As aid falls at the steepest rate on record and global health governance is redesigned without naming them, PMNCH launches a two-year campaign to mobilize domestic re
GENEVA, 21 July 2026– A woman dies giving birth every two minutes. In 2024, 4.9 million children did not live to see their fifth birthday. Twelve million adolescent girls give birth each year, and complications from pregnancy and childbirth remain a leading cause of death for girls aged 15 to 19. These numbers have been falling for two decades, slowly, on the back of financing that is now disappearing faster than at any point on record.
Official development assistance for health fell by 23.1 percent in 2025, the steepest single-year drop since records began A further 5.8 percent decline is projected for 2026. Development assistance for health is projected to fall by 29 to 46 percent from 2024 to 2026, a loss of roughly $5 to $8 billion dollars.
The cuts are not landing evenly. Maternal care, newborn health, family planning and adolescent services, already the most chronically underfunded parts of any health budget, are typically the first line item to go when a grant shrinks or a donor exits. A PMNCH snap survey of partner organizations across more than 20 countries in Africa, Latin America and Southeast Asia, conducted in late 2025, found that 89 percent had already experienced reduced funding, with many forced to scale back or suspend frontline services.
“We built this campaign around two goals because both fronts are collapsing at once,”said Rajat Khosla, Executive Director of PMNCH.“We cannot only defend the aid that is left. We have to build domestic financing that does not depend on any single donor’s political cycle. Neither goal works without the other.”
The financing collapse is arriving at the same moment as a once-in-a-generation renegotiation of how global health itself is governed. Major reform efforts now underway, including the UN80 Initiative, the WHO global health architecture reform and the Accra Reset among others, do not currently name women’s, children’s or adolescents’ health as an explicit priority, prompting warnings from partners that the field risks being written out of the very architecture being redesigned to respond to this crisis.
“The African Union’s 8th Specialized Technical Committee already agreed, unanimously, that financing for health in general and women’s, children’s and adolescents’ health more specifically is a matter of sovereignty, not charity,”said Dr. Patrick Ndzana Olomo, Head of Economic Policy and Sustainable Development at the African Union Commission.“As the global health architecture is redesigned, we are not asking for a new commitment. We are asking that the ones our Member States have already made be implemented.”
Debt is compounding the squeeze, particularly in Africa. More than 3 billion people, an even higher share of them in sub-Saharan Africa, live in countries that now spend more servicing debt than on health or education. African governments alone repaid an estimated US$89 billion in debt in 2025, more than 30 of them spent on health that same year. Some of that pressure can be absorbed through smarter use of existing resources: Africa CDC’s pooled procurement mechanism has already cut prices by up to 90 percent on ten priority maternal and newborn health commodities, evidence that debt relief and resource optimization need to be pursued together, not as alternatives.
“Debt service is quietly crowding out health budgets across the continent,” said Dr. Landry Dongmo Tsague, Director of the Center for Primary Health Care at Africa CDC and co-chair of the PMNCH Financing Working Group.“But governments are not powerless. Pooled procurement and coordinated purchasing can stretch a shrinking budget further without a single new dollar. Debt relief matters, and so does using the resources governments already have more intelligently.”
The economic case for reversing course, campaign organizers argue, is not in dispute. Every US$1 invested in reproductive, maternal, newborn and child health returns up to US$20 in economic and social value. Closing the gap in women’s health alone could add at least US$1 trillion a year to the global economy by 2040. Failing to invest in adolescent well-being, conversely, could cost the world an estimated US$110 trillion in lost economic benefit between 2024 and 2050.
“Every dollar invested in reproductive, maternal, newborn and child health returns up to twenty,” said Dr. Kalipso Chalkidou, Director of Performance, Financing and Delivery at the World Health Organization. “When ministries of finance look at that return, the case makes itself. The problem has never been the arithmetic. It has been political will, and a just transition away from aid dependency has to be paced so that domestic systems are ready to hold the weight before external support steps back.”
“African Heads of State have already shown that domestic financing follows political accountability, not the other way around,”said Joy Phumaphi, Executive Secretary of the African Leaders Malaria Alliance (ALMA) and co-chair of the PMNCH Financing Working Group. “When leaders are held to the commitments they make, budgets move. This campaign gives that same model of accountability to women’s, children’s and adolescents’ health, and it puts national coalitions in the driver’s seat rather than waiting on decisions made elsewhere.”
The PMNCH Financing Campaign responds to this moment on two fronts. The first is domestic: working with national partners to strengthen domestic resource mobilization for women’s, children’s and adolescents’ health (WCAH) in five initial countries, Malawi, Nigeria, Senegal, Tanzania and Zambia, and subsequently expanding to the wider group of ten. Support is phased and country-owned, moving from budget analysis and needs assessment, through parliamentary engagement and public advocacy, to expenditure tracking and shared learning across countries. The second is global: defending and expanding donor commitments through the Global Fund’s GC8, Gavi’s next funding cycle, the World Bank and Global Financing Facility, and debt relief measures that free up fiscal space for health, building directly on various health financing commitments made in 2025.
“When we surveyed our partners last year, 89 percent told us they had already lost funding,” said Rajat Khosla, Executive Director of PMNCH. “Organizations cannot absorb that alone, and they should not have to. This campaign exists to connect national coalitions to each other and to the tools they need, so no single organization is fighting this fight in isolation.”
PMNCH is calling on finance ministries, donor governments, multilateral institutions, civil society organizations and private sector partners to join the campaign: by engaging with national coalitions in the ten countries, by putting the #Act4WCA microsite’s toolkits and investment case materials to use, and by joining PMNCH’s Financing Working Group, co-chaired by Phumaphi and Tsague, to help shape the campaign’s approach over the next two years.
