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Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Global Burden of Disease Health Financing Collaborator Network Lancet (2017) C1

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spendi... more

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Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Global Burden of Disease Health Financing Collaborator Network Lancet (2020) C1

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to ... more

Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990

Dr. Micah et al. Global Burden of Disease 2020 Health Financing Collaborator Network (2021) CC

The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was di... more

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Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Global Burden of Disease 2021 Health Financing Collaborator Network The Lancet Glob Health (2023) C2

The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well ... more

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Monitoring financial protection and utilization of health services in Mongolia: 2009-2018

World Health Organization, Regional Office for the Western Pacific (2022) C1

Monitoring financial protection and utilization of health services in Mongolia 2009-2018 is based on national representative household socioeconomic surveys. The study finds that between 2009 and 2018, despite ambitious health reforms, the incidence of catastrophic health spending and impoverishing ... more

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Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments

Snow, RW.; Okiro, EO.; Gething, PW.; Atun, R.; Hayc, SI. The Lancet (2010) CC

Financing for malaria control has increased as part of international commitments to achieve the Millennium Development Goals (MDGs). We aimed to identify the unmet financial needs that would be biologically and economically equitable and would increase the chances of reaching worldwide malaria-contr... more

Addis Ababa Action Agenda - Final Document

United Nations (UN) United Nations (UN) (2015) CC

The final text of the outcome document adopted at the Third Internatinal Conference on Financing for Development (Addis Ababa, Ethiopia, 13–16 July 2015) and endorsed by the General Assembly in its resolution 69/313 of 27 July 2015.

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Addis Ababa Action Agenda - Zero Draft

United Nations (UN) United Nations (UN) (2015) CC

Zero draft of the outcome document adopted at the Third Internatinal Conference on Financing for Development (Addis Ababa, Ethiopia, 13–16 July 2015) and endorsed by the General Assembly in its resolution 69/313 of 27 July 2015.

Building blocks out of the crisis: The UN’s SDG Stimulus Plan

Molina G. and L. Jensen United Nations Development Programme (UNDP) (2023) CC

The UN’s SDG Stimulus Plan, which calls for additional liquidity, effective debt restructuring and the expansion of development financing, has the potential to free up significant fiscal space in developing economies. For 52 most debt-vulnerable economies, a 30 percent haircut of 2021 public exter... more

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Towards UHC: thinking public

World Health Organisation (WHO) (2017) C_WHO

Past quantitative research on health financing has focused mostly on the level and distribution of total expenditure, with little emphasis on the specific role of public funds, despite their known importance for universal health coverage (UHC). Health Accounts data do not disaggregate public expendi... more

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Funding the future of the HIV response

The Lancet Editorial (2022) CC

Substantial progress in the fight against HIV has been made over the past decade. Advances in HIV prevention, testing, and treatment have been matched by declines in HIV incidence and HIV-related deaths. The success of Botswana reaching the 95-95-95 targets, despite resource limitations, points to a... more

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Measuring the displacement and replacement of government health expenditure: a panel analysis

Dieleman, J.L.; Hanlon, M. The Lancet (2013) CC

Government health expenditure is a primary means of financing health services in many countries. Research assessing the relation between government health expenditure and development assistance for health channelled to governments (DAH-G) has produced contradictory conclusions. This research aims to... more

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Responding to aid volatility: government spending on district health care in Zambia 2006–2017

Jacksona, A.; Forsberg, B.; Chansa, C.; Sundewall, J. (2020) CC

A corruption event in 2009 led to changes in how donors supported the Zambian health system. Donor funding was withdrawn from the district basket mechanism, originally designed to pool donor and government financing for primary care. The withdrawal of these funds from the pooled financing mechanism ... more

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Tuberculosis Research Funding Trends 2005-2020

World Health Organisation (WHO) (2021) C_WHO

Previous advocacy efforts have achieved tangible goals in terms garnering political commitments to increase financing for TB—as seen at the 2018 UN High-Level Meeting on TB. The challenge now is to ensure that these commitments are actually met within a global biomedical research ecosystem that... more

Trends in the alignment and harmonization of reproductive, maternal, newborn, and child health funding, 2008–13

Martinez-Alvarez M.; Achary A.; Arregoces L. et al. Health Affairs (2017) CC

Donor financing to low- and middle-income countries for reproductive, maternal, newborn, and child health increased substantially from 2008 to 2013. However, increased spending by donors might not improve outcomes, if funds are delivered in ways that undermine countries’ public financial managemen... more

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National spending on health by source for 184 countries between 2013 and 2040

Dieleman, J.; Templin, T.; Sadat, N. et al. (2016) CC

A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at simi...lar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. Methods We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. Findings Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending. Interpretation Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action. Funding Bill & Melinda Gates Foundation. more

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Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review

Maurice Bucagu, Jean M. Kagubare, Paulin Basinga, Fidèle Ngabo, Barbara K Timmons & Angela C Lee Reproductive Health Matters (2012) CC

From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health. Based on a systematic review of the lit... more