Financing the transition: a roadmap for sustaining disease control in low- and middle-income countries after the 2025 contraction in development assistance for health.

In 2025, development assistance for health fell by about 21% in a single year, driven largely by a 67% reduction in United States financing, disrupting HIV, tuberculosis, malaria, immunization and maternal health programs across low- and middle-income countries. Modelling indicates millions of avoidable deaths by 2030 if the resulting gap is not filled, yet most recipient governments have not reprioritized budgets or raised domestic revenue in response. This brief argues that the contraction is structural rather than cyclical and sets out a sequenced transition-financing roadmap. It proposes phased, country-led actions: protect frontline services immediately; mobilize domestic revenue through progressive as well as consumption taxes and restructure debt over the medium term; and embed efficiency and pooled procurement under the Lusaka Agenda, without allowing efficiency to substitute for adequate public financing.