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 Center for Global Development (CGD), first in Is an IDA Health Window the Global Health Financing Solution? and then, in greater detail, in An IDA Health Window: The Future of Global Health Financing. His proposal takes the idea further by envisaging an IDA Health Window as a principal multilateral financing platform for country health systems, drawing on precisely these institutional strengths of the World Bank.

I like this convergence because, in a sense, it validates our respective perspectives: two independently developed lines of thinking have arrived at a similar direction of travel. More importantly, I believe this points to a reconfiguration of the global health financing architecture that is both fundamental and feasible—fundamental because it addresses the structural fragmentation at the heart of the current system, and feasible and pragmatic because it builds on an institution, financing instruments and country platforms that already exist. Rather than designing an entirely new architecture, the opportunity is to repurpose and expand the role of the World Bank in health, while progressively bringing greater coherence to the functions that remain across the global health financing ecosystem. I am increasingly convinced that this combination of ambition and pragmatism may offer one of the most credible pathways towards a global health financing architecture fit for the future.

I offered the a commentary on Pete’s latest contribution, An IDA Health Window: The Future of Global Health Financing, as a way of advancing this conversation and reflecting on how the IDA Health Window could be taken further.

Here is my commentary:

Pete Baker’s proposal for an IDA Health Window is arguably the most pragmatic and feasible pathway for restructuring the global health financing architecture, as I had argued before here (https://batumeyo.blogspot.com/2025/09/rethink-of-global-health-financing-architecture.html). The strength of this proposal is that it builds on existing institutions and, if implemented as proposed, allows the system to transition without or with minimal disruption.

Redirecting GHI health-systems strengthening grants to the IDA Health Window is an important first step, but it does not fully resolve fragmentation. The funds GHIs provide to countries are mostly spent on disease-specific health systems strengthening, which still poses a fragmentation problem to countries. GFF may be an exception because its broad maternal, newborn, child and adolescent health mandate effectively requires mainstream health-system strengthening and, hence, financing. Regardless, the logical progression should therefore be to eventually move all country-level GHI grant financing into the IDA Health Window, perhaps staggered over the 2028 and 2031 IDA Health Windows.

The consequence of this step is that what remains of GHI funds would be mostly the market-shaping and pooled procurement function, which is duplicated among them, with each focusing on its commodities of interest. These parallel arrangements should ultimately converge into a comprehensive, disease-agnostic procurement and market-shaping architecture devolved to the regions. In Africa, I refer to the African Pooled Procurement mechanism championed by Africa CDC as an example.

With respect to the suggested complementary reforms, I agree to establishing country coordination platforms. However, these are already in place in many countries; donor behaviour has been the constraint to their effectiveness, particularly in heavily donor-dependent countries. I therefore suggest that the author considers that GHA reform—in this case, the IDA Health Window—is a prerequisite for effective country coordination. Many of the same donors fund GHIs and the World Bank and provide bilateral funding to countries. Unless their behaviour and incentives change, effective country coordination will remain elusive.

I also support the proposed evolution of the Pandemic Fund to support the Health Commons to address international externalities. However, as with the rest of the GHIs, the Pandemic Fund should cede its country-level grant-giving function to the IDA Health Window because pandemic prevention, preparedness and response is fundamentally a health-systems function and, through One Health, extends into other sectors. This is precisely the kind of multisectoral financing for which IDA is better suited. Effectively, IDA, complemented by the IDA Health Window, can provide the financing platform for PPPR at country level, provided countries are able to prioritize and coordinate investments effectively across sectors.