Rethinking global health financing: from philanthropy to public good

Abstract

Global health financing has been dominated by philanthropic and donor-driven vertical programs over the past two decades. While this model has achieved major public health gains, it has also entrenched power asymmetries, fostered fragmentation, and undermined the sustainability and sovereignty of health systems in low- and middle-income countries. This perspective critiques the ethical and practical shortcomings of donor-driven approaches, including the marginalization of local ownership and democratic accountability. The COVID-19 pandemic exposed the fragility of relying on voluntary, unpredictable funding and underscored the need for a shift toward treating health as a global public good. The paper argues for a transition to more sustainable models based on domestic resource mobilization, pooled multilateral funding, and participatory governance, and outlines concrete recommendations for reform. Transitioning to a public goods approach requires reforming funding mechanisms to enhance predictability and alignment with national priorities, embedding participatory budgeting and accountability frameworks, and investing in health systems and governance. A new social contract grounded in solidarity, equity, and shared responsibility is essential to secure health for all.