Structural challenges, including financial constraints and shifting global priorities, are straining healthcare systems in the Global South. These overburdened and weak healthcare systems struggle to meet demand, worsening disparities, slowing progress on the Sustainable Development Goals (SDGs) and hurting economic growth. Ageing populations and declining funding exacerbate the crisis. Without action, healthcare systems risk collapse, deepening inequalities.

Strain on public healthcare systems

• Overburdened and underfunded healthcare struggles to meet demand: Public hospitals and clinics suffer from insufficient funding, leading to overcrowding, medical supply shortages and outdated infrastructure. Healthcare facilities are often under-equipped, limiting access to essential services. In South Africa, stagnant health spending over the past decade has failed to keep pace with growing needs.

• Healthcare worker shortages worsen service gaps: Many low- and middle-income countries (LMICs) face shortages in trained healthcare workers, exacerbated by unfunded posts, that further limit service delivery. Brain drain remains a major challenge as health professionals leave for better-paying jobs abroad, worsening healthcare-access gaps.

Health inequality: Weak healthcare systems deepen disparities and slow SDG progress

• Income inequality remains high: According to the World Bank’s 2024 Leveling the Playing Field report, over half of African countries have a Gini index above 40, indicating high inequality.While global extreme poverty has declined, on the continent poverty reduction has stalled over the past decade.South Africa remains the world’s most unequal country, with a Gini coefficient of 63.0.

• Weak healthcare reinforces social and economic disparities: Inadequate healthcare access leads to poorer health outcomes, reducing productivity and economic participation. Without intervention, inequality will widen, making it even harder to achieve SDG targets related to health, poverty reduction and economic growth.

• Economic development in the Global South depends on a healthy population: Economic growth and competitiveness in the Global South depend on a healthy, well-fed and productive population. The UN’s food security (SDG 2), healthcare (SDG 3) and reduced inequality (SDG 10) goals aim to build a resilient population that contributes to the economy. Without progress on these goals, poor health will weaken the workforce, lower productivity and hurt competitiveness.

Role of G20 presidencies in healthcare

The past three G20 presidencies focused strongly on pandemic preparedness and response (during and after COVID-19) by highlighting the importance of global solidarity in healthcare. They concentrated on strengthening global health systems, ensuring equitable access to healthcare for all, addressing health inequities through the promotion of universal health coverage (UHC), driving local vaccine production and strengthening health financing.

Yet past G20 presidencies had various shortcomings in their approach to healthcare. They could have done more to highlight the disparities between LMICs and high-income countries, such as insufficient focus on global health security, inadequate investment in health systems, a lack of effective mechanisms for addressing health crises and essential medicine and vaccine procurement. They could also have taken more direct action to reach consensus on critical health issues and translate commitments into action.

• Indonesia’s 2022 G20 presidency played a pivotal role in the global vaccine supply chain and advocated for vaccine equity. It encouraged G20 members to continue collaborating with all countries, especially LMICs, as well as with international and civil society organisations, and emphasised the need for G20 countries to work together to address health inequities. The presidency addressed the gaps in pandemic prevention, preparedness and response (PPR) and the need to strengthen health system recovery to respond to health emergencies. The three specific health priority issues for pandemic PPR were: building global health system resilience; harmonising global health protocols; and expanding global manufacturing and research hubs. It also agreed to implement the G20 Health Ministers’ Action to Strengthen Global Health Architecture.

• India’s 2023 G20 presidency encouraged cooperation to prevent and prepare for future pandemics, as well as the elimination of ongoing health threats to ensure robust and equitable economic and social development with a focus on equitable healthcare access for LMICs. India encouraged a strong G20 message regarding development, manufacturing, supply chain integration and delivery of medical pandemic preparedness countermeasures, such as vaccines and medicines. It also stressed the role of digital health applications and pushed for data sharing and health data interoperability across G20 countries. The presidency similarly prioritised the eradication of tuberculosis and mitigation of non-communicable diseases. It requested members to build capacity to strengthen the One Health Initiative and address antimicrobial resistance.

• Brazil’s 2024 G20 presidency prioritised the strengthening of pandemic prevention, preparedness and response, focusing on enhancing local and regional production of medicines, vaccines, diagnostics and strategic health supplies. It emphasised the need to build resilient health systems, improve digital health and address climate change’s impact on health. Health equity was a crosscutting theme, considering the right of every human being to enjoy the highest attainable standard of physical and mental health.

• South Africa’s 2025 G20 presidency is prioritising healthcare, particularly strengthening primary healthcare, building resilient health systems, promoting universal health coverage and addressing non-communicable diseases. The country aims to focus on local pharmaceutical and vaccine production, improve digital health transformation and encourage public–private collaboration to enhance science and innovation in the health sector. On global health challenges, it is urging the G20 to prioritise sustained investments in strengthening diagnostic ecosystems and developing rapid diagnostic tests for pandemic preparedness.

South Africa should use this opportunity to highlight the need for equal distribution of healthcare resources across all regions. Global healthcare crises can arise at any time and preparedness is essential. The G20 presidency can play an important role in addressing healthcare vulnerabilities in the Global South, especially in terms of sustainable health financing systems and equal distribution of healthcare resources. South Africa should do more than just emphasise local production of vaccines and pharmaceuticals by championing (through resourcing research and development) the establishment of financially sustainable production facilities for healthcare products.

This can be in line with the theme of the South African G20 presidency of ‘Solidarity, Equality and Sustainability’.

The Global South can no longer rely on foreign aid to meet the goals set by recent G20 presidencies. Rising protectionism and shifting national priorities have led to reduced foreign aid, worsening healthcare vulnerabilities.

• The Global South depends on foreign aid: The 2024 Financing Global Health report shows that many countries in the Global South rely on foreign aid to fund essential healthcare services, disease prevention programmes and medical infrastructure. In South Africa, the US funded 17% of the national HIV/AIDS programme, highlighting the critical role of external support.

• Deglobalisation and shifting priorities cut foreign aid, which will weaken healthcare: In January 2025, the US suspended foreign aid, leading to weakened healthcare services, stalled infrastructure projects and reduced access to life-saving treatments. Similar reductions in aid, such as US President Donald Trump’s 2017 ‘global gag rule’ cutting $11.6 billion, closed clinics, reduced contraception and HIV programmes and created major health challenges across Africa.

Conclusion

Growing social and economic disparities threaten global security, with the brunt of it putting the Global South at higher risk. Declining aid and demographic pressures push healthcare systems toward collapse, deepening disparities and stalling economic progress. Reduced foreign aid due to more protectionist policies, along with population growth, urbanisation and ageing, will overburden already-fragile healthcare systems, worsen inequalities and slow SDG progress even further.

The G20 should build on the foundations for pandemic preparedness laid by past presidencies to ensure strengthened global health security. Support for the Pandemic Fund, which provides sustainable financing for PPR in LMICs, should be emphasised. Support by the current G20 presidency for initiatives and calls for action on the growing threat of non-communicable diseases; promotion of universal health coverage; strengthening of health systems; attention to the accelerating threat of antimicrobial resistance; and strong advocacy for equitable vaccine distribution and global cooperation on vaccine equity will be instrumental for healthier, more resilient health systems.

The South African G20 presidency should also encourage greater financing for equal healthcare resource distribution across all regions. Fostering good relationships and collaboration with all global players, including the WHO, IMF, World Bank and regional leaders, will be critical in reshaping global health policy.