Global development aid is projected to fall by another 6.9% in 2026, extending an unprecedented three-year contraction, according to a new analysis from the Organisation for Economic Co-operation and Development. The decline would push overall assistance to its lowest level since 2014 and reduce support for health programs to levels not seen in almost two decades.
The forecast follows an 8.5% reduction in official development assistance in 2024 and a record 23.3% fall in 2025. Cuts by the United States and other major donors sharply reduced the money available for health care, humanitarian relief and poverty reduction, and several governments are still implementing multi-year spending reductions.
Health is expected to absorb the deepest sectoral cuts. Bilateral aid for health and population programs could fall by 29% to 46% between 2024 and 2026, a loss of roughly $5 billion to $8 billion. At the upper end of that range, health aid would stand 63% below its 2022 pandemic-era peak and return to levels last seen in 2008.
A third consecutive year of decline
The OECD’s projection is based on a survey of members of its Development Assistance Committee, information from other reporting institutions and publicly announced budget plans. It covers expected aid flows through 2028, although the organization cautions that final totals may change as governments revise spending or respond to new crises.
The scale of the retreat is unusual. The OECD said this would be only the second period on record in which development aid declined for three consecutive years, after a similar run between 1992 and 1995. Official development assistance includes grants and concessional financing intended to support economic development and welfare in lower-income countries.
The latest downturn is heavily concentrated among the world’s largest donors. Germany, France, Japan, the United Kingdom and the United States accounted for 93% of the total decline in net aid recorded in 2025, with the United States alone responsible for about 70%. Some European donors are maintaining steadier budgets, but their spending is not large enough to offset reductions elsewhere.
Health programs face the steepest cuts
The OECD’s health-sector projections show that reproductive health and infectious disease programs are particularly exposed. Aid for population and reproductive health is projected to fall by 54.1% between 2024 and 2026. Support for malaria control could fall by 59.6%, while tuberculosis funding could decline by 57.2% and aid for other infectious disease control by 40.4%.
Those categories include programs that supply medicines, train health workers, operate laboratories, track outbreaks and provide contraceptive and maternal health services. They are often delivered through a mix of national health ministries, United Nations agencies, charities and donor-backed initiatives, which means a single budget cut can affect several parts of a country’s health system at once.
The forecast follows warnings that earlier funding interruptions were already affecting care. A World Health Organization assessment of 108 country offices found disruptions involving maternal care, vaccination, disease surveillance and emergency preparedness. WHO later issued guidance to help governments manage sudden financing shocks and protect essential services.
HIV programs are among the most closely watched. Previous modeling reported by ScienceBlog estimated that major cuts to international HIV funding could lead to millions of additional infections and nearly 3 million deaths by 2030. A separate analysis found that unstable funding for the U.S. President’s Emergency Plan for AIDS Relief could place hundreds of thousands of children at risk.
The poorest countries have the least room to adjust
The projected cuts are not evenly distributed. Bilateral aid to sub-Saharan Africa is expected to fall by another 11.6% in 2026, while assistance to the world’s least developed countries could decline by 10.9%. Both groups are on course for a third straight annual drop, leaving support at its lowest level since the early 2000s.
Countries that rely on a small number of donors are especially vulnerable because one policy change can remove a large share of their external health budget. The OECD highlights Malawi, South Sudan, Mozambique, Lesotho and Uganda as countries where external financing plays a substantial role in supporting health systems. Replacing that money domestically is difficult when governments also face limited tax revenue, high debt-servicing costs and competing demands for education, infrastructure and basic public services.
A rapid donor withdrawal can translate into staff losses, medicine shortages, clinic closures or reduced disease-prevention work before national budgets can respond. The effects are also likely to extend beyond health, with humanitarian aid projected to fall by 40.3% from 2024 to 2026 and support for government and civil society expected to decline by 39.8%.
Multilateral organizations may not fill the gap
United Nations agencies and other multilateral institutions have historically helped spread donor financing across countries and emergencies. The OECD now expects contributions to multilateral organizations to decline by another 3.4% in 2026, marking a third consecutive annual reduction. Core funding for United Nations organizations could fall by around 31% between 2024 and 2026 and remain approximately 18% below its 2016 level by 2028.
That decline weakens the ability of international agencies to redirect flexible funds when a new outbreak, conflict or natural disaster emerges. The World Health Organization says severe funding constraints across the humanitarian system have already disrupted more than 6,600 health facilities and cut off care for over 53 million people. It estimates that 239 million people will require humanitarian assistance in 2026, placing additional pressure on a system with fewer available resources.
The figures are projections, but the direction is clear
The OECD emphasized that its 2026 numbers are projections rather than final spending totals. They are built from announced budgets and donor reporting, and they do not fully account for possible responses to escalating conflicts or other emergencies. Governments could still alter their plans, but many of the reductions are tied to budget decisions scheduled to continue through at least 2028.
The organization argues that donors should concentrate scarce grants on the poorest countries, coordinate withdrawals instead of ending support abruptly and use remaining resources more strategically. After decades in which global aid generally expanded, recipient countries are now being asked to absorb large reductions over a short period. Health systems are particularly sensitive because treatment programs, laboratories and trained workforces cannot always be paused and restarted without losing capacity.
For countries dependent on external financing, the immediate question is not only how much aid remains, but whether funding will arrive predictably enough to keep essential services operating. The OECD’s latest forecast suggests that, in 2026, both the amount and the reliability of that support will continue to weaken.