Many countries are facing a health financing crisis on the back of the Covid-19 aftermath, ongoing global economic uncertainty, and the 2025 abrupt aid reductions. With shrinking health budgets, decades of health gains are at immediate risk without swift, decisive action.
To weather the health financing storm, both the World Health Assembly and World Health Organization (WHO), respectively, in a May 2025 resolution and recent policy paper, have urged countries to protect domestic budgets for health, implement an ambitious and comprehensive range of new health financing policies, and improve the availability and quality of health expenditure data. The proposed health financing agenda covers how revenues for health are raised (e.g., innovative sources of financing, introduce or increase taxes on tobacco, sugar and alcohol), pooled (e.g., reduce fragmentation of programs, health financing schemes and funding flows) and spent (e.g., design health benefit packages based on inclusive and transparent processes, improve health system performance).
Will global progress on this ambitious agenda be made? Herein lies the problem: there’s no real way to know. Such a multi-dimensional health financing framework requires a fit-for-purpose monitoring framework—which currently does not exist.
Current global health financing monitoring tools are not up to the task
To systematically track whether health financing goals are met and action is taken across countries, we need a tool that:
- relies on routinely collected health financing data
- has a global scope
- is hosted by one or more clearly defined organisations
- covers the entire health financing agenda—not just one or two subtopics.
A plethora of different tools cover some of these characteristics (see Table 1), but important gaps remain.
- Many solo chefs in the kitchen: The WHO curates tools in most relevant areas, while the World Bank, the OECD, and the Institute for Health Metrics and Evaluation (IHME) host others. Existing tools are inconsistent and uncoordinated in scope, methodology, access, and presentation.
- Competing estimates of health expenditure: Both the WHO and IHME produce domestic health expenditure estimates, using entirely different methodologies. A memorandum of understanding between the two organisations only covered global burden of disease data for 2019–2023—a fairly narrow and time-limited subset of the overlap that excluded data on health financing. Meanwhile, both the OECD Development Assistant Committee Creditor Reporting System and IHME produce estimates of external health expenditure, which are quite challenging to compare directly because they collect and analyse data in different ways from a largely overlapping, but ultimately different sample of entities.
- Deafening silence on the details that matter: As discussed above, we have imperfect data for topline health expenditure—but for all other categories of relevant data, global tools are few or absent. Progress on health taxes, health system performance, financial protection, health benefit packages and the use of health technology assessment are captured by intermittent initiatives, with many years between data collection waves. Arguably, progress in these areas is slow, so annual updates would be overkill—but the current update intervals appear opportunistic and uncoordinated. Important data, such as primary healthcare expenditure, are available for only a selection of countries, and are currently complemented by standalone research studies e.g., Lancet Global Health Commission on Financing Primary Health Care (2022). Health financing fragmentation and countries’ use of innovative financing are not yet covered by any global monitoring tool.
Table 1. Global monitoring tools for an ambitious global health financing agenda
| Health financing imperative | Global monitoring tools (see Notes) |
|---|
| Protect domestic health expenditure | WHO Global Health Expenditure Database, last year available 2023 (update expected in December 2025) WHO Repository of health budgets, last year available 2021 IHME Global Health Spending 1995–2022 |
| Maintain external health expenditure | WHO Global Health Expenditure Database IHME Development Assistance for Health Database 1990–2025 OECD DAC CRS database |
| Improve health system performance or efficiency | None identified – standalone studies only e.g., IMF 2022, Lastuka et al. 2025 |
| Strengthen strategic purchasing | None identified – standalone studies only, e.g., by SPARC |
| Design health benefit packages based on inclusive and transparent processes, including mechanisms such as health technology assessment | WHO Health Technology Assessment and Health Benefit Package Survey, last iteration 2020/2021 |
| Improve financial protection | WHO-WB Tracking Universal Health Coverage global monitoring reports, last published in September 2023 (next iteration expected in September 2026) |
| Introduce or raise taxes on tobacco, sugar, and alcohol | World Bank Global SSB Tax Database, last updated August 2023 WHO tobacco tax database, last updated 2022 WHO report, last published in December 2023 |
| Reduce fragmentation of programs, health financing schemes and funding flows, for example by using sector wide approaches and health compacts | None identified |
| Introduce innovative sources of financing | None identified – standalone studies only e.g., Brikci et al. 2023, Thinkwell 2020 |
Abbreviations: IHME – Institute for Health Metrics and Evaluation; IMF – International Monetary Fund; OECD DAC CRS – Organization for Economic Cooperation and Development, Development Assistance Committee, Credit Reporting System; SPARC – Strategic Purchasing Africa Resource Center; SSB – Sugar Sweetened Beverages; UHC – Universal Health Coverage; WB – World Bank; WHO – World Health Organization.
Notes: weblinks accessed November 2025. Standalone studies mentioned are illustrative examples only, not to be viewed as the output of a systematic search or as endorsement of quality. Examples of standalone studies are not given where global databases are available—not to be interpreted as lack of standalone studies.
Towards a fit-for-purpose global health financing monitoring framework
The seeds for a fit-for-purpose global health financing monitoring framework are there, but there’s much more work to do. There are three top priorities:
- Bring available data and tools under one roof. A single platform is needed where health financing data and tools can be jointly accessed, queried, and interpreted—including clear explanations for methodological differences between competing estimates. Conceptually, the WHO’s Health Financing Progress Matrix (WHO HFPM) could serve as a starting point, as it offers a comprehensive portrait of a country’s health financing capacity across four maturity levels (emerging, progressing, established, advanced). The tool was not designed to measure global progress, but it could be adapted for this purpose and rolled out more broadly in use (as of November 2025, only 14 country reports were available).
- Adopt or develop new metrics and tools where needed. Capturing “[health system] efficiency,” “fragmentation,” “pooling [of funding flows],” “innovative [financing],” adequately across countries is difficult, in large part because data, context, and technical capacity vary across countries. Categorical or qualitative measures of progress rather than absolute values (such as in the WHO HFPM), as well as mixed methods approaches, can provide useful and constructive information while avoiding unnecessary controversy.
- Make clear who’s in charge of what. We need a clear division of responsibilities between the different players. The WHO is probably best positioned for a central role in global monitoring, but the broader effort will necessarily require collaboration and contributions for multiple coordinated and clearly scoped partners, including IHME, the World Bank, OECD, and regional bodies like the African Union.
With these principles, the world can track whether we’re on pace to meet global health financing goals by making appropriate policy choices—and direct attention, help and resources where they are needed most.
Comments from Pete Baker and Tom Drake on an earlier version are acknowledged gratefully.
