From dependency to self-reliance: A new chapter in global health
In the aftermath of World War Two, the countries of the world came together in the recognition that the only alternative to global conflict was global cooperation. In 1945 they formed the United Nations and, in 1948, the World Health Organization. The WHO Constitution became the first instrument of international law to affirm that the highest attainable standard of health is a fundamental right of all people, without distinction. But it went further, saying that health is also fundamental to the attainment of peace and security. That conviction remains as relevant today as it was 77 years ago.
In these divided and divisive times, health is one of the few areas in which countries that are otherwise political and economic rivals can work together to build a common approach to common threats.
Exhibit A is the Pandemic Agreement, which WHO member states adopted at the World Health Assembly in May this year. After three and a half years of negotiation, the countries of the world showed that it is still possible for countries to work together, and to find common ground for a common purpose. The adoption of the Pandemic Agreement was truly historic. It showed that multilateralism is alive and well.
Health as common ground in a divided world
The agreement came at an especially significant time. Around the world, dramatic reductions in aid are having severe impacts on health services in many developing countries, as billions of dollars in aid disappeared virtually overnight. We see disruptions affecting millions of people who are missing out on life-saving services and medicines, including vaccines; health facilities are being forced to close; and supply chains and information systems are breaking down.
Although this is an acute crisis now, it is a crisis long in the making. Many health systems around the world have long suffered from chronic underinvestment. As a result, out-of-pocket spending is the main source of health financing in many low-income countries and communities. At the same time, debt servicing costs restrict countries’ ability to invest in health. In fact, many countries spend more on debt interest payments than on education and health combined.
These conditions have contributed to a system of heavy aid dependency. Much aid does not flow through treasuries, but through parallel systems set up by donors. This makes forward planning and budgeting difficult or impossible. This has created a deep vulnerability that has now been exposed.
Turning crisis into a catalyst for change
At the same time, in every crisis there is an opportunity. Many leaders from developing countries have told me that they also see this current crisis as a chance to leave behind the era of aid dependency and transition towards sustainable self-reliance.
The WHO is supporting countries to make that transition by identifying tools to improve efficiency and generate new revenues and benefits for health from domestic sources, including through pooled procurement, public health insurance, and ‘health taxes’ on tobacco, alcohol and sugary drinks. Since 2022, at least 116 countries have introduced or increased such taxes, and in July this year, the WHO launched the ‘3 by 35’ initiative, which aims to support countries to increase the real prices of these three health-harming products by at least 50% by 2035.
Let me close by highlighting three major priorities going forward.
First, the mindset of aid dependency has to stop. Now is the time for leadership from governments to shake off the yoke of aid dependency and chart the path to self-reliance by mobilising domestic resources to support primary health care as the foundation of universal health coverage.
Second, we need leadership from lenders, in the form of concessional lending, at fair terms.
And third, we need leadership from generous donors, to help build capacity for health programmes so countries can run them themselves, rather than setting up parallel systems of salaries and operating costs. Self-reliance means national systems, national budgets and national priorities, in alignment with the Lusaka Agenda and the principles of ‘one plan, one budget, one report’.
The WHO stands ready to support all countries, and to work with all partners to turn this crisis into an opportunity. The choices we make now will shape the future of global health financing. Ultimately, health is not a cost to be contained. It is an investment to be nurtured – an investment in people, stability and economic growth, so that we can achieve Health for All and build a healthier, safer and fairer world.
