ADDIS ABABA, Ethiopia — Global health financing is entering a tougher reset as donor aid retreats, African health systems absorb rising outbreak pressure and officials look for ways to protect essential services before the next emergency hits, April 13, 2026. The shift is being driven by record aid declines, tighter fiscal space and a growing case for prevention-first spending, with One Health emerging as one of the few approaches that could lower outbreak risk while reducing response costs.
The financing squeeze is no longer theoretical. According to OECD preliminary 2025 aid data, official development assistance from Development Assistance Committee members fell 23.1% in 2025 to $174.3 billion, the sharpest annual contraction on record, while bilateral aid to sub-Saharan Africa dropped 26.3%.
Why global health financing is entering a reset
The health-specific picture is just as stark. IHME’s Financing Global Health 2025 estimates that development assistance for health fell 21% globally between 2024 and 2025, from $49.6 billion to $39.1 billion, with sub-Saharan Africa down 25%.
In Africa, the pressure is being amplified by debt, weak domestic fiscal space and a rising emergency load. In Africa CDC’s April 2025 financing paper, the agency said official development assistance to Africa’s health sector had dropped 70% from 2021 to 2025, while public health emergencies rose 41%, from 152 in 2022 to 213 in 2024. The same paper warned that African countries were expected to service $81 billion in debt in 2025, further squeezing room for health spending.
One Health may be the cheapest answer on the table
That is why One Health has moved from conference language to budget language. Rather than paying later for outbreaks, hospital surges and emergency procurement, governments are being pushed to invest earlier in surveillance, animal health, food systems, environmental risk reduction and joint planning. Africa CDC says integrated One Health costing tools could save up to $2.4 billion a year in response costs across Africa, citing the World Bank’s One Health investment work.
This does not eliminate the need for outside support. It changes what good support looks like. The next phase of financing is likely to reward countries that can align donor money with national plans, protect primary care, strengthen laboratories and supply chains, and show that prevention spending lowers future response bills.
The warning signs were visible before the current crunch
This reset did not arrive overnight. Reuters reported in August 2024 that Africa’s mpox response had secured less than 10% of the estimated $245 million it needed. By February 2025, Africa CDC Director-General Jean Kaseya was warning that the U.S. aid pause had left the agency about $200 million short in its mpox response.
Those episodes matter because they showed how quickly a financing gap becomes an outbreak-management gap. They also exposed the weakness of relying on emergency appeals after a crisis has already spread.
What comes next
The practical reset now being discussed is less about replacing every donor dollar immediately than about changing the mix. Expect more pressure for domestic revenue measures, better aid alignment, blended financing, regional mechanisms and stricter accountability for how money reaches frontline services.
In that environment, One Health stands out because it links fiscal discipline with health security. Spending earlier across ministries may be politically harder than paying for emergencies later, but it is one of the few strategies that promises to save money, reduce outbreak risk and strengthen resilience at the same time.
If aid keeps shrinking, global health financing will have to do more than plug holes. It will have to finance a different model, one that treats prevention, coordination and domestic ownership as core infrastructure rather than optional add-ons.
