Published by BMJ Global Health, a journal of the BMJ Publishing Group, the commentary examines the policy risks facing health systems as external donor funding declines. Authored by Edwine Barasa, Jane Chuma, Justice Nonvignon, and Olusoji O. Adeyi, the article addresses the growing pressure on low and middle-income countries (LMICs) to achieve health financing self-reliance while safeguarding equity and access.
The authors argue that although the transition away from donor dependence is unavoidable, certain policy responses threaten to undermine health system performance and progress toward universal health coverage. Drawing on observed trends across LMICs, the commentary identifies four problematic approaches, including increased reliance on out-of-pocket payments, contributory insurance schemes, and facility-centred service delivery at the expense of primary and community-based care. The authors call for evidence-informed, equity-oriented financing strategies that prioritise public funding, protect vulnerable populations, and preserve people-centred health systems during this critical transition.