Article by Syriacus Buguzi in The Lancet
Volume 406, Issue 10519p2525-2526November 29, 2025

"Following a large drop in international aid, and the harms that followed, Tanzania is taking steps to decrease its reliance on external funding for health. Syriacus Buguzi reports from Dar es Salaam.
Having relied for decades on foreign aid to tackle health issues such as HIV/AIDS, tuberculosis, and malaria, Tanzania is taking a major step to fund its own health care following US President Donald Trump's policies that led to widespread aid cuts. The east African nation now aims to generate additional revenue from taxpayers, totalling US$225 million—about half of its 2024–25 health-care budget—to make up for declining donor funding for HIV and other health initiatives.
Tanzania's move epitomises a broader global trend where developing nations are seeking greater self-reliance as international priorities shift. Inspired by the “trade, not aid” model, countries including Rwanda and Ethiopia have already made strides in domestic health financing, reducing dependency on external aid and minimising vulnerability to geopolitical changes.
Donors have historically funded more than 40% of Tanzania's health expenditures, according to REPOA, a policy research organisation in Tanzania. The USA was the largest funder, contributing $2·8 billion annually between 2012 and 2022, but other major donors include the UK, Canada, and Scandanavian countries as well as The Global Fund to Fight AIDS, Tuberculosis and Malaria, The World Bank, and WHO. In 2024, for example, Tanzania received $166 million in HIV/AIDS assistance from the USA. It is the seventh largest recipient of aid in Africa.

However, after Trump took office earlier this year, all foreign aid spending was frozen as part of his America First agenda, with the US Agency for International Development (USAID) dismantled and the US President's Emergency Plan for AIDS Relief (PEPFAR) transformed. Official development assistance to Tanzania plummeted from $761 million in 2013 to a projected $118 million in 2025, a severe reduction that forces the country to pursue a path of self-reliance.
For Tanzania, these changes have served as a wake-up call, prompting an overdue commitment to financial autonomy in the health sector. “The decline in development assistance is already palpable, and its impact is felt so acutely that it necessitates a huge investment in our healthcare systems now more than ever”, says Ntuli Kapologwe, a Tanzanian health systems researcher and Director General of the East, Central, and Southern Africa Health Community.
In June, in response to significant cuts in aid from the US Agency for International Development (USAID), Tanzania's then Minister of Finance, Mwigulu Nchemba, announced a raft of measures including new taxes and levies to raise additional revenue for health care. This includes increased excise duties on alcoholic beverages and electronic communication services, and new levies on fuel, minerals, imported vehicles, sports betting, land-based casinos, and train and air transportation tickets.

The Ministry of Finance said that 30% of the revenue from the taxes and levies go to the Universal Health Fund, established to help finance Tanzania's push towards universal health coverage. The other 70% of the revenue would be allocated to the AIDS Trust Fund—an initiative established by Parliament in 2001 to increase domestic funding for the country's HIV/AIDS response. According to UNAIDS, an estimated 1·7 million people in Tanzania were living with HIV in 2022. The fund “had remained largely dormant, despite showing promising results between 2016 and 2020 when there were efforts to implement initiatives”, says Elisha Osati, a researcher in infectious diseases and Chairman of the Tanzania Sickle Cell Disease Alliance who has been advocating for the revival of the AIDS fund in the wake of the aid crisis. The funds are expected to help sustain the supply of antiretroviral drugs, strengthen the wider national HIV health system, and support progress towards the UNAIDS 95-95-95 HIV goals."

Full text

Interesting article in IMF F&D Magazine

Behind the Veil of Tariff Fixation
MICHAEL PETTIS
September 2025

The world needs a broader conception of trade policy that considers how economies allocate income

"In the heated debates over trade policy in Washington and beyond, tariffs are often portrayed as the primary—or even the sole—instrument by which governments intervene in global commerce. They are easy to quantify, easier to politicize, and readily wielded in bilateral negotiations.

But this focus on tariffs is misleading. It obscures the more fundamental mechanisms by which countries shape their trade relationships with the world. Because a country’s internal imbalances between consumption and production must always be consistent with its external imbalances, anything that affects the former must affect the latter, and vice versa. Tariffs are just one of many tools a government can use to change a country’s internal imbalance.

Like most such tools, tariffs work by shifting income from consumers to producers. But because of their visibility, they are often among the most politically contentious of these tools. By contrast, many of the most powerful trade interventions in today’s world occur not as tariffs but as policy choices that don’t appear to be related to trade at all. Fiscal decisions, regulatory structures, labor policies, and institutional norms can all affect how income is distributed, and how economies are balanced between consumption and production, with far-reaching implications for global trade.

To understand why tariffs receive such disproportionate attention, it helps to consider their visibility. A tariff is a line item in a trade negotiation affecting the price of an imported good. It’s easy to identify, easy to weaponize, easy to reverse, and very obviously linked to trade. But the very simplicity that makes a tariff politically salient also makes it a poor proxy for trade policy as a whole."


https://www.imf.org/en/Publications/fandd/issues/2025/09/point-of-view-behind-the-veil-of-tariff-fixation-michael-pettis

A Case for Cities in Local Government Reorganisation and English Devolution
https://www.caseforcities.uk

Interesting and very readable report by Inner Circle Consulting https://www.innercircleconsulting.co.uk that focuses on devolving greater power and responsibility to cities in England.  This may have a resonance in other countries looking at devolution.

Brief Summary
Cities are England’s growth engines, but too many are still governed by outdated boundaries defined a generation ago.
This report sets out a practical plan to right-size city governance, embed prevention into public services, and create a connected network of high-performing cities that drives national prosperity. It’s a time-limited opportunity created by Local Government Reorganisation (LGR) and the new wave of devolution. We argue for decisive action now - before the window closes.

The Case for Cities report was prepared on behalf of the cities of Peterborough, Lincoln, Reading, Gloucester, Oxford, Norwich, Swindon, Exeter, Ipswich, and Cambridge. A coalition of fast growing cities of national significance
Harnessing the opportunities of population growth, while closing the productivity gap through the right powers, governance and geographies, is critical if cities are to realise their full potential as drivers of national prosperity. This will unleash the untapped potential of English cities
The data shows that cities in England have untapped potential when we compare them to international averages and perform unevenly when compared to national benchmarks. Some cities — from Ipswich to Swindon — perform strongly on productivity, most English cities fall well below international peers. Patterns of population growth are also varied: Cambridge, for example, grew by over 17% between 2013 and 2023, compared with 7% nationally and 6% in London.
Local government reorganisation and devolution represent a unique chance to address the barriers to urban growth and unlock potential for cities across England

A summary of the recommendations

To create the conditions for a network of enabled cities to contribute to our collective future, we need to:

Empower cities through single-tier governance
By creating a new generation of city-led unitaries, distinct from county-scale models, so cities can govern at the right scale to deliver growth, reform, and prevention for their communities.

Right-size city-led unitaries
By reforming outmoded boundaries so cities can plan and deliver across the real places where people live, work, and move.

Commit to a long term national cities strategy
By establishing a long term cross-government strategy that recognises cities’ role in delivering national missions and key commitments such as the spending review and industrial strategy.

Back a polycentric England
By investing in a connected network of high-performing cities, beyond the core city-led metropolitan areas, to drive balanced growth across England and the UK.

Hardwire prevention into public services
By equipping cities to lead on prevention by aligning health, housing, and care services at the urban scale, with the data, powers, and partnerships needed to act early.

Embed city-led unitaries in devolution deals
By ensuring all Mayoral Strategic Authorities (MSAs) have strong, empowered city-led unitaries, capable of driving delivery and shaping strategy from the ground up.


To me the most challenging recommendation is hardwire prevention into public services at the right scale so that the moment can be used to reform service delivery, giving cities the power to deliver effectively on prevention by aligning services across health, housing, and welfare at the urban scale, with the data, powers, and partnerships needed to act early.  This will require significant changes in how different agencies under different government structures work such as health care under central government and social care under local government.  This is something that has been talked about but nothing has actually happened. Will this require a city block grant system similar to that which is in place for Scotland?  This might require a change to the Barnett Formulae! And what about the surrounding rural areas with respect to specialist hospital health care which tend to be more city-located?  Perhaps a more regional approach combining rural and urban with a further city and rural focus within the region? Is this something that central government and a Treasury that is more focused on financial control would contemplate?

Perhaps the recommended scale of devolution may have a chance of being implemented as it may not frighten off the Treasury. Nevertheless this work is a great step forward in the area of devolution and brings me back to the Northern Region Strategy Team which reported in 1977!  Implementing its recommendations would have been a huge step forward and have achieved what the Cities report is aimed at.

Interesting paper on property taxes

A practical alternative to replace stamp duty and council tax
Tim Leunig
Chief Economist Onward

"The way Britain taxes households is both impractical and unfair. The stamp duty land tax raises transaction costs, preventing people from moving for new job opportunities, and undermines growth.
This report sets alternatives to the status quo and the rationale for these choices. In some cases, they are based on a clear and overwhelming economic principle. In others, they are a way to try to marry sometimes conflicting ideas
and sometimes they are a response to the realities of political consent."

https://www.ukonward.com/wp-content/uploads/2024/08/Onward-A-Fairer-Property-Tax.pdf

Interesting article in the Lancet which poses the question: IFC or IDA Is the former contradicting the latter?


"Despite promising to help alleviate poverty, World Bank investments in private hospitals in east Africa have resulted in catastrophic out-of-pocket payments for many. Ben Dooley and Micah Reddy for the International Consortium of Investigative Journalists."
World Bank-financed hospitals left patients with “crushing debt”
Dooley, Ben et al.
The Lancet, Volume 406, Issue 10499, 117 - 118
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01433-3