The 78th World Health Assembly picked up momentum Saturday as countries adopted a Nigeria-sponsored initiative to stimulate more public health spending; and  first-ever WHO resolutions recognizing rare diseases and neglected skin diseases as global equity issues.

The resolution on strengthening health finance globally EB156 (16), aims to accelerate progress towards long standing commitments on financing Universal Health Coverage. 

It echos a 2019 UN General Assembly appeal to governments to allocate “an additional 1% of gross domestic product or more for primary healthcare.” 

And it highlights potential fiscal levers that could raise more revenues for healthcare, such as “introducing and increasing taxes on tobacco, sugar and alcohol…  that reduces risk factors for noncommunicable diseases.”

Member States also are encouraged “to focus domestic resources on an affordable package of essential health benefits, based on evidence and developed through inclusive and transparent processes supported by health technology assessment.” 

The resolution is also noteworthy because it was initiated by Nigeria – Africa’s most populous nation. 

Countries’ commitments to finance UHC are way off track   

Citing findings from the WHO’s 2023 Global Monitoring Report, the resolution notes that “the world is off track in making meaningful progress towards universal health coverage and alignment with the Sustainable Development Goal indicators  by 2030.”

According to the draft resolution, almost two billion people globally continue to face financial hardship from health expenditures, and over 340 million are being pushed or further pushed into extreme poverty due to out-of-pocket spending. “One billion people globally [are] spending more than 10% of their household budgets on healthcare,” the resolution states, noting the urgency for reforms.

While there was a 60% increase overall in per-capita health expenditures between 2000 and 2022 –  in low income countries this was largely driven by a sharp rise in out-of-pocket spending (OOP), a December 2024 WHO report on public health expenditures found. 

The spending outlays fall far below the longstanding commitments of the 2001 Abuja Declaration, in which member states pledged to set aside at least 15% of their national budget for the health sector. 

Over the last two decades, donor outlays made up for the stagnation in domestic spending on public health systems in the poorest countries, according to the December 2024 WHO report – but now that support has been cut drastically, due largely to the massive US reductions in global health outlays.

WHA Resolution urges member states to improve social protection 

The new WHA resolution urges Member States to “tackle the causes of poor financial protection and improve access to healthcare services without financial hardship.” 

It emphasizes the importance of prioritizing public financing for health systems, encouraging governments to focus on “government revenue as the primary source of financing,” and recommends reducing fragmentation through “pooling of government funds, including revenue from direct and indirect taxes and levies, where applicable.”

Finally, the resolution also encourages global health initiatives, donors, and financial institutions “to finance domestic priorities with consideration of favourable terms, aligned with country planning, budgetary processes, monitoring and evaluation cycles,” and calls for improved transparency and reporting through systems such as national health accounts.

The resolution requests WHO “to prepare reports on health expenditures and the state of global health financing to be presented in 2026, 2028 and 2030” and to “provide support for improvement in the quality and availability of data and in the timeliness and transparency of tracking domestic and external financing flows.”

In the light of WHO budget cuts, that’s a politically significant request in that it should help preserve WHO’s work tracking public health spending by countries and regions. See related story. 

Public Health Spending in Low Income Countries Stagnates – Out of Pocket Costs Soar 

To support country-level reform, the Director-General is also asked to support member states in “the development of prioritized national health financing road maps to mobilize technical assistance and financial resources.” 

Strong support from member states 

The resolution, initiated by Nigeria, had strong support from Member States, with several highlighting national efforts to scale up domestic financing.

 Zimbabwe reaffirmed its commitment to sustainable health investments, announcing plans for a “proposed national health insurance scheme to ensure sustainable and equitable health.” This aligns with the resolution’s call for countries to reduce reliance on out-of-pocket expenditure and prioritize pooled, public funding for healthcare.

Public Services International, representing global public sector workers, called on Member States “to walk the talk of adequate public funding,” warning that the increased privatization of healthcare “undermines the essence of UHC.” They urged debt cancellation for developing countries to free up fiscal space for primary healthcare investment, and emphasized the importance of treating health workers with fairness and dignity—echoing the resolution’s provisions on workforce protection.

The International Federation of Medical Students Associations also backed the resolution, calling it a timely response to growing inequities. They advocated for “sustainable public health financing to reduce out-of-pocket costs” and emphasized that health system reforms must be “grounded in equity and people-centered primary healthcare.”

Ailan Li, Assistant Director-General for Universal Health Coverage at WHO, reaffirmed WHO’s commitment to supporting countries in implementing the resolution’s recommendations, noting that financing reform “is at the core of our work as we go forward.” .

First-of-its-kind rare diseases resolution also approved

During the session, Member States also unanimously adopted the resolution Rare diseases: a global health priority for equity and inclusion (EB156(15)), the first of its kind within the WHO framework. 

A rare disease is described as a specific health condition affecting fewer than 1 in 2000 individuals in [the] general population, according to the resolution, which places rare diseases firmly within the global UHC and equity agenda.

Over 300 million people globally are living with one of more than 7,000 known rare diseases, many of which are chronic, disabling, and often undiagnosed or misdiagnosed, the resolution notes. 

Li called the measure a “landmark”. 

“These are complex issues to manage, they are expensive issues to manage, and that is the reason that we brought it into [WHO’s] GPW 14, with the support of so many member states and partners,” she said. She confirmed that WHO would proceed with the development of a 10-year global action plan, to be presented at  the World Health Assembly in 2028.

Beyond policy symbolism, the resolution outlines tangible action points: it urges countries to integrate rare diseases into national health strategies, improve access to diagnosis and treatment, and develop registries and data systems. It also emphasizes social inclusion, noting that individuals with rare diseases often face “stigmatization, social exclusion, and limited access to essential services.”

The adoption of EB156(15) was widely praised by civil society and health organizations advocating for rare disease patients. Delegates welcomed WHO’s commitment to ensure that “persons living with a rare disease… receive timely and appropriate healthcare services,” including through improved diagnostics, workforce training, and dedicated research efforts.

Strengthening medical imaging capacity and tackling skin diseases  

In other actions Saturday, the Assembly approved several more resolutions on:  strengthening medical imaging capacity; bolstering national uptake of norms and standards (EB 156/17 and EB156/14); raising the profile of skin diseases as a global health priority (EB156/24). It also endorsed a strategy for accelerating the eradication (Guinea Worm Disease) dracunculiasis (EB156/23) and reviewed progress on the 202o roadmap for accelerating the elimination of meningitis by 2030 (A78/4).  

“Over 10% of skin diseases are NTDs which disproportionately impact underserved communities in LMICs and cause physical, mental and social harm, yet diagnosis is limited and many treatments are outdated or toxic,” noted a representative of the Drugs for Neglected Diseases Initiative. 

“We support the resolution’s focus on R&D and access to health tools, but commercial R&D systems continue to neglect skin NTDs. Governments must drive innovation through collaborative models that prioritize patient needs and build local capacity, domestic leadership and regional collaboration is key.

“The recent Memorandum of Understanding signed this week by six African countries on visceral leishmaniasis elimination demonstrates the power of coordinated cross border efforts. National political commitment is vital through integrating skin NTDs into health plans, resource allocation and training frontline healthcare workers to improve early detection and care.”

See related story here: 

https://healthpolicy-watch.news/cross-border-collaboration-gains-political-traction-as-africa-targets-visceral-leishmaniasis-elimination/

Image Credits: Abanima at the Arabic language Wikipedia, CC BY-SA 3.0, , Twitter: @WHOAFRO, WHO, DNDi.