Senior leaders set out a vison for future financing of health and global health functions
In "A New Paradigm for Global Health Financing," published in Project Syndicate, Donald Kaberuka, Muhammad Ali Pate, Budi Gunadi Sadikin, Erna Solberg, Mauricio Cárdenas and Gunilla Carlsson set out what the future of health financing looks like and how to get there.
The new model is already taking shape, built on domestic resources, answerable to domestic priorities, and accountable to citizens. It centres on health not as a cost, but as an investment that drives growth and builds resilience, with international cooperation aligned behind national ambition rather than substituting for it.
In this new article, the authors suggest three mutually reinforcing shifts will shape the future.
Domestic financing as the foundation, not a footnote. Every country's starting point differs, but the direction is shared: tax reform, budget prioritization, good governance, and public trust that spending delivers. None of it will be achieved in isolation. Expanding fiscal space and rebuilding systems requires growth, which means unlocking private investment, using blended finance and debt-for-health swaps, and easing the debt burdens that in some countries still absorb more than governments spend on health.
Development assistance as a transition, not a permanent fixture. ODA is projected at roughly $150 billion in 2026 , back to 2015 levels but still an important part of the picture. What changes is how it's used: concentrated where it is genuinely irreplaceable – fragile settings, the lowest-income countries, humanitarian surge capacity – and otherwise strategic, force-multiplying, and time-bound, designed to accelerate its own exit. For many funders, that means ceding power to regional and national institutions.
Global public goods, financed with a new fit-for-purpose model. ODA – politically contingent, fiscally unreliable – was never built to finance functions whose value is universal. It's time for a model that broadens the contribution base, distributes according to capacity, and moves decisively away from governance where the ability to pay confers the power to decide.