From critical health worker shortages to rising noncommunicable diseases and climate threats, health systems in low- and middle-income countries are under immense strain. Understanding these challenges is key to building resilient systems that save lives and reduce economic burden.
In many low-income countries, accessing basic healthcare can be risky, expensive—or impossible. From hospitals running out of supplies to families pushed into poverty by out-of-pocket payments, health systems in low- and middle-income countries (LMICs) often falter under pressure. And when emergencies strike, the cracks widen.
According to the World Health Organization (WHO), over 8 million people die each year from preventable causes linked to poor-quality care, with LMICs bearing the brunt. The global economic impact? An estimated $6 trillion in losses annually.
These aren't abstract numbers. They reflect real-world outcomes—from missed prenatal visits to untreated chronic conditions—all rooted in the same core issue: under-resourced, overstretched, and structurally vulnerable health systems.
The WHO projects a global shortfall of 10 million healthcare workers by 2030, with LMICs hit hardest. While the most severe shortages affect LMICs, workforce instability—manifesting as burnout and strikes—has also been seen in countries such as South Korea, the UK, and New Zealand. This underscores that even stronger health systems globally are struggling, but the consequences are most damaging in resource-limited settings.
Over 70% of surveyed nations report serious health service disruptions—often triggered by sudden cuts in official development assistance. These cuts have led to medicine shortages, job losses, and weakened emergency preparedness—conditions that resemble the peak disruptions of the COVID-19 era. (WHO)
Diseases like diabetes, heart disease, and cancer now account for 80% of deaths in LMICs, overtaking infectious diseases. Yet most health systems in these countries remain unequipped to manage long-term, chronic care. (World Economic Forum)
About half the world's population lacks access to essential health services. Two billion people face severe financial hardship from healthcare costs. In LMICs, poverty, geography, and infrastructure gaps continue to limit access and quality. (World Bank)
Telemedicine, health apps, and digital records offer hope—but limited internet access, electricity shortages, and privacy concerns hinder progress. Even the most innovative tools can't scale without reliable infrastructure. (World Economic Forum)
Even when services exist, quality remains a major concern. Poor care—not just lack of care—is a leading cause of preventable deaths. Specialized services like surgery and anesthesia remain out of reach in many LMIC settings. (ScienceDirect, MDPI)
Resilience starts at the primary healthcare level. Strengthening public healthcare systems can save up to 60 million lives and boost life expectancy by 3.7 years by 2030. Rwanda, for example, scaled up its community-based health insurance (Mutuelle de Sante) from 36% coverage in 2006 to over 90%, improving access and reducing financial strain during health crises.
Governance reforms and smarter economic policies also play a role. Strengthening financing models, accountability, and local leadership can build durable systems that withstand shocks.
And as climate threats grow, climate-resilient health infrastructure becomes urgent. WHO calls for $65 billion in investment over the next 5-8 years to adapt health systems to extreme weather, food insecurity, and rising disease burdens—all intensified by climate change.
Organizations working on health system strengthening aren't just identifying the issues —they're equipping local advocates with tools to create real policy change.
In Nigeria's Kano State, advocacy led to a doubling of budget allocations for noncommunicable disease prevention. In Uganda, support for local coalitions helped secure funding for epidemic preparedness. In the Maldives, targeted policy efforts contributed to historic investments in civil registration systems.
Groups like the Global Health Advocacy Incubator offer technical assistance in areas like legal strategy, political mapping, and communications—supporting civil society organizations to lead change from within their own systems.
Fixing health systems in LMICs isn't about silver bullets. It's about consistent, strategic action across funding, quality, equity, and governance—especially at the local level. While the problems are complex, the solutions are within reach when advocacy, policy, and expertise align.
