021 (Abridged Version)

UN Office for the Coordination of Humanitarian Affairs (OCHA) (2020) C1

COVID-19 has triggered the deepest global recession since the 1930s. Extreme poverty has risen for the first time in 22 years, and unemployment has increased dramatically. Women and young people aged 15 – 29 working in the informal sector are bein ... more

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Promoting Cardiovascular Health in the Developing World

Institute of Medicine (2010) CC

Cardiovascular disease (CVD) is often thought to be a problem of wealthy, industrialized nations. The term “cardiovascular disease” is used throughout the report to refer to cardiac disease, vascular diseases of the brain and kidney, and peripheral vascular disease. The report’s main focus is ... more

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CDC Global Immunization Strategic Framework 2021–2030

Centers for Disease Control and Prevention CDC (2021) C_CDC

A World of Healthy People Who are Protected from Vaccine-Preventable Disease, Disability, and Death. Progress toward that vision is structured around five capacity building goals, and implemented using four guiding principles, to achieve health impa ... more

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Alcohol consumption and sustainable development: fact sheet on Sustainable Development Goals (‎SDGs)‎: health targets

World Health Organization WHO (2020) C_WHO

The Sustainable Development Goals (‎SDGs)‎ aim to transform our world. They are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and prosperity. It is critical that no one is le ... more

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World Bank Group Approach and Action Plan for Climate Change and Health

World Bank Group (2017) C1

Climate change (CC) impacts on health outcomes, both direct and indirect, are sufficient to jeopardize achieving the World Bank Group’s visions and agendas in poverty reduction, population resilience, and ... more

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An Advocate’s Guide: Strategic Indicators for Universal Access to Sexual and Reproductive Health and Rights
recommended

TK Sundari Ravindran Asian-Pacific Resource & Research C0entre for Women (ARROW) (2015) C1

This guide was prepared to enable advocates to use data when advocating for universal access to SRHR at the national, regional and global levels. It is a direct outcome of the Strategic SRHR Indicators workshop held in Kuala Lumpur, Malaysia on ... more

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COVID-19 and Human Development: Exploring global preparedness and vulnerability

reliefweb (2020) C2

The United Nations Development Programme (UNDP) today released two new data dashboards that highlight the huge disparities in countries’ abilities to cope with and recover from the COVID-19 crisis. The pandemic is more than a global ... more

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Climate-Smart Healthcare : Low-Carbon and Resilience Strategies for the Health Sector

The World Bank Group (2017) CC

Climate change is damaging human health now and is projected to have a greater impact in the future. Low- and middle-income countries are seeing the worst effects as they are most vulnerable to climate shifts and least able to adapt given weak ... more

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When the Drugs Don’t Work – Antibiotic Resistance as a Global Development Problem

The Dag Hammarskjöld Foundation and ReAct (2019) C2

This paper focuses on the Sustainable Development Goals related to poverty, economic growth, inequality, health, food production and the environment. It presents concrete examples of the underlying and complex aspects of antibiotic resistance and it ... more

The 2022 Europe report of the Lancet Countdown on health and climate change: towards a climate resilient future recommended

An Advocate’s Guide: Strategic Indicators for Universal Access to Sexual and Reproductive Health and Rights recommended

The 2022 Europe report of the Lancet Countdown on health and climate change: towards a climate resilient future
recommended

An Advocate’s Guide: Strategic Indicators for Universal Access to Sexual and Reproductive Health and Rights
recommended