Global reductions in development assistance could reverse decades of health progress in Bangladesh and trigger nearly 23 million additional deaths by 2030 across 93 low- and middle-income countries, including 5.4 million children under five, according to a new study published in The Lancet Global Health.
The peer-reviewed analysis, led by researchers at the Barcelona Institute for Global Health (ISGlobal) and supported by The Rockefeller Foundation, warns that deep cuts to official development assistance (ODA) by major donor countries could undermine progress achieved over the past two decades in child survival, infectious disease control, and health-system strengthening.
Bangladesh is among 21 Asian countries examined in the study, alongside India, Pakistan, Afghanistan, Nepal, Myanmar, and Indonesia. Researchers note that three out of four people worldwide live in countries where gains against infectious diseases and child mortality could stall or reverse if aid reductions continue.
Aid cuts and global impact
In 2024, international assistance fell for the first time in six years. Major donors, including the United States, United Kingdom, France, and Germany, reduced contributions, while the Organization for Economic Co-operation and Development projects a further 10%–18% decline in ODA from 2024 to 2025.
Using 20 years of development data from 2002 to 2021 and country-level microsimulation models, ISGlobal researchers projected two scenarios for 2025–2030:
- Mild defunding: A 6% annual reduction in aid could result in 9.4 million additional preventable deaths globally, including 2.5 million children under five.
- Severe defunding: A $32 billion (15.1%) cut between 2024 and 2025, followed by further reductions, could lead to 22.6 million additional deaths, including 5.4 million children under five.
Lead author Davide Rasella, an ICREA research professor at ISGlobal and the Brazilian Institute of Collective Health, said: “Withdrawing this support now would not only reverse hard-won progress, but would translate directly into millions of preventable adult and child deaths in the coming years.”
Two decades of gains at risk
The study highlights the impact of ODA between 2002 and 2021 across the 93 countries examined, including:
- A 23% reduction in all-cause mortality
- A 39% decline in child mortality
- A 70% reduction in HIV/AIDS-related deaths
- A 56% drop in deaths from malaria and nutritional deficiencies
- Over a 50% reduction in deaths from diarrheal diseases and neglected tropical diseases
Aid flows also strengthened health systems, improved disease surveillance, and enhanced epidemic preparedness. An earlier ISGlobal study found that dismantling the United States Agency for International Development (USAID) alone could lead to more than 14 million additional deaths by 2030; the new analysis covers all OECD donor countries.
Implications for Bangladesh
For Bangladesh, which has long relied on international support for key health interventions, projected aid cuts could have far-reaching consequences. Critical programs dependent on external funding include:
- Tuberculosis and malaria control
- Maternal and child health initiatives
- Nutrition interventions
- Epidemic preparedness
- Climate-health resilience
Dr Mohammad Shawkat Hossain Khan, director of the Health Economics Unit of the Government of Bangladesh, told Dhaka Tribune: “icddr,b has already laid off more than 2,000 staff due to funding shortages. A tuberculosis project has been shut down, a malaria project discontinued, and research funding has declined significantly. Donations to implementing agencies have dropped sharply. As a developing country, we are at serious risk if this trend continues.”
He added that Bangladesh, as a lower-middle-income country still grappling with infectious diseases, malnutrition, and climate vulnerability, remains highly exposed to volatility in external funding.
Professor Dr Sheikh Sayidul Haque, additional director general (Planning and Development) of the Directorate General of Health Services (DGHS), said: “We will receive the new cycle of the Global Fund within the next week; then we can reassess our next action plan.”
Public health experts warn that abrupt reductions in international aid could destabilise disease surveillance, disrupt medicine supply chains, and weaken public health infrastructure—threatening hard-earned gains in child and maternal health, infectious disease control, and epidemic preparedness.
A global warning
Rajiv J Shah, president of The Rockefeller Foundation, described the findings as “a warning of the profound moral cost” of shrinking foreign-aid commitments.
“The question before humanity today is whether we will accept a global retreat from commitments to feed the hungry, cure the sick, and lift up the most vulnerable,” he said.
With many low- and middle-income countries still confronting climate shocks, food insecurity, and post-pandemic recovery challenges, the study argues that sustained international financing is critical to protecting both global and national health gains.
