New World Bank Group Report Highlights Health Financing Challenges for the Future Workforce
Washington, D.C., November 19, 2025—Despite efforts by many developing countries to sustain health spending under fiscal pressure, investments remain insufficient to fund essential health services—critical for saving lives, creating jobs, and driving growth—according to a new World Bank Group report released today.
At a Crossroads: Prospects for Government Health Financing Amidst Declining Aid finds that in 2024, combined government and donor spending on health averaged just $17 per capita in low-income countries—less than one-third of the $60 estimated minimum needed to deliver a basic package of essential services. In lower-middle income countries, that figure was $47, barely half the benchmark of $90.
Despite growing needs, spending has stagnated in real terms since 2018 with the priority for health falling in many countries. The implications are stark for health, job creation, and growth. Lower investment in health often means fewer antenatal visits, limited access to vaccines, frontline worker shortages, and under-resourced clinics. The poorest and most vulnerable are most affected with many being forced to either pay out of pocket and fall deeper into poverty or forego care. These setbacks further limit their access to employment opportunities.
“This report is a reminder that while progress is possible, it requires continued commitment and collaboration,” said Mamta Murthi, Vice President for the People Vice Presidency at the World Bank Group. “Reaching 1.5 billion more people with essential health services by 2030 will take a shared effort—through smarter investments, more domestic financing, and deeper partnerships between governments, the private sector, and development partners.”
Over the next five years, low- and lower middle-income countries face growing challenges with a projected decline in development assistance for health (DAH). While government health spending is projected to increase in two-thirds of all countries, sharp DAH cuts will reduce the total resources available for health. By 2030, over 80% of low-income countries and 40% of lower-middle income countries are projected to have lower government and donor spending on health than in 2024.
Countries are at a crossroads in their universal health coverage (UHC) journey for increased access to quality, affordable health services for all. While they face substantial challenges, they also have an opportunity for bold reforms to fundamentally reshape health systems. The report outlines three priorities for action:
- Use resources more efficiently. Targeting high-impact primary healthcare, improving health budget execution, and aligning remaining donor support with national priorities can deliver better results with current levels of government spending on health.
- Increase the share of public spending on health in public spending. One in three countries already has fiscal space to prioritize health within existing budgets.
- Expand fiscal space through broader macro-fiscal reforms. Faster economic growth, strengthening domestic revenue mobilization and reallocating spending away from inefficient and poorly targeted subsidies to create room for greater investment in development priorities, including health.
Continued collaboration will be essential among governments, partners, and donors to ensure health financing strategies are responsive to current realities, while remaining anchored in long-term ambitions. This approach underpins Health Works, a World Bank initiative helping countries to develop national country compacts that set out priority reforms and an implementation roadmap to boost health investment and access.
The upcoming Universal Health Coverage (UHC) High-level Forum on December 6 in Tokyo will be a pivotal moment to accelerate global progress toward health for all. UHC. Hosted by the Government of Japan and co-convened by the World Bank Group and the World Health Organization, the Forum will bring together global leaders to assess progress and commit to stronger, more equitable health systems.
At a Crossroads is the first in a World Bank annual series—Government Resources and Projections for Health—that tracks government spending on health in low- and lower-middle income countries and helps countries adjust course and ensure progress.