Title
Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3
Date Issued
05 September 2020
Access level
open access
Resource Type
journal article
Author(s)
Micah A.E.
Su Y.
Bachmeier S.D.
Chapin A.
Cogswell I.E.
Crosby S.W.
Cunningham B.
Harle A.C.
Maddison E.R.
Moitra M.
Sahu M.
Schneider M.T.
Simpson K.E.
Stutzman H.N.
Tsakalos G.
Zende R.R.
Zlavog B.S.
Abbafati C.
Abebo Z.H.
Abolhassani H.
Abrigo M.R.M.
Ahmed M.B.
Akinyemi R.O.
Alam K.
Ali S.
Alinia C.
Alipour V.
Aljunid S.M.
Almasi A.
Alvis-Guzman N.
Ancuceanu R.
Andrei T.
Andrei C.L.
Anjomshoa M.
Antonio C.A.T.
Arabloo J.
Arab-Zozani M.
Aremu O.
Atnafu D.D.
Ausloos M.
Avila-Burgos L.
Ayanore M.A.
Azari S.
Babalola T.K.
Bagherzadeh M.
Baig A.A.
Bakhtiari A.
Banach M.
Banerjee S.K.
Bärnighausen T.W.
Basu S.
Baune B.T.
Bayati M.
Berman A.E.
Bhageerathy R.
Bhardwaj P.
Bohluli M.
Busse R.
Cahuana-Hurtado L.
Cámera L.L.A.
Castañeda-Orjuela C.A.
Catalá-López F.
Cevik M.
Chattu V.K.
Dandona L.
Dandona R.
Dianatinasab M.
Do H.T.
Doshmangir L.
El Tantawi M.
Eskandarieh S.
Esmaeilzadeh F.
Faraj A.
Farzadfar F.
Fischer F.
Foigt N.A.
Fullman N.
Gad M.M.
Ghafourifard M.
Ghashghaee A.
Gholamian A.
Goharinezhad S.
Grada A.
Haghparast Bidgoli H.
Hamidi S.
Harb H.L.
Hasanpoor E.
Hay S.I.
Hendrie D.
Henry N.J.
Herteliu C.
Hole M.K.
Hosseinzadeh M.
Hostiuc S.
Huda T.M.
Humayun A.
Hwang B.F.
Ilesanmi O.S.
Iqbal U.
Irvani S.S.N.
Publisher(s)
Elsevier B.V.
Abstract
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 measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods: We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings: Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was $5·1 billion (4·9–5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019, $374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation: Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Funding: The Bill & Melinda Gates Foundation.
Start page
693
End page
724
Volume
396
Issue
10252
Language
English
OCDE Knowledge area
Salud pública, Salud ambiental
Ciencias del cuidado de la salud y servicios (administración de hospitales, financiamiento)
Virología
Enfermedades infecciosas
Scopus EID
2-s2.0-85085626757
PubMed ID
Source
The Lancet
ISSN of the container
01406736
Sponsor(s)
R O Akinyemi acknowledges supports from the US National Institutes of Health (NIH; Grant U01HG010273) as part of the H3Africa Consortium and a Global Challenges Research Fund (GCRF) fellowship grant (FLR/R1/191813) from the UK Royal Society and the African Academy of Sciences. S M Aljunid acknowledges International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, and Faculty of Public Health, Kuwait University for the approval and support to participate in this research project. M Ausloos acknowledges partial support from a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI (project number PN-III-P4-ID-PCCF-2016-0084). T W Bärnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the Federal Ministry of Education and Research. S I Hay acknowledges primary support from the Bill & Melinda Gates Foundation (grant OPP1132415). Claudiu Herteliu acknowledges partial support from a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI (project number PN-III-P4-ID-PCCF-2016-0084) and from a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness (project ID P_40_382). B-F Hwang acknowledges support from China Medical University (CMU 107-Z-04), Taichung, Taiwan. S M S Islam acknowledges funding from the National Heart Foundation of Australia and Deakin University. M Jakovljevic acknowledges the Ministry of Education Science and Technological Development of the Republic of Serbia for co-funding for the Serbian part of this Global Burden of Disease (GBD) contribution (grant OI 175 014). A M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. M M Santric Milicevic acknowledges support from The Ministry of Education, Science and Technological Development, Serbia (contract number 175087). A Sheikh acknowledges support from Health Data Research UK. R Tabarés-Seisdedos acknowledges support in part from Generalitat Valenciana (grant number PROMETEOII/2015/021) and from Instituto de Salud Carlos III-La Federación Española de Enfermedades Raras (national grant PI17/00719). J F M van Boven acknowledges support from the Department of Clinical Pharmacy and Pharmacology of the University Medical Center Groningen, University of Groningen, Groningen Netherlands. S B Zaman acknowledges the Australian Government research training programme for providing a scholarship in support of his academic career. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
C A T Antonio reports personal fees from Johnson & Johnson (Philippines) outside of the submitted work. A E Berman reports personal fees from Biosense Webster outside of the submitted work. S L James reports grants from Sanofi Pasteur and future employment with Genentech/Roche outside of the submitted work. J J Jóźwiak reports personal fees from VALEANT, ALAB Laboratoria, and AMGEN outside of the submitted work. M J Postma reports grants and personal fees from MSD, GlaxoSmithKline (GSK), Pfizer, Boehringer Ingelheim, Novavax, Bristol-Myers Squibb, AstraZeneca, Sanofi, Seqirus, and IQVIA; grants from Bayer, BioMerieux, WHO, the European Union? FIND, Antilope, DIKTI, LPDP, and BUDI; personal fees from Novartis, Pharmerit, and Quintiles; holds stocks in Ingress Health and Pharmacoeconomics Advice Groningen; and is advisor to Asc Academics outside of the submitted work. M Savic reports employment with the GSK group of companies and hold restricted shares in the GSK group of companies. M G Shrime reports grants from Mercy Ships and Damon Runyon Cancer Research Foundation outside of the submitted work. J A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Spherix, Practice Point communications, the National Institutes of Health and the American College of Rheumatology, and Simply Speaking; participating in the Speaker's Bureau at Simply Speaking; owning stock options in Amarin Pharmaceuticals and Viking Pharmaceuticals; membership in the FDA Arthritis Advisory Committee, Veterans Affairs Rheumatology Field Advisory Committee, and in the Steering Committee of Outcome Measures in Rheumatology (OMERACT), and acting as Editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis outside of the submitted work. All other authors declare no competing interests.
Although economic development is associated with reducing the domestic health financing burden that is funded by out-of-pocket spending, considerable variation exists in this association ( figure 5A ). For any one level of GDP per capita, a sizeable range of the fraction of domestic health spending is financed by out-of-pocket spending, suggesting that economic development does not solely determine the transition away from household financing. Additionally, large variation exists across countries in the association between rate of change in the fraction of domestic health spending that is out-of-pocket and the rate of change in the proportion of households with catastrophic health expenditure ( figure 5B ). A reliance on domestic government, prepaid, and pooled health financing is a means towards achieving universal health coverage and financial risk protection. Globally, this fraction contributing to universal health coverage ranges from 6·7% (95% UI 4·5–9·1) in Afghanistan to 100% (100–100) in Greenland (for more details see the WHO Global Health Data Exchange).
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