Health Systems Under Financial Contraction: Assessing the Impacts of Global and National Health Funding Reductions and Advancing Mitigation Strategies

Over many decades, sustained investment in global and domestic health has improved the lives of billions extending life expectancy, reducing preventable deaths, and advancing health equity across regions and income groups. These achievements have been grounded in scientific evidence and guided by shared commitments, most notably Sustainable Development Goal 3 (SDG 3), which calls for universal health and well-being for all ages.

Since 2025, however, significant disruptions to health funding have reshaped this landscape. The US withdrawal from the WHO coupled with sweeping cuts to global health programmes, and reductions in national health systems and health research budgets in a variety of countries, have triggered cascading consequences that continue to unfold. For high-burden diseases such as Tuberculosis and HIV/AIDS, modelling studies suggest these reductions could result in millions of avoidable deaths by 2030. The impacts extend well beyond mortality: patients, caregivers, healthcare professionals, researchers, and the broader public are all affected - across low-, middle-, and high-income countries alike.

Potential mitigation strategies may include service redesign, priority-setting frameworks, workforce innovations, alternative financing mechanisms, digital health solutions, community-led approaches, procurement reforms, and new methods for evaluating interventions under conditions of resource contraction.

As this crisis has deepened, the need for rigorous, evidence-based analysis has never been greater. Alongside assessment, there is urgent demand for actionable mitigation strategies including policy responses, system adaptations, and innovative financing mechanisms that can protect health outcomes and sustain equitable access to care under constrained resources. Traditional frameworks, such as Incremental Cost Effectiveness Ratios and innovation pathways, were largely designed around resource growth; new methods adapted to resource contraction are now critically needed.

This Research Topic has two interconnected aims. First, to consolidate and publish rigorous assessments of the impact of health funding reductions across all relevant domains, from health outcomes and workforce to research capacity and health system resilience. Second, to advance scientific understanding of the policies, management interventions, and system-level strategies that can most effectively mitigate these impacts equitably and sustainably.

The topic is co-hosted in Frontiers in Health Services and Frontiers in Public Health, reflecting its deliberately cross-disciplinary scope. Contributions are welcome from health services researchers, public health scientists, policy analysts, health economists, and practitioners working at global, national, and local levels.

Given the funding constraints affecting the very research community this topic addresses, we particularly encourage methodologically rigorous work that does not require large resource investments: qualitative studies (interviews, focus groups, document analysis), descriptive quantitative studies, secondary data analyses, modelling studies, and rapid reviews. Frontiers in Health Services also offers article types well suited to the pace and nature of this challenge, including Community Case Studies, Policy and Practice Reviews, Policy Briefs, and Brief Research Reports.