Is the World Bank Ready for a Bigger Role in Global Health Financing?

The global health architecture is facing a financing crisis. Various proposals have been put forward, including an International Development Association (IDA) Health Window, proposed by Pete Baker—a ring-fenced fund at the World Bank for countries to seek support for financing their health systems. But could the World Bank absorb and effectively channel a greater share of health financing in the future? As the largest and most influential multilateral development bank, it is an attractive option: it works directly with country governments, provides financing through national budgets, offers both loans and grants, and supports investments across sectors based on country demand.

To stress-test the feasibility of this proposal, we undertook a descriptive analysis of the World Bank’s current health portfolio at the project and country level, supplemented by a literature review and 42 stakeholder interviews, to understand how the Bank engages in the health sector (findings are available in full in the policy paper and summarized below). Overall, we find that the Bank is already a major health financier with global coverage. It has strengths that would position it well for an expanded role in health, but would need operational and structural improvements.

The size and scope of the World Bank’s current health portfolio: Key takeaways

1. The World Bank is a major health funder with broad global coverage

We analyzed all 382 World Bank projects with a health component active in 2025, identifying how the Bank is currently funding health. We find that the World Bank is a major financier of health, with an estimated $7 billion in 2025 health commitments—approximately 18 percent of the $39.1 billion in total development assistance for health—and comparable in size to Gavi and the Global Fund combined. Of that amount, IDA accounts for half of health commitments at $3.5 billion, the International Bank for Reconstruction and Development (IBRD) contributes 40 percent at $2.8 billion, and trust funds make up the remaining 10 percent ($713 million).

Ninety percent (70 of 78) of IDA-eligible countries and 57 percent (38 of 67) of IBRD countries have World Bank projects with a health component. Among these projects, the vast majority (87 percent) are dedicated health projects rather than multisectoral operations with health embedded (13 percent).

2. The World Bank (intentionally) cannot control how much goes to health

By design, countries choose how to allocate their borrowing across sectors, so health ends up representing a small and variable slice of a much larger non-health portfolio. The typical IDA-eligible country has three health projects alongside roughly 17 non-health projects, and the typical IBRD country has roughly two health projects alongside 12 non-health operations. Taken together, health represents just 11 percent (mean) of IDA countries' active portfolios (7 percent median), and even less in IBRD countries (6 percent mean, 1 percent median). To increase this share substantially will require an innovation such as an IDA Health Window.

3. IDA reaches the poorest countries, but it could do more

Reflecting their respective mandates, health financing from IDA, IBRD, and trust funds targets different regions and income groups.

IDA’s $3.5 billion is directed almost entirely to low-income countries (LICs) and lower-middle-income countries (LMICs), where 49 and 47 percent of its health financing flows, respectively. Regionally, 70 percent of IDA health commitments are concentrated in Africa.

Despite IDA's stated focus on the poorest countries, a significant share (44 percent) of IDA health commitments flow to countries with a GNI per capita above the $1,325 IDA eligibility cutoff. While this reflects IDA's performance-based allocation formula, ongoing disbursements from pre-graduation projects, and deliberate transition policies, it is worth interrogating whether these policies need reform (along the lines recently suggested by colleagues) to ensure IDA health resources are reaching the countries with the greatest need.

Conversely, IBRD directs over half of its $2.8 billion health resources to upper-middle-income countries (UMICs), followed by LMICs at 41 percent. This financing is spread relatively evenly across the Middle East, East Asia and the Pacific, Europe and Central Asia, and Latin America and the Caribbean.

Trust fund financing is a modest top-up at $713 million, concentrated in the Middle East, North Africa, Afghanistan, and Pakistan region, and Europe and Central Asia (including Ukraine), reflecting substantial flows to health projects in fragile and conflict-affected settings. The Global Financing Facility (GFF) is an outlier in terms of breadth, providing $181 million across 58 countries.

4. World Bank health lending is a critical contributor for IDA countries but a drop in the bucket for IBRD countries

For IDA-eligible countries, World Bank health financing represents a substantial share of government health spending at a median of 16 percent. In fact, World Bank health lending exceeds domestic health spending in several fragile states. Meanwhile, Bank health financing represents a negligible share of total health spending for IBRD countries, with a median of 0.4 percent. This difference primarily reflects growing domestic health expenditure and country borrowing choices rather than a withdrawal of Bank support. Notably, the median IBRD country spends $314 per capita on health domestically compared to $25 for the median IDA country.

5. Most countries sustain health lending after IDA graduation, with notable exceptions

We analyzed Bank health lending patterns before and after IDA graduation across 19 countries with usable data. Most countries receive substantial support during graduation: the majority sustained or increased health lending through new IBRD commitments, and some continued to benefit from prolonged IDA disbursements alongside IBRD. However, roughly a third saw sharp declines in new health lending after graduation, and legacy IDA disbursements can mask whether countries are actively securing new IBRD health financing or simply running down existing commitments.

How the World Bank engages in health: Key takeaways

1. The World Bank’s mix of loans and grants can support countries as they grow—facilitating sustainable health financing in a way grant-only institutions cannot

The World Bank’s provision of both loans and grants for health enables it to meet countries where they are along the development continuum. Nearly a quarter (24 percent) of IDA financing is in the form of grants, which allows the World Bank to provide financing to the poorest and most vulnerable LICs, and IDA grants regularly support recurrent health system costs similarly to Gavi and the Global Fund. Meanwhile, loans stretch resources further, allowing the World Bank to provide four times more support than it could otherwise. Indeed, new official development assistance contributions make up just 23 percent of IDA’s last replenishment, with reflows and private borrowing making up the rest.

Trust funds, such as the GFF, are another vehicle at the World Bank’s disposal for channeling health financing. Unlike IDA and IBRD, trust funds can earmark specifically for health, and trust fund projects are still integrated with Bank operations. They can also attract funding from philanthropies—an important benefit as bilateral aid dwindles. The GFF typifies the promises and pitfalls of this mechanism: it mobilizes additional philanthropic funding while leveraging IDA, yet it lacks the scale of IDA, disbursing just $181 million in 2025 compared to IDA’s $3.5 billion in health commitments; can use only grants, not loans; relies on a different governance mechanism dominated by a few donors; and its investment case process adds administrative burden.

2. Donor-weighted governance, but country-level autonomy

The World Bank’s governance model gives donor countries, particularly the US, greater influence over the Bank’s strategic direction. However, the same is true of Gavi and the Global Fund. IDA-eligible countries have 15.2 percent of votes on the Board, compared to Gavi’s 18.5 percent and Global Fund’s 35 percent of Board seats allocated to implementing countries. Balancing this donor control to some extent, the World Bank's operational model gives recipient countries much more meaningful control over how financing is used. Bank funds flow through national treasuries and count toward national budgets, and the World Bank's multisectoral nature means countries can allocate across sectors based on their own priorities.

Unlike the boards of Gavi and the Global Fund, however, the World Bank’s board lacks civil society representation. If the Bank scaled up health funding, it would likely need to develop stronger models for civil society engagement—probably at the country level—to address concerns around achieving health equity objectives.

3. Health is championed but competes with other priorities

An expanded role in health fits well with the World Bank’s mandate, and World Bank President Ajay Banga has stated that health is a priority during his tenure, setting a goal of reaching 1.5 billion people with health services by 2030. Yet health represents just 7 percent of the Bank's active portfolio, and the Bank's demand-driven model means it cannot guarantee countries will prioritize health over or even alongside other sectors. At the same time, the World Bank’s overarching goal of creating jobs, together with calls from the US government to “get back to basics,” could crowd out health. New mechanisms to increase the prioritization of health spending, such as an IDA Health Window, could help counteract these pressures.

4. Ironing out operational kinks would bolster the World Bank’s suitability as a health financing hub

A range of operational issues arose during our review that, if resolved, could strengthen the case for the World Bank’s greater role in health:

• Project development times are widely perceived as slow, with 59 percent of IDA-eligible countries reporting processing times as long.
• Variable experience and expertise among task team leaders overseeing country operations leads to inconsistency in project effectiveness.
• Staff incentives tend to reward disbursement rather than health impact or long-term sustainability.
• Results measurement in health lacks consistency and transparency.
• The World Bank lacks the disease-specific health expertise and pooled procurement track record of Gavi and the Global Fund.

Realigning staff incentives toward health outcomes, reducing lead times in project development, and investing in stronger results tracking and communication would all bolster effectiveness. Most importantly, the World Bank’s impact on health will be greatest if it doesn’t try to do everything itself and instead leads on financing while drawing on an ecosystem of partners: the World Health Organization for normative guidance, technical assistance providers for design and delivery, and global and regional procurement mechanisms to support countries.

5. The World Bank is well placed to lead on donor coordination but needs to invest in partnerships

The World Bank is often not perceived by stakeholders as transparent or cooperative. Given its presence in nearly all LICs, though, the Bank has a real opportunity to support governments in coordinating donors at the country level and improving visibility of financing flows. The National Health Compacts could form the foundation of this effort. The Bank could also increase its co-financing with global health institutions to support defragmentation and country alignment. Doing so will require investment in communication, collaboration, and aligning staff incentives with a more partnership-oriented way of working.

Conclusion

Our analysis finds that the World Bank is well positioned to play an important role in the future of health financing. The World Bank is already active in nearly all LICs, delivers financing on-budget to national governments, blends grants and loans, and works through ministries of finance. Together, these strengths position the Bank to play an important role in the future of health financing by reducing fragmentation and supporting more sustainable financing of health systems. Realizing that potential, however, will require the World Bank to adopt novel approaches to prioritize health spending—such as an IDA Health Window—learning from the GFF experience. The World Bank will also need to strengthen transparency and accountability to clients, enhance results tracking and reporting, improve alignment of internal incentives, place a stronger emphasis on LICs, continue to improve its model in fragile and conflict settings, and invest more in supporting countries during the design phase. These changes are essential if the World Bank is to deliver high-impact health financing that encourages donor confidence, builds health systems, and supports greater national health sovereignty.