Tracking development assistance for health, 1990-2030: historical trends, recent cuts, and outlook.

backgroundDevelopment assistance for health (DAH) rose to its highest levels during the COVID-19 pandemic but has since reduced amid rising global economic uncertainty and competing fiscal demands. In early 2025, major donors including the USA and the UK announced substantial reductions in aid, prompting concerns about the future of health financing in middle-income and low-income countries. To date, no comprehensive assessment has quantified the effects of these announced cuts on overall DAH levels or its future trajectories.

methodsWe estimated DAH from 1990 to 2030, drawing from a wide range of data sources including the Organisation for Economic Co-operation and Development Creditor Reporting System database, online databases of agencies such as The Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization (Gavi), and financial reports from private philanthropies and non-governmental organisations. Disbursements were categorised by source, disbursing agency, health focus area, and recipient country using standardised keyword tagging methods developed over 15 years of Institute For Health Metrics and Evaluation Financing Global Health reports. For 2025, we incorporated budget cuts announced by major donors to develop preliminary estimates. Forecasts to 2030 used donor-specific funding targets and linear regression models. Additional refinements for this iteration of our DAH tracking included expanded donor coverage and disaggregation of health areas for additional disbursing entities.

findingsDAH peaked at US$80·3 billion in 2021 and fell to $49·6 billion in 2024. In 2025, announced budget cuts-particularly reductions in US bilateral aid-are expected to contribute to further declines in global DAH to $38·4 billion, amounts last seen in 2009. Key global health institutions (eg, Foreign, Commonwealth & Development Office and US Agency for International Development and Agence Française) providing DAH for key infectious diseases and childhood vaccines will contract their own disbursements. Because these key multilateral development banks have been protected from the major funding cuts, the World Bank has increased its relative share of total DAH disbursements. Forecasts indicate continued stagnation in DAH until 2030 under current policies, reaching $36·2 billion in 2030. Our sensitivity analyses suggest that our estimate for 2025 could range from $36·8 billion in a pessimistic scenario to $40·0 billion in an optimistic scenario, based on changes in US cuts. Similarly, in the next 5 years, total DAH is expected to reach $37·8 billion in 2030 under a positive scenario for US contribution and $34·5 billion under a negative scenario for US contribution.

interpretationThe global health financing landscape is entering a period of sustained cuts. Major reductions in DAH, particularly from historically leading donors, threaten to widen health disparities unless mitigated by increased domestic resource mobilisation or alternative financing mechanisms. This study highlights the urgent need for greater efficiency, strategic reprioritisation, and strengthened fiscal resilience in recipient countries to safeguard the substantial global health gains of the previous three decades.

fundingGates Foundation.