The global health landscape will not be the same 5 and 10 years from now. Transitions are occurring in so many ways, in so many contexts, and creating profound changes in global health, John Lange from the United Nations (UN) Foundation remarked. These interlinked transitions are both economic and programmatic. A cohort of countries that have historically relied on development assistance for health (DAH) is transitioning into higher-income status. Increased income status triggers graduation out of several multilateral health financing initiatives. Additionally, one large program focused on disease eradication is nearing its goal and will soon end. At the same time, countries that have provided DAH are shifting focus away from traditional development assistance in favour of investments focused on value for money and global public goods.
In response, processes are underway to transition countries out of traditional bilateral and multilateral health funding mechanisms, and countries are expected to spend more of their own resources on health systems. These transition processes are often well defined in criteria and approach; however, their implications, particularly when they occur simultaneously, are not well understood. With current trends, there is the potential for 24 countries to face significant changes in access to global health financing over the next 5 years (Action, 2017). The effects on health outcomes and health systems globally could be large scale. For example, nearly half of the projected effect of routine vaccination on deaths adverted in 2016–2020 is allocated to countries projected to be phasing out Gavi funding within that period (Kallenberg et al., 2016). Some countries health systems have been heavily dependent for decades on the soon to sunset Global Polio Eradication Initiative (GPEI), with 25–50 percent of staff funded through GPEI spending time on nonpolio activities in support of health systems (TIMB, 2017). The 2017 World Report on Malaria provides a sobering picture of how quickly advances in global health can backslide when resources decline (WHO, 2017).
At the same time that countries are transitioning out of external funding mechanisms, they are facing transitions in the burden of disease, primarily the significant rise in noncommunicable diseases (NCDs) (Bollyky and Shendruk, 2017) while they are still working to control many infectious diseases. To date, DAH has largely ignored NCDs (Dieleman et al., 2015), and countries themselves are often faced with competing demands of immediate importance often forcing complex NCD challenges to the bottom of their national agendas. As countries transition out of external funding mechanisms, the rising burden of NCDs requires increased and significant attention while, simultaneously, the health improvements supported by DAH over the last several decades need to be sustained and accelerated.