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Commentary on “An IDA Health Window: The Future of Global Health Financing.”

Pete Baker and I independently arrived at a similar conclusion about one of the most important shifts needed in the future of global health financing: a much greater role for the World Bank in financing health at country level. In my September 2025 article, Rethinking the Global Health Financing Architecture: Principles and a Proposed Model , I proposed that the World Bank, alongside an expanded Global Financing Facility (GFF), should become a principal platform for financing holistic health development. I argued that the Bank was particularly well suited to this role because of its capacity to support country-led priority-setting, use national public financial management systems, provide concessional financing for health-system strengthening, operate through established country platforms, and finance health in a broader, integrated and multisectoral manner rather than through disease-specific silos. Pete subsequently developed a closely related proposition through his work at the Cent...
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Financing Africa’s Health Security and Sovereignty requires Governments and their citizens to work together

Africa is the biggest financier of its own health care — but in the most painful way possible. In 2022, 77% of Africa’s health expenditure was domestic and 23% was external. Out-of-pocket ( OOP) spending accounted for about 64 % of domestic health expenditure. This creates a troubling paradox. On the one hand, Africa is less dependent on aid and is funding more of its health needs domestically. On the other, this “self-financing” is being carried largely by households at the point of care, exposing millions of families to catastrophic health expenditures and pushing many into poverty each year. Financing health this way is neither equitable nor sustainable, and it undermines the very notion of health security and sovereignty. The question, therefore, is not whether Africa has the potential to finance its health. The evidence shows that it does. The real question is whether Africa can harness this potential without households continuing to bear the brunt of the cost of illness. Doing...
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Rethinking the Global Health Financing Architecture: Principles and a Proposed Model

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Author: Gerald Manthalu   Introduction The Lusaka Agenda has been gaining momentum, driven by interested stakeholders and accelerated by the recent cuts in foreign aid. Notable progress  includes: 1) the joint work of the Global Health Initiatives (GHIs) and pathfinder countries through the joint committee working group (JCWG) of Gavi, the Global Fund and the Global Financing Facility (GFF) and countries (Malawi, Mozambique, Guinea, Ethiopia and Chad) and similar work by the Africa Centres for Disease Control and Prevention (AfricaCDC) & the World Health Organization (WHO) AFRO with countries (Central African Republic, the Democratic Republic of Congo, Ethiopia, Ghana, Malawi, Mozambique, Senegal, and South Sudan) focussing on country specific reforms across the five strategic shifts of the Lusaka Agenda; 2)  country led aid alignment efforts such as  Sector Wide Approach (SWAp) approaches, One plan, One budget, and One monitoring and evaluation (M&E) mec...
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My perspective on the impact of the aid freeze on the health sector in a low-income setting

  My perspective on the impact of the aid freeze on the health sector in a low - income setting The recent aid freeze by the American Government has caus ed chaos, panic , and uncertainty across the world . M illions of beneficiaries, hundreds of recipient governments , and thousands of non-governmental organizations ( NGOs ) and civil society organizations ( CSOs ) have experienc ed loss of funding and support . Understanding the extent of th ose loss es and the relative impact s o n these different recipient groups is crucial in order to call for the right action. Having heard many policy experts, government leaders, and advocates express concern for beneficiaries in poor countries, I provide my perspective of what the loss for beneficiaries and recipient governments may have been particularly in the health sector. From the beneficiary' s perspective, the primary impact of aid cuts would be the reduction in donor-funded direct service provision and the ne...
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