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--2050.

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From: The Lancet(Vol. 398, Issue 10308)
Publisher: Elsevier B.V.
Document Type: Article
Length: 1,566 words

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Abstract :

Summary 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. * Correspondence to: Dr Angela E Micah, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA (footnote)[Dagger] Collaborators are listed at the end of the paper Byline: Angela E Micah [amicah@uw.edu], Ian E Cogswell, Brandon Cunningham, Satoshi Ezoe, Anton C Harle, Emilie R Maddison, Darrah McCracken, Shuhei Nomura, Kyle E Simpson, Hayley N Stutzman, Golsum Tsakalos, Lindsey E Wallace, Yingxi Zhao, Rahul R Zende, Cristiana Abbafati, Michael Abdelmasseh, Aidin Abedi, Kedir Hussein Abegaz, E S Abhilash, Hassan Abolhassani, Michael R M Abrigo, Tara Ballav Adhikari, Saira Afzal, Bright Opoku Ahinkorah, Sepideh Ahmadi, Haroon Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Marjan Ajami, Budi Aji, Yonas Akalu, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Khurshid Alam, Fahad Mashhour Alanezi, Turki M Alanzi, Yosef Alemayehu, Robert Kaba Alhassan, Cyrus Alinia, Syed Mohamed Aljunid, Sami Almustanyir Almustanyir, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Saeed Amini, Mostafa Amini-Rarani, Hubert Amu, Robert Ancuceanu, Catalina Liliana Andrei, Tudorel Andrei, Blake Angell, Mina Anjomshoa, Carl Abelardo T Antonio, Catherine M Antony, Muhammad Aqeel, Jalal Arabloo, Morteza Arab-Zozani, Timur Aripov, Alessandro Arrigo, Tahira Ashraf, Desta Debalkie Atnafu, Marcel Ausloos, Leticia Avila-Burgos, Asma Tahir Awan, Getinet Ayano, Martin Amogre Ayanore, Samad Azari, Gulrez Shah Azhar, Tesleem Kayode Babalola, Mohammad Amin Bahrami, Atif Amin Baig, Maciej Banach, Nastaran Barati, Till Winfried Bärnighausen, Amadou Barrow, Sanjay Basu, Bernhard T Baune, Mohsen Bayati, Habib Benzian, Adam E Berman, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Sadia Bibi, Ali Bijani, Virginia Bodolica, Nicola Luigi Bragazzi, Dejana Braithwaite, Nicholas J K Breitborde, Alexey V Breusov, Nikolay Ivanovich Briko, Reinhard Busse, Lucero Cahuana-Hurtado, Emily Joy Callander, Luis Alberto Cámera, Carlos A Castañeda-Orjuela, Ferrán Catalá-López, Jaykaran Charan, Souranshu Chatterjee, Soosanna Kumary Chattu, Vijay Kumar Chattu, Simiao Chen, Arrigo Francesco Giuseppe Cicero, Omid Dadras, Saad M A Dahlawi, Xiaochen Dai, Koustuv Dalal, Lalit Dandona, Rakhi Dandona, Dragos Virgil Davitoiu, Jan-Walter De Neve, Antonio Reis de Sá-Junior, Edgar Denova-Gutiérrez, Deepak Dhamnetiya, Samath Dhamminda Dharmaratne, Leila Doshmangir, John Dube, Elham Ehsani-Chimeh, Maysaa El Sayed Zaki, Maha El Tantawi, Sharareh Eskandarieh, Farshad Farzadfar, Tomas Y Ferede, Florian Fischer, Nataliya A Foigt, Alberto Freitas, Sara D Friedman, Takeshi Fukumoto, Nancy Fullman, Peter Andras Gaal, Mohamed M Gad, MA Garcia-Gordillo, Tushar Garg, Mansour Ghafourifard, Ahmad Ghashghaee, Asadollah Gholamian, Ali Gholamrezanezhad, Ghozali Ghozali, Syed Amir Gilani, Ionela-Roxana Glavan, Ekaterina Vladimirovna Glushkova, Salime Goharinezhad, Mahaveer Golechha, Srinivas Goli, Avirup Guha, Veer Bala Gupta, Vivek Kumar Gupta, Annie Haakenstad, Mohammad Rifat Haider, Alemayehu Hailu, Samer Hamidi, Asif Hanif, Harapan Harapan, Risky Kusuma Hartono, Ahmed I Hasaballah, Shoaib Hassan, Mohamed H Hassanein, Khezar Hayat, Mohamed I Hegazy, Golnaz Heidari, Delia Hendrie, Ileana Heredia-Pi, Claudiu Herteliu, Kamal Hezam, Ramesh Holla, Sheikh Jamal Hossain, Mehdi Hosseinzadeh, Sorin Hostiuc, Tanvir M Huda, Bing-Fang Hwang, Ivo Iavicoli, Bulat Idrisov, Olayinka Stephen Ilesanmi, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Nahlah Elkudssiah Ismail, Gaetano Isola, Mohammad Ali Jahani, Nader Jahanmehr, Mihajlo Jakovljevic, Manthan Dilipkumar Janodia, Tahereh Javaheri, Sathish Kumar Jayapal, Ranil Jayawardena, Seyed Behzad Jazayeri, Ravi Prakash Jha, Jost B Jonas, Tamas Joo, Farahnaz Joukar, Mikk Jürisson, Billingsley Kaambwa, Rohollah Kalhor, Tanuj Kanchan, Himal Kandel, Behzad Karami Matin, Salah Eddin Karimi, Getinet Kassahun, Gbenga A Kayode, Ali Kazemi Karyani, Leila Keikavoosi-Arani, Yousef Saleh Khader, Himanshu Khajuria, Rovshan Khalilov, Mohammad Khammarnia, Junaid Khan, Jagdish Khubchandani, Neda Kianipour, Gyu Ri Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Stefan Kohler, Soewarta Kosen, Rajasekaran Koteeswaran, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, G Anil Kumar, Dian Kusuma, Demetris Lamnisos, Van Charles Lansingh, Anders O Larsson, Savita Lasrado, Long Khanh Dao Le, Shaun Wen Huey Lee, Yeong Yeh Lee, Stephen S Lim, Stany W Lobo, Rafael Lozano, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Mokhtar Mahdavi Mahdavi, Azeem Majeed, Alaa Makki, Afshin Maleki, Reza Malekzadeh, Ana Laura Manda, Fariborz Mansour-Ghanaei, Mohammad Ali Mansournia, Carlos Alberto Marrugo Arnedo, Adolfo Martinez-Valle, Seyedeh Zahra Masoumi, Richard James Maude, Martin McKee, Carlo Eduardo Medina-Solís, Ritesh G Menezes, Atte Meretoja, Tuomo J Meretoja, Mohamed Kamal Mesregah, Tomislav Mestrovic, Neda Milevska Kostova, Ted R Miller, GK Mini, Andreea Mirica, Erkin M Mirrakhimov, Bahram Mohajer, Teroj Abdulrahman Mohamed, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Modhurima Moitra, Ali H Mokdad, Mariam Molokhia, Mohammad Ali Moni, Yousef Moradi, Jakub Morze, Seyyed Meysam Mousavi, Christine Mpundu-Kaambwa, Moses K Muriithi, Saravanan Muthupandian, Ahamarshan Jayaraman Nagarajan, Mukhammad David Naimzada, Vinay Nangia, Atta Abbas Naqvi, Aparna Ichalangod Narayana, Bruno Ramos Nascimento, Muhammad Naveed, Biswa Prakash Nayak, Javad Nazari, Rawlance Ndejjo, Ionut Negoi, Sandhya Neupane Kandel, Trang Huyen Nguyen, Justice Nonvignon, Jean Jacques Noubiap, Vincent Ebuka Nwatah, Bogdan Oancea, Foluke Adetola Ogunyemi Ojelabi, Andrew T Olagunju, Babayemi Oluwaseun Olakunde, Stefano Olgiati, Jacob Olusegun Olusanya, Obinna E Onwujekwe, Adrian Otoiu, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Jagadish Rao Padubidri, Raffaele Palladino, Songhomitra Panda-Jonas, Eun-Cheol Park, Fatemeh Pashazadeh Kan, Shrikant Pawar, Hamidreza Pazoki Toroudi, David M Pereira, Arokiasamy Perianayagam, Konrad Pesudovs, Cristiano Piccinelli, Maarten J Postma, Sergio I Prada, Mohammad Rabiee, Navid Rabiee, Fakher Rahim, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Rahman, Mosiur Rahman, Amir Masoud Rahmani, Usha Ram, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Priya Rathi, David Laith Rawaf, Salman Rawaf, Lal Rawal, Reza Rawassizadeh, Robert C Reiner Jr, Andre M N Renzaho, Bhageerathy Reshmi, Mavra A Riaz, Rezaul Karim Ripon, Anas M Saad, Mohammad Ali Sahraian, Maitreyi Sahu, Joseph S Salama, Sana Salehi, Abdallah M Samy, Juan Sanabria, Francesco Sanmarchi, João Vasco Santos, Milena M Santric-Milicevic, Brijesh Sathian, Miloje Savic, Deepak Saxena, Mehdi Sayyah, Falk Schwendicke, Subramanian Senthilkumaran, Sadaf G Sepanlou, Allen Seylani, Saeed Shahabi, Masood Ali Shaikh, Aziz Sheikh, Adithi Shetty, Pavanchand H Shetty, Kenji Shibuya, Mark G Shrime, Kanwar Hamza Shuja, Jasvinder A Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Shahin Soltani, Moslem Soofi, Emma Elizabeth Spurlock, Simona Catalina Stefan, Viktória Szerencsés, Miklós Szócska, Rafael Tabarés-Seisdedos, Biruk Wogayehu Taddele, Yonas Getaye Tefera, Aravind Thavamani, Ruoyan Tobe-Gai, Roman Topor-Madry, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Lorainne Tudor Car, Anayat Ullah, Saif Ullah, Nasir Umar, Eduardo A Undurraga, Pascual R Valdez, Tommi Juhani Vasankari, Jorge Hugo Villafañe, Francesco S Violante, Vasily Vlassov, Bay Vo, Sebastian Vollmer, Theo Vos, Giang Thu Vu, Linh Gia Vu, Richard G Wamai, Andrea Werdecker, Mesfin Agachew Woldekidan, Befikadu Legesse Wubishet, Gelin Xu, Sanni Yaya, Vahid Yazdi-Feyzabadi, Vahit Yigit, Paul Yip, Birhanu Wubale Yirdaw, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Ismaeel Yunusa, Telma Zahirian Moghadam, Hamed Zandian, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Arash Ziapour, Yves Miel H Zuniga, Simon I Hay, Christopher J L Murray, Joseph L Dieleman

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Gale Document Number: GALE|A678305559