Stars राजेश Health
Health is not merely a human right but also a cornerstone of global economic and social stability. The COVID-19 pandemic starkly revealed the fragility of health systems worldwide, exposing deep structural inequities in the way healthcare is financed and delivered. While high-income countries mobilized trillions of dollars for testing, treatment, and vaccine rollouts, many low- and middle-income countries (LMICs) were left behind, facing shortages in vaccines, oxygen, and health workforce support. This disparity was not simply the result of geography, but of longstanding failures in the global health financing architecture. To achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs), there is an urgent need to rethink how global health financing is structured, governed, and sustained.
The World Health Organization (WHO) estimates that LMICs face an annual financing gap of at least $371 billion to achieve SDG health targets by 2030. At present, global health financing relies heavily on a fragmented patchwork of bilateral aid, multilateral funds (such as Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria), and concessional loans. While these mechanisms have saved millions of lives, they remain vulnerable to donor fatigue, shifting geopolitical priorities, and short-term funding cycles.
The pandemic was a case study in inequitable financing. As of mid-2021, over 70% of vaccines had been administered in just ten countries, while many African nations struggled to vaccinate even 10% of their populations (Our World in Data, 2021). This inequity delayed global recovery, widened economic gaps, and underscored the failure of financial solidarity in times of crisis. Similarly, in countries like Sierra Leone, per capita health expenditure remains under $50 annually, compared to over $10,000 in the United States, leaving health systems chronically underfunded (World Bank, 2022).
Why Financing Matters
Health financing is more than money; it is about how resources are mobilized, pooled, and allocated to ensure access, efficiency, and equity. Insufficient financing translates into higher out-of-pocket (OOP) payments, which push millions into poverty each year. According to WHO, 930 million people globally spend at least 10% of their household income on healthcare, with catastrophic consequences for the poor. Without structural reforms in global financing, health inequities will persist, undermining both public health and economic stability.
Case Vignette 1: Thailand’s Universal Coverage Scheme
Thailand provides a striking example of how domestic financing reform can deliver equity. In 2002, Thailand launched its Universal Coverage Scheme funded primarily through general taxation, despite being an upper-middle-income country with limited resources at the time. Today, the scheme covers over 48 million citizens, dramatically reducing catastrophic health spending and achieving some of the highest equity scores in Asia (Tangcharoensathien et al., 2020). The lesson is clear: when financing is aligned with political will and domestic priorities, universal health is possible even in resource-constrained settings.
A SWOT analysis offers a structured way to assess the internal strengths and weaknesses of the current financing landscape, as well as external opportunities and threats that shape its trajectory.
Strengths
The current system benefits from established multilateral platforms such as Gavi and the Global Fund, which have mobilized billions and standardized procurement. These institutions provide legitimacy and speed, evidenced by their ability to channel resources quickly during health crises. Furthermore, global political attention to health is at its peak following the pandemic, creating momentum for reform. Another strength is the rise of private capital and impact investing, which increasingly targets health-related ESG opportunities, offering new avenues for blended finance. Finally, digital financial innovation, from mobile money in Kenya to blockchain-enabled supply chains, lowers transaction costs and expands access to essential services.
Weaknesses
However, these strengths are undermined by critical weaknesses. The funding landscape remains fragmented, with duplication and inefficiencies caused by donor-driven vertical programs that often bypass national priorities. Financing is also short-term and unpredictable, preventing long-term investments in health workforce and infrastructure. Many LMICs also struggle with limited absorptive capacity, where governance and procurement bottlenecks undermine the impact of available funds. Moreover, heavy dependence on external aid exposes health systems to the volatility of donor priorities, leaving them vulnerable to shocks.
Opportunities
Despite these weaknesses, opportunities abound. Blended finance mechanisms can crowd in private investment for health infrastructure, cold chains, and local vaccine manufacturing. Results-based financing and social impact bondspresent innovative models that tie disbursements to measurable outcomes, increasing accountability. In addition, digital-enabled micro-insurance and cash transfers have shown promise in countries like Ghana and Kenya, where mobile health wallets reduce OOP payments. Finally, growing political momentum for pandemic preparedness can be leveraged to institutionalize long-term financing instruments.
Threats
At the same time, global health financing faces substantial threats. Macroeconomic shocks, including rising interest rates and global recessions, constrain both donor and domestic budgets. Geopolitical fragmentation threatens multilateralism, as rival blocs may prioritize domestic interests over global solidarity. Many LMICs also face debt crises, forcing austerity measures that cut health budgets. Finally, technology risks such as cybersecurity breaches or exclusion of marginalized groups from digital systems could undermine trust in new financing models.
In summary, the SWOT analysis underscores that while global health financing is equipped with strong platforms and innovative potential, it is weighed down by fragmentation and dependency, leaving it vulnerable to external shocks.
Case Vignette 2: IFFIm and Vaccine Bonds
An example of global financing innovation is the International Finance Facility for Immunisation (IFFIm). By issuing vaccine bonds in capital markets, IFFIm frontloads long-term donor pledges into immediate financing for Gavi programs. Since 2006, IFFIm has raised over $8 billion, enabling rapid immunization campaigns in dozens of LMICs (Gavi, 2023). This demonstrates the power of financial engineering to transform future commitments into life-saving present investments.
A PESTEL analysis: Political, Economic, Social, Technological, Environmental, and Legal, helps map the macro forces that influence financing sustainability.
Political
Global health financing is deeply shaped by political will. On the one hand, initiatives like the G20 Pandemic Fund show that health is on the global agenda. On the other, donor fatigue and rising nationalism threaten multilateral commitments. For example, U.S. policy shifts under different administrations significantly alter funding for WHO and other mechanisms. Sustained progress requires binding international frameworks that shield health financing from domestic political cycles.
Economic
Economic factors are decisive. During downturns, donor countries often cut aid budgets, while LMICs face reduced fiscal space due to debt burdens. For example, Zambia spends more on debt servicing than on health, highlighting the zero-sum trade-off (World Bank, 2021). However, opportunities exist: health earmarked taxes, such as tobacco and alcohol levies, have successfully financed programs in countries like the Philippines. Furthermore, concessional credit lines from the World Bank can reduce borrowing costs for infrastructure projects.
Social
Demographics and inequality play central roles. Rising demand for health services in aging societies and urbanized LMICs increases financing pressures. At the same time, inequities between and within countries mean that the poor disproportionately face catastrophic spending. Public pressure, however, can catalyze reforms, citizens in Thailand pushed for universal coverage, resulting in one of the most equitable health systems in Asia.
Technological
Technology is transforming financing pathways. Mobile payments (e.g., M-Pesa in Kenya) enable micro-insurance, while digital health records improve efficiency and accountability. Yet, digital divides risk leaving rural and marginalized populations behind. Moreover, data security and privacy regulations must keep pace with adoption to prevent breaches that undermine trust.
Case Vignette 3: M-Pesa Health Wallets in Kenya
Kenya’s M-Pesa mobile money platform illustrates how technology can revolutionize health financing. Through mobile health wallets, households can save, borrow, and pay for health services seamlessly. Programs like M-TIBA have enrolled millions, offering micro-insurance and subsidies directly via mobile phones. Evaluations show that M-TIBA reduces catastrophic OOP spending while improving healthcare utilization among low-income groups (Ondigo et al., 2021). This demonstrates how digital innovation bridges gaps where traditional banking and insurance fail.
Environmental
Climate change intensifies the burden on health financing. Increased frequency of floods, droughts, and heatwaves amplifies disease outbreaks, demanding flexible emergency funds. Small island developing states like Vanuatu and Fiji are especially vulnerable, as climate-related disasters strain already thin health budgets. At the same time, green bonds and climate-health financing instruments present opportunities for resilience-building.
Legal
Finally, legal and regulatory frameworks profoundly shape costs and access. Intellectual property (IP) regimes under TRIPS often drive up drug prices, as seen during debates over COVID-19 vaccine patents. Harmonizing procurement laws and enabling IP flexibilities in emergencies could lower costs and accelerate equitable access. Regulatory environments also affect investor confidence, requiring predictable legal frameworks to scale blended finance.
The combined SWOT and PESTEL analyses make one point clear: bridging the financing gap requires systemic rethinking, not incremental tweaks. A multi-pronged strategy is necessary.
First, pooling and alignment must be prioritized. Donor fragmentation should give way to country-led platforms where external aid supports national strategies. Second, innovative financing instruments should be mainstreamed: blended finance, health bonds, and results-based financing can mobilize capital beyond traditional aid. Third, domestic resource mobilization is essential. Sin taxes, digital transaction levies, and debt-for-health swaps can create sustainable fiscal space. Fourth, governance and absorptive capacity must be strengthened, ensuring that every dollar translates into measurable outcomes. Finally, global solidarity must be institutionalized. Pandemic preparedness funds, legally binding commitments, and reformed IP regimes are crucial to ensuring equitable access during future crises.
Global health financing stands at a crossroads. The pandemic revealed both the possibilities of rapid mobilization and the perils of inequity. A SWOT analysis highlights the system’s internal strengths and weaknesses, while PESTEL underscores the powerful external forces that shape its trajectory. Together, they reveal a financing architecture full of potential yet constrained by fragmentation, unpredictability, and inequity.
Rethinking global health financing is not simply about plugging budgetary gaps. It is about restructuring the system to deliver equity, resilience, and sustainability. Health must be recognized not only as a human right but as a global public good and economic investment. Bridging the financing gap is therefore not an act of charity, it is an urgent global responsibility that determines whether humanity can achieve universal access to healthcare, withstand future pandemics, and build a more equitable world.
References
Byiringiro, F., Otieno, C. and Rutebemberwa, E., 2023. Digital financial services for health in support of universal health coverage: Case studies from Kenya and Rwanda. BMC Health Services Research, 23(1). Available at: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09893-8
Gavi, 2023. What is IFFIm. Available at: https://www.gavi.org/vaccineswork/what-iffim
International Finance Facility for Immunisation (IFFIm), 2022. IFFIm Resource Guide 2022. Available at: https://iffim.org/sites/default/files/IFFIm-Resource-Guide-2022.pdf
IFFIm, 2023. IFFIm returns to market with £300 million 3-year bond to support global vaccine programs. Available at: https://iffim.org/news/iffim-returns-market-ps300-million-3-year-bond-support-global-vaccine-programs
IFFIm, 2023. Investor Centre – Vaccine Bonds. Available at: https://iffim.org/investor-centre/vaccine-bonds
IFFIm, 2023. Sterling bond takes total vaccine bond issuance over US$10 billion milestone. Available at: https://iffim.org/news/iffim-sterling-bond-takes-total-vaccine-bond-issuance-over-us-10-billion-milestone
International Labour Organization (ILO), 2020. Case Brief: M-TIBA Digital Health Platform. Geneva: ILO. Available at: https://www.ilo.org/sites/default/files/wcmsp5/groups/public/%40ed_emp/documents/publication/wcms_749427.pdf
Mumo, C., Omolo, J. and van Ginneken, W., 2022. A digital mobile health platform increasing efficiency and transparency: The case of M-TIBA in Kenya. Journal of Global Health Economics and Policy, [online] Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9005819/
Patcharanarumol, W., Tangcharoensathien, V. and Limwattananon, S., 2024. Thailand’s Universal Health Coverage Scheme: Performance, Equity, and Lessons for Global Health. Journal of Global Health, [online] Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11097804/
Patcharanarumol, W. et al., 2019. Universal health coverage and primary care, Thailand. Bulletin of the World Health Organization, 97(8), pp. 563–570. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6560367/
PharmAccess, 2015. How Mobile Health Technology Is Transforming Access to and Utilization of Quality Healthcare in Kenya. Amsterdam: PharmAccess Foundation. Available at: https://www.pharmaccess.org/wp-content/uploads/2016/05/2015_10_HowMobileHealthTechnologyIsTransformingAccessToAndUtilizationOfQualityHealthcareInKenya.pdf
PharmAccess, 2019. M-TIBA is truly leapfrogging healthcare in Kenya. Available at: https://www.pharmaccess.org/update/m-tiba-is-truly-leapfrogging-healthcare-in-kenya/
Tangcharoensathien, V., Limwattananon, S. and Prakongsai, P., 2013. Promoting universal financial protection: how the Thai universal coverage scheme was designed to ensure equity. Health Research Policy and Systems, 11(25). Available at: https://health-policy-systems.biomedcentral.com/articles/10.1186/1478-4505-11-25
World Bank, 2019. Health Financing Reform in Thailand. Washington DC: World Bank. Available at: https://openknowledge.worldbank.org/entities/publication/303864e9-d0eb-5289-818a-bb9d3e2b78b1
By: Adinda Aisyah Nindyani
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