A Thematic Review of the Potential Future Role of the World Bank in Financing Health Systems

Sharp aid cuts in 2025 and the immediate financing crisis they precipitated have brought to the fore calls to address longstanding challenges in the global health aid architecture. While a greater role for multilateral development banks (MDBs) moving forward has been suggested, the feasibility and suitability of such a shift have yet to be explored in depth. This paper pairs a descriptive analysis of the World Bank’s health portfolio with a thematic analysis of how the Bank engages in the health sector. The aim is to describe the World Bank’s current role in health financing, identify its strengths and weaknesses, and inform discussions on its potential future role—as well as the broader role of MDBs—in health financing. We find that the World Bank is a major financier of health, with an estimated $7.0 billion in 2025 health commitments: $3.5 billion from the International Development Association (IDA), $2.8 billion from the International Bank for Reconstruction and Development (IBRD), and $713 million from trust funds. World Bank financing is equivalent to 16 percent of government health expenditure in IDA countries and just 0.4 percent in IBRD countries. However, health comprises a relatively small share of the World Bank’s overall active portfolio, at 7 percent. The World Bank has substantial advantages that could be built on: a country-led approach, coverage of nearly all low-income countries, on-budget financing, the ability to use both loans and grants, and a multisectoral approach to health. The World Bank also has significant downsides. It has many competing priorities and limited tools to earmark resources for health; given its demand-driven nature, governments choose which sectors to prioritize with Bank financing, and health is often not at the top of the list. The World Bank also faces external pressures, internal incentive structures, and operational challenges that risk undermining the effectiveness of an expanded health portfolio. If these challenges can be mitigated, the World Bank has a prominent role to play in the future of health financing.