ODA Spending

How much ODA does the US allocate to global health?

In 2022, the US was the largest donor to global health, providing US$15.8 billion in health ODA. The US spent 30% of its development assistance on global health, second only to Canada in terms of relative prioritization.

How does the US allocate global health ODA?

As with its overall development budget, the US channeled the majority of its ODA bilaterally in 2022.

Bilateral Spending

The US spent a total of US$11.8 billion on bilateral health ODA in 2022, including earmarked funding through multilaterals. This represented 75% of its ODA to health.

Multilateral Spending and Commitments

The remaining 25% of the US’ health ODA was channeled as core funding to multilaterals. The US also pledged US$1.2 billion in direct contributions to Gavi for 2020-2023, an increase of US$200 million over its 2015-2018 pledge. In 2022, the US pledged a total of US$6 billion to the Global Fund for 2023-2025. The Global Fund continues to have strong bipartisan support on Capitol Hill.

Funding and Policy Outlook

What is the current government's outlook on global health ODA?

Global health has traditionally received bipartisan support, including for PEPFAR, which is the largest bilateral global health programs: Despite this, global health was cut slightly from FY2023 to FY2024, down from US$10.6 billion to US$10 billion. The FY2025 request was US$9.9 billion. Most of this decrease is due to falling contributions to the Global Fund, which are limited by the US law restricting US contributions proportionally to other donors. Global health security saw increases in the wake of COVID-19. The FY2024 budget requested US$1.3 billion for this sector, however, the final allocation was US$700 million. The FY2025 budget slightly increases MNCH and family planning and reproductive health, while leaving funding for bilateral HIV, TB, malaria, nutrition, vulnerable children, and NTDs essentially level.

The US’ main global health priorities are controlling the HIV/AIDS epidemic, fighting infectious diseases, and preventing child and maternal deaths: US global health spending for FY2023 includes US$4.4 billion for PEPFAR, as well as funding for SRHR, HIV/AIDS, malaria, tuberculosis, MNCH, and nutrition. According to the Kaiser Family Foundation, funding from the US accounted for 73% of international assistance to HIV from donor governments in 2021. The PEPFAR, which covers bilateral funding for HIV/AIDS and TB programs, as well as US contributions to the Global Fund and UNAIDS, channels about two-thirds of all US funding for global health. The US is also the largest funder of global initiatives to combat malaria. The US’ efforts against malaria are achieved primarily through PMI, an interagency initiative led by USAID. In FY2023, US bilateral malaria funding amounted to US$795 million. The Biden administration’s FY2024 budget proposes to reduce this funding down to US$780 million. In October 2021, PMI released a five-year End Malaria Faster strategy for 14 African countries, following the WHO’s approval of a groundbreaking malaria vaccine.

Global health emerged as a focus of the US’ ODA following the COVID-19 pandemic: In 2021, Biden allocated US$3.5 billion to the Global Fund and US$5.2 billion to USAID. Biden also launched a National Security Council Directorate on Global Health Security and Biodefense. In July 2021, the Biden administration released a US COVID-19 Global Response and Recovery Framework to end the pandemic, mitigate its negative impacts, and strengthen future pandemic preparedness.

In a global health policy speech in April 2023, USAID outlined a three-point strategy for turning the tide on global public health. The three focus areas include: managing COVID-19 as an endemic disease, building up global capacity to address potential future pandemics, and investing in primary healthcare workers across the globe. Biden’s FY2025 budget requested US$20 million for a global health workers’ initiative, which is US$10 million more than FY2024 enacted levels.

A significant focus of US health ODA is support for MNCH: In FY2024, US$915 million went toward MNCH, much of which is allocated through USAID. The FY2025 request is for US$940 million. Despite the US’ policy emphasis on MNCH, family planning is a contentious issue in the US, particularly under Republican administrations. The Biden Administration repealed two policies reinstituted under the first Trump administration that restrict US funding for SRHR programming: the Kemp-Kasten Amendment and the Mexico City Policy. The Kemp-Kasten Amendment withheld all US funding to UNFPA. The Mexico City Policy, also known as the ‘global gag rule’, blocked US global health funding for both non- US NGOs directly involved in abortion services or abortion rights advocacy and for those who fund or support other groups that provide or discuss abortion. Family planning funding has remained level from FY2023 through FY2024 at US$608 million. Biden’s FY2025 budget request asks for US$623 million for family planning.

In March 2023, USAID released its MNCH strategy document Preventing Child and Maternal Deaths: A Framework for Action in a Changing World, 2023-2030. The strategy advances plans to reduce preventable maternal and child mortality in 25 target countries to 12% or lower as compared to total deaths by 2030.

To meet these objectives, the USAID strategy outlined the following priorities:

• Primary health care among the most underserved populations;
• Fostering local partnerships and commitments;
• Increasing investment in the healthcare workforce;
• Tailoring solutions to local contexts and priorities; and
• Increasing and improving evidence-based results.

Key Bodies

Global health R&D is also important to addressing many of the global health challenges that disproportionately affect the world’s most disadvantaged people. For more information on how donor countries are supporting global health R&D across three main areas — 1) EIDs; 2) PRNDs; and 3) SRH — read the excellent G-Finder reports and explore the interactive data portal created by Policy Cures Research. Not all funding mentioned in these analyses qualifies as ODA.