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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 Publisher Pubmed



Micah AE1 ; Su Y1 ; Bachmeier SD1 ; Chapin A1 ; Cogswell IE1 ; Crosby SW1 ; Cunningham B1 ; Harle AC1 ; Maddison ER1 ; Moitra M1 ; Sahu M1 ; Schneider MT1 ; Simpson KE1 ; Stutzman HN1 Show All Authors
Authors
  1. Micah AE1
  2. Su Y1
  3. Bachmeier SD1
  4. Chapin A1
  5. Cogswell IE1
  6. Crosby SW1
  7. Cunningham B1
  8. Harle AC1
  9. Maddison ER1
  10. Moitra M1
  11. Sahu M1
  12. Schneider MT1
  13. Simpson KE1
  14. Stutzman HN1
  15. Tsakalos G1
  16. Zende RR1
  17. Zlavog BS1
  18. Abbafati C4
  19. Abebo ZH5
  20. Abolhassani H6, 16
  21. Abrigo MRM17
  22. Ahmed MB18, 19
  23. Akinyemi RO21
  24. Alam K22
  25. Ali S23
  26. Alinia C24
  27. Alipour V25, 26
  28. Aljunid SM29, 30
  29. Almasi A32
  30. Alvisguzman N35, 36
  31. Ancuceanu R38
  32. Andrei T40
  33. Andrei CL39
  34. Anjomshoa M42
  35. Antonio CAT43, 44
  36. Arabloo J26
  37. Arabzozani M45
  38. Aremu O46
  39. Atnafu DD47
  40. Ausloos M40, 49
  41. Avilaburgos L50
  42. Ayanore MA51
  43. Azari S26
  44. Babalola TK52, 53
  45. Bagherzadeh M55
  46. Baig AA56, 57
  47. Bakhtiari A9
  48. Banach M58, 59
  49. Banerjee SK60
  50. Barnighausen TW62, 64
  51. Basu S68
  52. Baune BT70, 71
  53. Bayati M73
  54. Berman AE75
  55. Bhageerathy R77
  56. Bhardwaj P80, 81
  57. Bohluli M82, 83
  58. Busse R84
  59. Cahuanahurtado L85
  60. Alberto Camera LLA86, 87
  61. Castanedaorjuela CA89, 90
  62. Catalalopez F91, 92
  63. Cevik M93, 94
  64. Chattu VK95
  65. Dandona L1, 96
  66. Dandona R1, 96
  67. Dianatinasab M72, 97
  68. Do HT98
  69. Doshmangir L100
  70. Tantawi ME104
  71. Eskandarieh S14
  72. Esmaeilzadeh F105
  73. Faraj A109
  74. Farzadfar F15
  75. Fischer F110
  76. Foigt NA111
  77. Fullman N1
  78. Gad MM112, 113
  79. Ghafourifard M101
  80. Ghashghaee A26, 28
  81. Gholamian A115, 116
  82. Goharinezhad S27
  83. Grada A118
  84. Bidgoli HH120
  85. Hamidi S121
  86. Harb HL122
  87. Hasanpoor E105
  88. Hay SI1, 2
  89. Hendrie D123
  90. Henry NJ1
  91. Herteliu C40
  92. Hole MK124
  93. Hosseinzadeh M106, 114
  94. Hostiuc S37, 125
  95. Huda TM126, 128
  96. Humayun A129
  97. Hwang BF130
  98. Ilesanmi OS20, 131
  99. Iqbal U132
  100. Irvani SS221
  101. Islam SMS63, 127, 133
  102. Islam MM134
  103. Jahani MA135
  104. Jakovljevic M136, 137
  105. James SL1
  106. Javaheri Z119
  107. Jonas JB61, 138
  108. Joukar F139
  109. Jozwiak JJ140
  110. Jurisson M141
  111. Kalhor R142, 143
  112. Matin BK34
  113. Karimi SE103
  114. Kayode GA144, 145
  115. Karyani AK33, 34
  116. Kinfu Y146, 147
  117. Kisa A148
  118. Kohler S62
  119. Komaki H150, 151
  120. Kosen S152
  121. Kotlo A154
  122. Koyanagi A155, 156
  123. Kumar GA96
  124. Kusuma D67, 157
  125. Lansingh VC158, 159
  126. Larsson AO160, 161
  127. Lasrado S162
  128. Lee SWH164, 165
  129. Lim LL166, 167
  130. Lozano R1, 2
  131. El Razek HMA168
  132. Mahdavi MM169, 170
  133. Maleki S31
  134. Malekzadeh R10, 74
  135. Mansourghanaei F139
  136. Mansournia MA7
  137. Mantovani LG171, 172
  138. Martinez G173
  139. Masoumi SZ149
  140. Massenburg BB3
  141. Menezes RG174
  142. Mengesha EW48
  143. Meretoja TJ175, 177
  144. Meretoja A176, 178
  145. Mestrovic T179, 180
  146. Kostova NM181, 182
  147. Miller TR123, 183
  148. Mirica A40, 184
  149. Mirrakhimov EM185, 186
  150. Moghadaszadeh M99, 102
  151. Mohajer B14, 15
  152. Mohamadi E11
  153. Darwesh AM108
  154. Mohammadianhafshejani A187
  155. Mohammadpourhodki R188
  156. Mohammed S189
  157. Mohebi F12, 15
  158. Mokdad AH1, 2
  159. Morrison SD3
  160. Mosser JF1
  161. Mousavi SM8
  162. Muriithi MK190
  163. Muthupandian S191
  164. Myint CY192
  165. Naderi M31
  166. Nagarajan AJ193, 194
  167. Nguyen CT195
  168. Nguyen HLT195
  169. Nonvignon J196
  170. Noubiap JJ197
  171. Oh IH198
  172. Olagunju AT54, 199
  173. Olusanya JO200
  174. Olusanya BO200
  175. Bali AO107
  176. Onwujekwe OE201
  177. Otstavnov SS202, 204
  178. Otstavnov N202, 205
  179. Owolabi MO21
  180. Padubidri JR76
  181. Palladino R66, 206
  182. Pandey A96
  183. Postma MJ207, 209
  184. Prada SI210, 211
  185. Pribadi DRA212
  186. Rabiee M213
  187. Rabiee N55
  188. Rahim F13, 214
  189. Ranabhat CL215, 216
  190. Rao SJ217
  191. Rathi P78
  192. Rawaf S66, 218
  193. Rawaf DL69, 219
  194. Rawal L220
  195. Rawassizadeh R117
  196. Rezapour A26
  197. Sabour S222
  198. Sahraian MA14
  199. Salman OM223, 224
  200. Salomon JA225
  201. Samy AM226
  202. Sanabria J227, 228
  203. Santos JV229, 230
  204. Santric Milicevic MM231, 232
  205. Jose BPS233
  206. Savic M234
  207. Schwendicke F235
  208. Senthilkumaran S236
  209. Sepanlou SG10, 74
  210. Servanmori E50
  211. Setayesh H237
  212. Shaikh MA153
  213. Sheikh A238
  214. Shibuya K239
  215. Shrime MG65
  216. Simonetti B241, 242
  217. Singh JA243, 244
  218. Singh P245
  219. Skryabin VY246
  220. Soheili A247, 248
  221. Soltani S34
  222. Stefan SC41
  223. Tabaresseisdedos R249, 250
  224. Topormadry R251, 252
  225. Tovanipalone MR253
  226. Tran BX254
  227. Travillian R1
  228. Undurraga EA255, 256
  229. Valdez PR88, 257
  230. Van Boven JFM208, 209
  231. Vasankari TJ258
  232. Violante FS259, 260
  233. Vlassov V203
  234. Vos T1, 2
  235. Wolfe CDA240, 261
  236. Wu J1
  237. Yaya S262
  238. Yazdifeyzabadi V263, 264
  239. Yip P265, 266
  240. Yonemoto N267
  241. Younis MZ268, 269
  242. Yu C270, 272
  243. Zaidi Z273
  244. Zaman SB128, 163
  245. Zastrozhin MS274, 275
  246. Zhang ZJ271
  247. Zhao Y276
  248. Murray CJL1, 2
  249. Dieleman JL1, 2

Source: The Lancet Published:2020


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. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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