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The Future of Global Health Financing: Insight from CSIS's The CommonHealth Live

On August 6, 2025, the Civitas One team attended The CommonHealth Live!, an event hosted by the Center for Strategic and International Studies (CSIS) under its Bipartisan Alliance for Global Health Security. The program brought together global health leaders, researchers, and policymakers to examine the current state of international health financing and explore strategies for navigating a rapidly shifting funding landscape.


The discussion was moderated by Dr. Stephanie Psaki, Senior Adviser at the CSIS Global Health Policy Center, and Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME). Together, they addressed recent trends in health aid, the implications of reduced donor engagement, and the critical importance of efficiency in a period of fiscal constraint.


Dr. Christopher Murray speaking at a Global Burden of Disease conference. Image via UW Medicine Newsroom
Dr. Christopher Murray speaking at a Global Burden of Disease conference. Image via UW Medicine Newsroom

Decline in Health Financing 


The Financing Global Health 2025 report from IHME paints a stark picture. Development Assistance for Health (DAH) rose to a pandemic-era peak of approximately 80 billion USD as governments mobilized resources to address COVID-19. However, between 2024 and 2025, DAH fell by 22 percent. Dr. Murray projects that it will stabilize at around 36 billion USD annually. This level is significantly lower than the funding available in the 2010s, raising concerns about the sustainability of critical programs.


The reduction in aid comes at a time when global health systems are still addressing the residual impacts of the pandemic. Many countries have yet to recover the health workforce capacity and infrastructure lost or strained during COVID-19. With fewer resources available, programs in disease prevention, maternal and child health, and infectious disease treatment risk being scaled back or discontinued.


International Implications 


The contraction in funding is not limited to the United States. Major donors including the United Kingdom, France, and Germany have implemented cuts of up to 40 percent in their DAH budgets. Dr. Murray described this as a widespread "contraction of commitment" among high-income countries that have historically supported health programs in low and middle-income nations.

This trend has serious consequences for countries where external aid makes up a significant portion of total health expenditure. In Mozambique, Zambia, Malawi, and Somalia, foreign aid covers more than 15 percent of all health spending. A sudden decline in support threatens the availability of basic services such as vaccinations, HIV treatment, and malaria prevention.


Dr. Psaki raised the key question of who will fill the funding gap in the short and long term. Dr. Murray explained that some governments may turn to compensatory spending, which involves increasing domestic expenditure to offset the loss of aid. While this strategy may be viable in countries with stronger economies, such as Nigeria, it is unlikely to work in extremely low-income countries that already face budgetary constraints.


Emerging donors could provide some relief. China has been the most notable new contributor, funding targeted initiatives and infrastructure projects. However, Dr. Murray expressed skepticism about the ability of these donors to fully replace the commitments of long-standing Western partners. Emerging donor contributions are often short-term, issue-specific, and insufficient to meet the scale of the current shortfall.


The Efficiency Crisis 


Dr. Murray shared an unspoken truth commonly circulated in the global health community: the gaps in efficiency differ greatly between country to country. Equally resourced countries deliver more care for every dollar spent. In certain services, highlighting family planning, HIV treatments, and vaccinations, costs can vary significantly across low income countries with similar infrastructures. 

With global health financing diminishing sharply, efficiency is no longer a technical matter for specialists. Rather, it has become a political necessity. Focusing on efficiency forces difficult trade-offs. Donors concentrate resources where the data show they have the largest impact. However, is this at the expense of cutting funding to countries with historical ties or political importance? Dr.Murray argues a consensus needs to be reached. 


Innovation at a Crossroads 


The cuts come at an especially frustrating time for the field, as the innovation pipeline is strong. Advancements to preventative and treatment medications are rapidly rising. However, actually deploying these breakthroughs often require more money upfront. Manufacturing, training, and distribution costs are high. In a strained funding environment, not only implementation is halted, but ethical dilemmas rise. Should the Global Fund concentrate resources on the poorest nations to create fiscal space? Or should it maintain a broad portfolio, even if this slows innovation adoption? 


Talk of technological innovation draws attention towards artificial intelligence. AI has the potential to be a transformative factor for global health care. Bringing both quality and efficiency to the table, AI could be used to free up labor intensive resources, such as diagnostic screenings and data analysis. However, AI is only as effective as the data it is trained on and without a sustained investment in these systems, there is no certainty AI will be a reliable tool. 


Key Takeaways


Dr. Murray’s warning was straightforward: when funding is abundant, inefficiency may go unnoticed. When funding is scarce, inefficiency becomes a central challenge that must be addressed. Cost variations between programs are not minor technical issues but reflections of political and ethical choices. While the current fiscal climate brings significant constraints, it also presents an opportunity to reassess global health priorities and systems. There is potential to redesign funding structures, improve efficiency, and strengthen health security as a shared international responsibility.


The decisions made during this budget cycle will shape the trajectory of global health for years to come. Leaders, donors, and institutions must decide whether to maintain the status quo or take the difficult steps required to build a more effective, resilient, and equitable global health system.



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