African countries at the World Health Assembly called for increased support to health systems across the continent following major cuts to all World Health Organization (WHO) regional office budgets amid a financial crisis triggered by the US withdrawal from the agency and falling global health spending.

The African region suffered the largest total cut, losing over $150 million in funds for WHO operations across the continent.

“It is imperative that the WHO provides focused support to strengthen the capacities and the capabilities in countries, including through enhanced local production technology transfer and equitable distribution mechanisms,” the Ethiopian delegation said on Wednesday in a joint statement on behalf of the 47 countries in the WHO Africa region.

The statement added that African nations need support in “strengthening integrated clinical services and everyday systems to handle emergencies, and the readiness in countries to deliver a timely and effective response.”

Middle-income countries also made cases to be prioritised alongside low-income ones. “Health resilience can only be achieved with long-term, predictable and equitable financing. We are calling for the pandemic fund to be bolstered with increased accessibility for middle-income countries,” a delegate from Morocco said.

The plea from low- and middle-income nations follows member states’ approval on Tuesday of a new WHO budget for the 2026-27 period that slashed $1.1 billion from its previous target while raising membership fees by 20%. All WHO regions suffered the same flat 14% cut amid the financial squeeze, except Geneva headquarters, which faces a drop of nearly a quarter year-on-year.

Even with an extra $170 million raised from member states on Tuesday, the agency faces a $1.5 billion funding gap on top of the $1.1 billion already slashed from projections for the biennial budget prior to the US exit from the body, highlighting the impossible choices facing WHO as it confronts the largest financial crisis in its 76-year history.

Countries said the funding cuts leave them increasingly vulnerable as new health threats emerge.

“Geopolitical instability, climate change and emerging diseases reinforce the need for international cooperation and predictable financing to overcome challenges in global health system,” the delegate from Bangladesh said. “We need empathy, solidarity and unity.”

Crisis deepens funding gap

Before the US exit, WHO’s 2026-27 budget targeted $5.3 billion over two years to cover its core operations. After Tuesday’s vote, that target dropped to $4.2 billion, a 22% reduction affecting the UN health agency’s work worldwide.

During Tuesday’s budget debates, WHO officials countered criticism of cuts to cash-strapped regions with a harsh truth: every regional office outside Europe and Geneva still has more allocated funding than the agency can actually spend.

“We can only implement the budget if we have the financing,” Imre Hollo, director of strategic planning and budget at WHO, told member states.

The exit of US funds has affected 23.8 million people worldwide, causing closure or reduction in services at over 2,600 health facilities, WHO’s Independent Oversight and Advisory Committee said Wednesday.

The US had committed $154 million in voluntary contributions to WHO’s base budget (29% of total voluntary contributions) for 2024-25, plus another $235 million to emergency operations (15% of total voluntary contributions).

But not all of this funding came through.

“Along with the reduction in voluntary contributions from other donors, the freeze and withholding of voluntary contributions from the United States resulted in an 18% decrease in overall financing available,” the IOAC analysis found.

Global aid for health at decade low

The US government under the Trump administration has slashed $60 billion in total aid, with severe implications for global health programs covering malnutrition, maternal mortality, and prevention and immunization programs for HIV, malaria, tuberculosis and other infectious diseases.

The US cuts represent the extreme edge of a global trend in reducing aid, especially for healthcare.

Setting aside COVID-19 spending, health-focused overseas aid in 2023 stayed beneath 2019 figures across the United States, Britain, Germany, Canada, European Union bodies, France, Italy and the Netherlands. Healthcare development funding also dropped year-over-year from 2022 to 2023 in Germany, Italy and Canada.

“The share of official development assistance going to health has dropped to its lowest point in 10 years,” an analysis by ONE found in January. “All indicators suggest this will fall even lower in years to come at a time when progress against preventable deaths is at risk of backsliding.”

Analysis by the Centre for Global Development classified 37 nations as “highly exposed” to US aid cuts, facing losses equivalent to 10% or more of their government’s national health expenditures. Twenty-five countries face losses of 20% or more, while 10 face losses of at least 50%.

Extreme scenarios include Afghanistan, Somalia, South Sudan and Malawi, where US health aid equals 341%, 237%, 235%, and 207% of national health spending respectively.

“This will also have knock-on impacts on disease detection, access to medical countermeasures, R&D, and social determinants of health from nutrition to clean water in some of the world’s most vulnerable settings,” the UK delegation said.

Calls for efficiency amid crisis

WHO is urging countries to look at domestic options wherever possible, using the funding crisis as a chance to reduce reliance on external health financing and build domestic infrastructure.

“From expanding domestic financing to pioneering real-time data systems, many of you are advancing solutions that are scalable, sustainable and rooted in equity,” WHO Director-General Tedros Adhanom Ghebreyesus told ministers gathered in Geneva on Thursday.

“Data and sustainable financing are not just technical matters,” Tedros added. “They are political choices. They shape who is reached, how quickly, and with what quality of care. And they determine whether we progress or fall behind.”

Professor Senait Fisseha, Vice President of Global Programs at the Susan Thompson Buffett Foundation, urged countries to “use this moment to rethink data and financing in a way that best meets your needs and the needs of your people.”

“For countries to truly lead and for funders and development partners to start to learn how to follow, data and financing are a natural place to start,” Fisseha added. “That is where ministers are telling us to start.”

As WHO asks member states to fight the crisis with efficiency gains and data-driven approaches, members are demanding the same from the agency. Financial constraints are forcing WHO to reduce its workforce alongside other cuts.

The agency’s emergency program exemplifies the squeeze, cutting its budget from $1.2 billion to $812 million while facing mounting crises.

“We’ve adjusted our workforce. We’ve strategically controlled our expenses. We’ve put in place more efficient processes,” said Dr Mick Ryan, outgoing director of emergencies at WHO. “But there are headwinds… increasing frequency and intensity of conflict, increasing frequency and intensity of natural disasters and epidemics.”

Discussions ahead of Tuesday’s budget vote made clear approval of the financial lifeline for the UN health agency – which included member states agreeing to the 20% membership fee increase – came with expectations that WHO would continue reform efforts to be more “efficient,” “transparent”, and “cost-effective.”

“We have already taken serious measures, and we will continue to take serious measures to reform the organisation for the better,” Tedros said following the vote to approve the new budget.

“There is a crisis,” he added. “But we will use this crisis as an opportunity and make sure our organization emerges sharper and more empowered.”

Push for flexible funding

A demand that emerged from states at the World Health Assembly was the need for WHO funding to be flexible. Agency funding frequently comes with restrictions and is earmarked only for certain regions or projects, leaving limited resources to respond to critical issues like climate change and women’s health.

“We urge flexible and non-earmarked voluntary contributions for WHO to overcome current financing constraints,” the Bangladesh delegate said.

A major step in this direction came this week as member states agreed to the membership fee increase, which brings the total for the base budget funded by flexible dues up to 40%, rising from just 16% in 2020.

However, the agency remains critically reliant on voluntary funds. WHO’s emergency and polio budgets rely entirely on voluntary funding and bring the total target budget for operations from 2026-27 to $6.2 billion – meaning WHO is still around 75% reliant on voluntary funds across all operations.

Sri Lanka recommended WHO engage in high-level negotiations toward resource mobilisation to secure sustainable funding.

“We support the call for diversified financing from global health donors, development banks and private sector partners,” the country’s delegate said.

Image Credits: WHO/X, ONE, ONE.