Former President Ameenah Gurib-Fakim,
Honourable Minister, Monica Garcia,
EIB President Nadia Calviño,
And I would like to recognize the presence of Joseph Stiglitz and Mariana Mazzucato.
My friends, especially heads of agencies represented here.
Excellencies, Honourable Ministers, dear colleagues and friends
Buenas tardes. It is an honour to have you all joining us today.
To Spain, thank you for bringing the world together during these difficult times. Congratulations on the successful Sevilla Conference for finance for development.
A decade ago, when I was Foreign Minister of Ethiopia, I chaired the Third International Conference on Financing for Development, the main committee. So, I feel in a way as if I have come home, because FfD is special to me.
At the time, in 2015, everything was converging: The Paris Agreement, the Finance for Development Addis Ababa Action Agenda, Sustainable Development Goals - you name it, these are just some in the list. But things have really changed a lot since then.
At the time, the Addis Ababa Action Agenda was a landmark commitment by the nations of the world in support of the economic, health, and environmental targets of the Sustainable Development Goals.
Today, the world looks very different from the optimism of ten years ago.
Around the world, dramatic reductions in aid are having severe impacts on health services in many countries, especially developing countries.
We see disruptions affecting millions of people who are missing out on life-saving services and medicines; health facilities are being forced to close; supply chains and information systems are disrupted; and out-of-pocket health spending is on the rise.
Although this is an acute crisis now, it is a crisis long in the making.
Many health systems around the world have long suffered from chronic underinvestment.
For instance, out-of-pocket spending is the main source of health financing in 27 African countries.
At the same time, debt servicing costs in many countries restrict their ability to invest in health.
Globally, in 2024, 3.4 billion people were living in countries that spent more on debt interest payments than on education and health combined.
These conditions have contributed to heavy aid dependency in many countries.
In fact, since 2006, aid has consistently surpassed domestic public spending on health in low-income countries.
Much of this aid does not flow through treasuries, but through parallel systems set up by donors. This makes forward planning and budgeting impossible.
This over-reliance has created a deep vulnerability that has now been exposed.
Countries are moving quickly to adjust.
And in this crisis, lies an opportunity.
Many leaders, especially health ministers, have told me that the current disruptions are opening the door to help them to leave behind the era of aid dependency and move towards sustainable self-reliance, by mobilizing domestic resources.
WHO is supporting countries to navigate this crisis, sustain essential health services, and to adjust to the new reality.
There are many tools available to countries to improve efficiency and generate new revenue for health.
For example, by introducing or increasing taxes on tobacco, alcohol, and sugary drinks, or through pooled procurement, public health insurance for the informal sector, and by using health technology assessment so that countries get the biggest benefit for their money.
Most importantly, countries must improve domestic revenue and tax systems, to generate sustainable flows of public funding for health, education, infrastructure and other essential government services.
However, efficiency gains and domestic revenue generation alone will not be enough for many countries, who need concessional loans to support the most cost-effective investments, aligned to country priorities and flowing through country systems.
For this to happen, we need all sources of financing for health to work together, including grants, private sector, multilateral development banks, and domestic funding, all aligned behind government priorities.
That means moving away from heavily earmarked funds, so that countries can set their own priorities.
WHO and partners have a variety of initiatives to support countries in optimising the design and execution of their health budgets through stronger public financial management systems.
We’ve joined with the International Monetary Fund and the World Bank Group to support countries to build capacity for pandemic preparedness through the Resilience and Sustainability Facility.
The Facility has just announced US$ 700 million will be made available to support Jordan’s efforts to address long term vulnerabilities, including public health emergencies and pandemics.
This is the first such arrangement channelling these funds towards health system resilience.
And with the European Investment Bank, and my friend EIB President Nadia Calviño and other multilateral development banks, we’ve established the Health Impact Investment Platform.
This initiative is already working with 16 countries — identifying priority health investments, costing them, and helping governments build credible investment plans to support their national health priorities.
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Colleagues and friends, the mindset of aid dependency has to stop.
The difference between crisis and opportunity is leadership - leadership from all of us.
First, now is the time for leadership from governments, to shake off the yoke of aid dependency and chart the path to self-reliance.
Second, we need leadership from lenders, in the form of concessional lending, at fair terms.
When lower-income countries pay more to borrow than high-income countries, there is something wrong with the system.
And third, we need leadership from generous donors to build capacity so countries can have ownership and run health programmes themselves.
We don’t need support for earmarked projects cherry-picked by donors, but for national systems, national budgets and national priorities, in alignment with the Lusaka Agenda and the principles of “one plan, one budget, one report”.
WHO stands ready to support countries, and to work with our partners to turn this crisis into an opportunity, and it's possible.
The choices we make now will shape the future of global health financing. We must get it right.
Because ultimately, health is not a cost to be contained. It is an investment to be nurtured – an investment in people, stability and economic growth.
Muchas gracias, I thank you.