In a Comment published in The Lancet, Kumanan Rasanathan, Maylene M Beltran, Alberta A Biritwum-Nyarko, Mark S Blechner, Mark Dybul, Hajime Inoue, and colleagues raise the alarm on the steep decline in development assistance for health and the deepening crisis it has triggered. Titled “Navigating health financing cliffs: a new era in global health,” the piece reflects on the end of the global health financing era inaugurated by the Millennium Declaration and warns of the cascading consequences of sharp aid cuts, rising debt burdens, and stagnating domestic health investment, especially in low-income countries.
Drawing on examples from South Africa, Nigeria, Thailand, and Uganda, the authors emphasise the urgent need for transitional financing, systemic reforms, and enhanced national leadership to prevent service disruptions and ensure sustainable progress toward universal health coverage. This Comment is a timely call to reimagine the global health financing architecture for a more resilient and equitable future.