Article processing charges and health research output in low-income countries: funding cuts, implications for health policy and system management

Article processing charges (APCs) pose a material barrier to the dissemination of health research from low income countries where recent funding cuts compound limited domestic financing and fragile health systems. Despite carrying a disproportionate share of global disease, these settings contribute under one percent of global research publications. This Perspective piece explores how APCs and funding cuts intersect to shape research output, summarises mitigation efforts and gaps, and proposes practical options for more equitable access to scholarly publishing. APCs are reported to shape venue choice for researchers in low income countries, while reduced external funding leaves fewer upstream resources to absorb costs. Country examples point to institutional and capacity pressures. Early career researchers often face disproportionate obstacles including slower progression and reduced competitiveness. Waiver policies and regional initiatives such as AJOL, SciELO South Africa and AfricArXiv offer partial relief, yet inconsistencies in eligibility, awareness and implementation persist with ethical implications. A rights and equity oriented response would include tiered APC models, automatic waivers linked to country income classification, ring fenced support for health research in low income settings, greater investment and independent evaluation of diamond open access platforms, and focused research on the effects of funding cuts on APCs and dissemination in low income contexts.