{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T08:48:54Z","timestamp":1774601334416,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>External health aid is contracting sharply, and this moment is often framed as a stress test of health system resilience. This perspective argues that it is equally a stress test of global health ethics and governance: When external actors withdraw from essential services, they are not merely responding to fiscal constraints\u2014they are shaping who loses care. In 2025, the World Health Organization (WHO) projected a 30%\u201340% decline in external health aid to low\u2010 and middle\u2010income countries (LMICs) and urged governments to protect essential services, integrate programs into primary healthcare, and improve efficiency. Yet recent developments show that even well\u2010intentioned national reforms cannot fully absorb abrupt donor exits when core functions have long depended on external finance and coordination. Drawing on up\u2010to\u2010date evidence from Nepal and Afghanistan, this article shows how abrupt reductions in WHO and United States (US) support have simultaneously disrupted family planning, nutrition, immunization, community\u2010based care, and disease surveillance. In Nepal, the halt of US assistance exposed profound single\u2010donor dependence for contraceptive supply, nutrition programing, and elements of immunization financing\u2014turning commodity gaps into system\u2010wide operational strain. In Afghanistan, a funding shortfall placed a large share of WHO\u2010supported facilities at risk of closure as measles and other outbreaks intensified, amplifying existing access barriers\u2014especially for women and girls. These cases reveal a missing governance standard: There is no shared rulebook for how external actors should exit from essential services in fragile settings. This perspective proposes \u201ctransition discipline\u201d as a practical global norm that links any reduction in support to (i) a time\u2010bound grace period, (ii) a publicly specified minimum protected service package, and (iii) a transparent, joint transition plan with clear responsibility. Transition discipline cannot eliminate all risk, but it can make inevitable cuts more predictable, accountable, and less detrimental.<\/jats:p>","DOI":"10.1002\/puh2.70208","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T08:44:52Z","timestamp":1773218692000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Not Every Country Can Absorb a Shock: Unequal Capacity to Withstand World Health Organization Aid Cuts"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2167-5771","authenticated-orcid":false,"given":"Animesh","family":"Ghimire","sequence":"first","affiliation":[{"name":"Sustainable Prosperity Initiative Nepal  Kathmandu Nepal"},{"name":"School of Public Health Chitwan Medical College  Chitwan Nepal"},{"name":"School of Nursing Chitwan Medical College Chitwan Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"WHO WHO Issues Guidance to Address Drastic Global Health Financing Cuts(WHO2025) https:\/\/www.who.int\/news\/item\/03\u201011\u20102025\u2010who\u2010issues\u2010guidance\u2010to\u2010address\u2010drastic\u2010global\u2010health\u2010financing\u2010cuts."},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.17834.1"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czaa032"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2017.36"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2025.101279"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czac063"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102020\u2010003896"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12992\u2010023\u201000999\u20106"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/13540661251391116"},{"key":"e_1_2_15_11_1","unstructured":"CediRates Government Uncaps NHIS Injecting About GH\u00a234b to Strengthen Scheme(CediRates 2025) https:\/\/cedirates.com\/news\/government\u2010uncaps\u2010nhis\u2010injecting\u2010about\u2010gh34b\u2010to\u2010strengthen\u2010scheme\/."},{"key":"e_1_2_15_12_1","unstructured":"International Trade Administration Ghana Country Commercial Guide(International Trade Administration 2025) https:\/\/www.trade.gov\/country\u2010commercial\u2010guides\/ghana\u2010healthcare."},{"key":"e_1_2_15_13_1","unstructured":"Africa Reach Nigeria's Proactive Response to USAID Funding Freeze: A Model for Sustainable Health Financing(Africa Reach 2025) https:\/\/www.africareach.org\/nigerias\u2010proactive\u2010response\u2010to\u2010usaid\u2010funding\u2010freeze\u2010a\u2010model\u2010for\u2010sustainable\u2010health\u2010financing\/."},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2025.2543103"},{"key":"e_1_2_15_15_1","unstructured":"WHO Eighty Percent of WHO\u2010Supported Facilities in Afghanistan Risk Shutdown by June(WHO 2025) https:\/\/www.emro.who.int\/afg\/afghanistan\u2010news\/eighty\u2010percent\u2010of\u2010who\u2010supported\u2010facilities\u2010in\u2010afghanistan\u2010risk\u2010shutdown\u2010by\u2010june.html."},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.9745\/ghsp\u2010d\u201018\u201000425"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12992\u2010023\u201000945\u20106"},{"key":"e_1_2_15_18_1","article-title":"U.S. Aid Halt to Nepal's Health Sector: Nutrition and Immunization Programs in Crisis","author":"Nepal Health News","year":"2025","journal-title":"Nepal Health News"},{"key":"e_1_2_15_19_1","unstructured":"A.Poudel Health Facilities Across the Country Without Birth Control Shots for Months(Kathmandu Post 2025) https:\/\/kathmandupost.com\/health\/2025\/11\/06\/health\u2010facilities\u2010across\u2010the\u2010country\u2010without\u2010birth\u2010control\u2010shots\u2010for\u2010months."},{"key":"e_1_2_15_20_1","volume-title":"The Trump Administration Is Gutting USAID. Nepali Infants Will Starve, Officials Warn","author":"Kandel Y. 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