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 Academic Article uri icon

  •  
  • Overview
  •  
  • Research
  •  
  • Identity
  •  
  • Additional Document Info
  •  
  • View All
  •  

abstract

  • 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.

authors

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

publication date

  • October 2021