The new administration in the USA: impact of policy changes in development assistance on low- and middle-income countries, with the example of Nepal.

Investing in health drives individual wellbeing, productivity, educational achievements, and economic growth. Collective global efforts have historically eradicated diseases like smallpox and are making progress against others, such as polio and malaria. In many low- and middle-income countries (LMICs), public health spending is insufficient, with per capita expenditure far below what is needed to deliver and sustain essential health services. High-income countries, such as the United States, are contributing to LMICs to bridge these gaps through bilateral and multilateral development assistance. The United States Government's longstanding support in Nepal has helped to strengthen the health systems and resulted remarkable achievements. However, the new United States administration's abrupt decisions to halt the development assistance and closure of most of the projects will significantly impact global health initiatives, jeopardize health gains, and pose a risk to global health security. This call-for-action urge stakeholders to evaluate the current and potential impact of these decisions and adopt a cohesive approach to maintain development cooperation. LMICs also must reassess their health investments and implement reforms to build resilient, self-sustaining health systems.