The Fragile Lifeline: Aid Cuts Threaten Essential Health Services in Nepal and Afghanistan
Recent analysis highlights the precarious state of essential health services in countries heavily reliant on external aid, specifically citing Nepal and Afghanistan as case studies. A perspective published in Public Health Challenges examines how reductions in external health aid can destabilize multiple services simultaneously, from vaccination programs to maternal care, and proposes a framework for more responsible aid transitions.1
Declining Global Health Aid and the Risk to Essential Services
The World Health Organization (WHO) warned in 2025 that external health aid to low- and middle-income countries could decrease by as much as 40%, raising concerns about the sustainability of critical health programs.2 Many nations depend on donor support for immunization, nutrition, and disease control initiatives, and abrupt funding cuts can create significant disruptions to service delivery, supply chains, and the health workforce.
Unequal Capacity to Withstand Health System Shocks
Countries exhibit varying capacities to absorb financial shocks to their health systems. Some nations possess sufficient domestic funding or robust public service infrastructure to mitigate the impact of aid reductions. However, many low-income countries lack the resources and infrastructure to adapt, leading to widespread disruption when funding is withdrawn.1 This can manifest as shortages of essential medications, compromised healthcare access, and weakened disease surveillance systems.
Nepal’s Health System Under Strain
Nepal exemplifies the multi-faceted impact of aid withdrawal. For years, the country relied on funding from the United States Agency for International Development (USAID) for basic health services, including nutrition, vaccines, and family planning.1 When this support declined in 2025, health facilities reported shortages of contraceptives, such as Depo-Provera injections and intrauterine devices. Rising import costs due to currency fluctuations further exacerbated the funding gap, increasing demand on already strained public facilities.1
Nutrition programs also faced uncertainty, potentially jeopardizing gains made in reducing child stunting. Immunization programs, dependent on both domestic and international financing, were similarly affected, threatening progress in lowering child mortality rates.1 These interconnected disruptions underscore how aid withdrawal impacts the entire healthcare system, not just isolated programs.
Afghanistan’s Health System on the Brink
The situation in Afghanistan demonstrates a more severe outcome in a fragile setting. By March 2025, funding shortages placed 80% of WHO-supported health facilities at risk of closure by June, potentially leaving millions without access to care.1 This collapse affected primary healthcare clinics, nutrition programs, and disease surveillance systems. Cases of measles, malaria, and other infectious diseases increased, and the lack of functioning clinics hindered detection and response efforts.1 Restrictions on women’s employment further limited access to healthcare, disproportionately affecting vulnerable populations.
The Need for a “Transition Discipline” Framework
To mitigate the harmful effects of aid withdrawal, the concept of “transition discipline” has been proposed as a governance framework. This approach emphasizes a set grace period for budget adjustments, a minimum package of essential services to be maintained, and a transparent transition plan outlining responsibilities for both donors and governments.1 Implementing such a framework could help prevent sudden disruptions and reduce harm to vulnerable populations.
Implications for Global Health Governance
The reduction in external health aid exposes critical weaknesses in global health systems, particularly in countries with high donor dependence. The experiences of Nepal and Afghanistan highlight the need to move beyond a sole focus on building resilience and address the governance of aid withdrawal processes. A “transition discipline” framework offers a pathway toward more predictable, transparent, and ethically managed funding reductions, ultimately protecting essential services and minimizing avoidable harm.1
WHO’s Perform in Nepal
The WHO continues to play a vital role in Nepal’s health sector. Recent activities include supporting the country’s efforts to eliminate lymphatic filariasis by 2030, collaborating with the National Public Health Laboratory to expand surveillance networks, and assisting in outbreak response.3 The WHO Country Cooperation Strategy (CCS) 2023-2027 focuses on strengthening the federal health system, enhancing health security, harnessing data and technology, and addressing health determinants through multisectoral partnerships.3, 4
- Ghimire, A. Not Every Country Can Absorb a Shock: Unequal Capacity to Withstand World Health Organization Aid Cuts. Public Health Challenges. 2026;3(1):1-7. https://pmc.ncbi.nlm.nih.gov/articles/PMC12976653/
- News-Medical.net. Nepal and Afghanistan show how abrupt aid cuts can unravel essential care. 2026. https://www.news-medical.net/news/20260324/Nepal-and-Afghanistan-show-how-abrupt-aid-cuts-can-unravel-essential-care.aspx
- World Health Organization. WHO Nepal. Accessed March 25, 2026. https://www.who.int/nepal/
- ReliefWeb. Nepal-WHO Country Cooperation Strategy (CCS) 2023-2027. Accessed March 25, 2026. https://reliefweb.int/report/nepal/nepal-who-country-cooperation-strategy-ccs-2023-2027
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