TY - JOUR
T1 - Tracking development assistance for health and for COVID-19
T2 - a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050
AU - Global Burden of Disease 2020 Health Financing Collaborator Network
AU - Micah, Angela E.
AU - Cogswell, Ian E.
AU - Cunningham, Brandon
AU - Ezoe, Satoshi
AU - Harle, Anton C.
AU - Maddison, Emilie R.
AU - McCracken, Darrah
AU - Nomura, Shuhei
AU - Simpson, Kyle E.
AU - Stutzman, Hayley N.
AU - Tsakalos, Golsum
AU - Wallace, Lindsey E.
AU - Zhao, Yingxi
AU - Zende, Rahul R.
AU - Abbafati, Cristiana
AU - Abdelmasseh, Michael
AU - Abedi, Aidin
AU - Abegaz, Kedir Hussein
AU - Abhilash, E. S.
AU - Abolhassani, Hassan
AU - Abrigo, Michael R.M.
AU - Adhikari, Tara Ballav
AU - Afzal, Saira
AU - Ahinkorah, Bright Opoku
AU - Ahmadi, Sepideh
AU - Ahmed, Haroon
AU - Ahmed, Muktar Beshir
AU - Ahmed Rashid, Tarik
AU - Ajami, Marjan
AU - Aji, Budi
AU - Akalu, Yonas
AU - Akunna, Chisom Joyqueenet
AU - Al Hamad, Hanadi
AU - Alam, Khurshid
AU - Alanezi, Fahad Mashhour
AU - Alanzi, Turki M.
AU - Alemayehu, Yosef
AU - Alhassan, Robert Kaba
AU - Alinia, Cyrus
AU - Aljunid, Syed Mohamed
AU - Almustanyir, Sami Almustanyir
AU - Alvis-Guzman, Nelson
AU - Alvis-Zakzuk, Nelson J.
AU - Amini, Saeed
AU - Amini-Rarani, Mostafa
AU - Amu, Hubert
AU - Ancuceanu, Robert
AU - Andrei, Catalina Liliana
AU - Andrei, Tudorel
AU - Nonvignon, Justice
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2021/10/9
Y1 - 2021/10/9
N2 - Background: 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 disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Funding: Bill & Melinda Gates Foundation.
AB - Background: 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 disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Funding: Bill & Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85116527441&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(21)01258-7
DO - 10.1016/S0140-6736(21)01258-7
M3 - Article
C2 - 34562388
AN - SCOPUS:85116527441
SN - 0140-6736
VL - 398
SP - 1317
EP - 1343
JO - The Lancet
JF - The Lancet
IS - 10308
ER -