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Spending on Health and Hiv/Aids: Domestic Health Spending and Development Assistance in 188 Countries, 1995–2015 Publisher Pubmed



Dieleman JL1 ; Haakenstad A1 ; Micah A1 ; Moses M1 ; Abbafati C2 ; Acharya P3 ; Adhikari TB4 ; Adou AK5 ; Kiadaliri AA6 ; Alam K7 ; Alizadehnavaei R8 ; Alkerwi A12 ; Ammar W13 ; Antonio CAT14 Show All Authors
Authors
  1. Dieleman JL1
  2. Haakenstad A1
  3. Micah A1
  4. Moses M1
  5. Abbafati C2
  6. Acharya P3
  7. Adhikari TB4
  8. Adou AK5
  9. Kiadaliri AA6
  10. Alam K7
  11. Alizadehnavaei R8
  12. Alkerwi A12
  13. Ammar W13
  14. Antonio CAT14
  15. Aremu O15
  16. Asgedom SW17
  17. Atey TM17
  18. Avilaburgos L18
  19. Awasthi A19
  20. Ayer R20
  21. Badali H9
  22. Banach M21
  23. Banstola A22
  24. Barac A23
  25. Belachew AB16
  26. Birungi C24
  27. Bragazzi NL25
  28. Breitborde NJK26
  29. Cahuanahurtado L18
  30. Car J27, 29
  31. Catalalopez F30, 31
  32. Chapin A1
  33. Dandona L1, 32
  34. Dandona R1, 32
  35. Daryani A10
  36. Dharmaratne SD33
  37. Dubey M34
  38. Edessa D35
  39. Eldrenkamp E1
  40. Eshrati B36, 37
  41. Faro A38
  42. Feigl AB39
  43. Fenny AP40
  44. Fischer F41
  45. Foigt N42
  46. Foreman KJ1, 29
  47. Fullman N1
  48. Ghimire M43
  49. Goli S44
  50. Hailu AD45, 46
  51. Hamidi S47
  52. Harb HL13
  53. Hay SI1, 48
  54. Hendrie D49
  55. Ikilezi G1
  56. Javanbakht M50
  57. John D51
  58. Jonas JB52
  59. Kaldjian A1
  60. Kasaeian A53, 54
  61. Kates J58
  62. Khalil IA1
  63. Khang YH59, 60
  64. Khubchandani J61
  65. Kim YJ62
  66. Kinge JM63
  67. Kosen S64
  68. Krohn KJ1
  69. Kumar GA32
  70. Lam H65
  71. Listl S66, 68
  72. El Razek HMA69
  73. El Razek MMA70
  74. Majeed A28
  75. Malekzadeh R55
  76. Malta DC71
  77. Mensah GA72
  78. Meretoja A73, 74
  79. Miller TR49, 75
  80. Mirrakhimov EM76, 77
  81. Mlashu FW35
  82. Mohammed E17
  83. Mohammed S67, 68, 78
  84. Naghavi M1
  85. Nangia V79
  86. Ngalesoni FN80
  87. Nguyen CT81
  88. Nguyen TH81
  89. Niriayo Y17
  90. Noroozi M82
  91. Owolabi MO83, 84
  92. Pereira DM85
  93. Qorbani M87
  94. Rafay A88, 89
  95. Rafiei A11
  96. Rahimimovaghar V56
  97. Rai RK90
  98. Ram U34
  99. Ranabhat CL91, 92
  100. Ray SE1
  101. Reiner RC1
  102. Sadat N1
  103. Sajadi HS57
  104. Santos JV86, 93
  105. Sarker AR94
  106. Sartorius B95, 96
  107. Satpathy M97
  108. Savic M63
  109. Schneider M1
  110. Sepanlou SG55
  111. Shaikh MA98
  112. Sharif M10
  113. She J99
  114. Sheikh A100, 101
  115. Sisay M35
  116. Soneji S102
  117. Soofi M103
  118. Tadesse AH104
  119. Tao T1
  120. Templin T105
  121. Tesema AG17
  122. Thapa S106
  123. Thomson AJ107
  124. Tobegai R108
  125. Topormadry R109, 110
  126. Tran BX111, 112
  127. Tran KB113
  128. Tran TT81
  129. Undurraga EA114
  130. Vasankari T115
  131. Violante FS116
  132. Wijeratne T73, 117
  133. Xu G118
  134. Yonemoto N119
  135. Younis MZ120
  136. Yu C121
  137. El Sayed Zaki M69
  138. Zhou L122
  139. Zlavog B1
  140. Murray CJL1
Show Affiliations
Authors Affiliations
  1. 1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  2. 2. La Sapienza University, Rome, Italy
  3. 3. Nepal Development Society, Chitwan, Nepal
  4. 4. Faculty of Health Sciences, Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
  5. 5. Association Ivoirienne pour le Bien-Etre Familial, Abidjan, Cote d'Ivoire
  6. 6. Clinical Epidemiology Unit, Department of Clinical Sciences, Department of Orthopaedics, Lund, Lund University, Lund, Sweden
  7. 7. School of Population and Global Health, University of Western Australia, Perth, WA, Australia
  8. 8. Gastrointestinal Cancer Research Center
  9. 9. Invasive Fungi Research Center
  10. 10. Toxoplasmosis Research Center
  11. 11. Molecular and Cell Biology Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  12. 12. Luxembourg Institute of Health, Strassen, Luxembourg
  13. 13. Ministry of Public Health, Beirut, Lebanon
  14. 14. Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
  15. 15. University Department of Public Health and Therapies, Birmingham, United Kingdom
  16. 16. School of Public Health, Mekelle, Ethiopia
  17. 17. Mekelle University, Mekelle, Ethiopia
  18. 18. National Institute of Public Health, Cuernavaca, Mexico
  19. 19. Indian Institute of Public Health, Gandhinagar, India
  20. 20. University of Tokyo, Tokyo, Japan
  21. 21. Department of Hypertension, Medical University of Lodz, Lodz, Poland
  22. 22. Public Health Perspective Nepal, Pokhara, Nepal
  23. 23. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  24. 24. University College London, London, United Kingdom
  25. 25. University of Genoa, Genoa, Italy
  26. 26. Ohio State University, Columbus, OH, United States
  27. 27. LKCMedicine, Nanyang Technological University, Singapore
  28. 28. Department of Primary Care & Public Health
  29. 29. Imperial College London, London, United Kingdom
  30. 30. Department of Medicine, INCLIVA Health Research Institute, CIBERSAM, University of Valencia, Valencia, Spain
  31. 31. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
  32. 32. Public Health Foundation of India, Gurugram, India
  33. 33. Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  34. 34. International Institute for Population Sciences, Mumbai, India
  35. 35. Haramaya University, Harar, Ethiopia
  36. 36. Ministry of Health and Medical Education, Tehran, Iran
  37. 37. Arak University of Medical Sciences, Arak, Iran
  38. 38. Federal University of Sergipe, Aracaju, Brazil
  39. 39. Department of Global Health and Population, T H Chan School of Public Health, Harvard University, Boston, MA, United States
  40. 40. University of Ghana, Legon, Ghana
  41. 41. School of Public Health, Bielefeld University, Bielefeld, Germany
  42. 42. Institute of Gerontology, Academy of Medical Science, Kyiv, Ukraine
  43. 43. University of Tsukuba, Tsukuba, Japan
  44. 44. Jawaharlal Nehru University, New Delhi, India
  45. 45. Addis Ababa University, Addis Ababa, Ethiopia
  46. 46. University of Bergen, Bergen, Norway
  47. 47. Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  48. 48. Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford University, Oxford, United Kingdom
  49. 49. School of Public Health, Curtin University, Perth, WA, Australia
  50. 50. University of Aberdeen, Aberdeen, United Kingdom
  51. 51. Campbell Collaboration, New Delhi, India
  52. 52. Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
  53. 53. Hematology-Oncology and Stem Cell Transplantation Research Center
  54. 54. Hematologic Malignancies Research Center
  55. 55. Digestive Diseases Research Institute
  56. 56. Sina Trauma and Surgery Research Center, Iran
  57. 57. National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
  58. 58. Kaiser Family Foundation, Washington, DC, United States
  59. 59. Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
  60. 60. Institute of Health Policy and Management, Seoul National University Medical Center, Seoul, South Korea
  61. 61. Department of Nutrition and Health Science, Ball State University, Muncie, IN, United States
  62. 62. School of Medicine, Xiamen University Malaysia Campus, Sepang, Malaysia
  63. 63. Norwegian Institute of Public Health, Oslo, Norway
  64. 64. Center for Community Empowerment, Health Policy and Humanities, National Institute of Health Research & Development, Jakarta, Indonesia
  65. 65. Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
  66. 66. Radboud University Medical Center, Nijmegen, Netherlands
  67. 67. Institute of Public Health, Heidelberg, Germany
  68. 68. Heidelberg University, Heidelberg, Germany
  69. 69. Faculty of Medicine, Mansoura University, Mansoura, Egypt
  70. 70. Aswan University Hospital, Aswan Faculty of Medicine, Aswan, Egypt
  71. 71. Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  72. 72. Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
  73. 73. Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
  74. 74. Department of Neurology, Helsinki University Hospital, Helsinki, Finland
  75. 75. Pacific Institute for Research & Evaluation, Calverton, MD, United States
  76. 76. Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
  77. 77. National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
  78. 78. Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
  79. 79. Suraj Eye Institute, Nagpur, India
  80. 80. Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
  81. 81. Institute for Global Health Innovations, Duy Tan University, Da Nang, Viet Nam
  82. 82. Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
  83. 83. Department of Medicine, University of Ibadan, Ibadan, Nigeria
  84. 84. Blossom Specialist Medical Center, Ibadan, Nigeria
  85. 85. REQUIMTE/LAQV, Laboratorio de Farmacognosia, Departamento de Quimica, Faculdade de Farmacia
  86. 86. Faculty of Medicine, University of Porto, Porto, Portugal
  87. 87. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  88. 88. Contech International Health Consultants, Lahore, Pakistan
  89. 89. Contech School of Public Health, Lahore, Pakistan
  90. 90. Society for Health and Demographic Surveillance, Suri, India
  91. 91. Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, South Korea
  92. 92. Health Science Foundation and Study Center, Kathmandu, Nepal
  93. 93. Department of Community Medicine, Information and Health Decision Sciences, Center for Health Technology and Services Research – CINTESIS, Porto, Portugal
  94. 94. International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
  95. 95. Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
  96. 96. UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council, Durban, South Africa
  97. 97. Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
  98. 98. Karachi, Pakistan
  99. 99. Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
  100. 100. University of Edinburgh, Edinburgh, United Kingdom
  101. 101. Harvard Medical School, Boston, MA, United States
  102. 102. Dartmouth College, Hanover, NH, United States
  103. 103. Kermanshah University of Medical Sciences, Kermanshah, Iran
  104. 104. Mizan-Tepi University, Mizan-Teferi, Ethiopia
  105. 105. Stanford University, Palo Alto, CA, United States
  106. 106. KU Leuven, Leuven, Belgium
  107. 107. Adaptive Knowledge Management, Victoria, BC, Canada
  108. 108. National Center for Child Health and Development, Tokyo, Japan
  109. 109. Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
  110. 110. Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
  111. 111. Johns Hopkins University, Baltimore, MD, United States
  112. 112. Hanoi Medical University, Hanoi, Viet Nam
  113. 113. Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
  114. 114. School of Government, Pontificia Universidad Catolica de Chile, Santiago, Chile
  115. 115. UKK Institute for Health Promotion Research, Tampere, Finland
  116. 116. University of Bologna, Bologna, Italy
  117. 117. Western Health, Footscray, VIC, Australia
  118. 118. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
  119. 119. Department of Biostatsistics, School of Public Health, Kyoto University, Kyoto, Japan
  120. 120. Jackson State University, Jackson, MS, United States
  121. 121. Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Wuhan University, Wuhan, China
  122. 122. Jinan Central Hospital, Jinan, China

Source: The Lancet Published:2018


Abstract

Background: Comparable estimates of health spending are crucial for the assessment of health systems and to optimally deploy health resources. The methods used to track health spending continue to evolve, but little is known about the distribution of spending across diseases. We developed improved estimates of health spending by source, including development assistance for health, and, for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries. Methods: We collected published data on domestic health spending, from 1995 to 2015, from a diverse set of international agencies. We tracked development assistance for health from 1990 to 2017. We also extracted 5385 datapoints about HIV/AIDS spending, between 2000 and 2015, from online databases, country reports, and proposals submitted to multilateral organisations. We used spatiotemporal Gaussian process regression to generate complete and comparable estimates for health and HIV/AIDS spending. We report most estimates in 2017 purchasing-power parity-adjusted dollars and adjust all estimates for the effect of inflation. Findings: Between 1995 and 2015, global health spending per capita grew at an annualised rate of 3·1% (95% uncertainty interval [UI] 3·1 to 3·2), with growth being largest in upper-middle-income countries (5·4% per capita [UI 5·3–5·5]) and lower-middle-income countries (4·2% per capita [4·2–4·3]). In 2015, $9·7 trillion (9·7 trillion to 9·8 trillion) was spent on health worldwide. High-income countries spent $6·5 trillion (6·4 trillion to 6·5 trillion) or 66·3% (66·0 to 66·5) of the total in 2015, whereas low-income countries spent $70·3 billion (69·3 billion to 71·3 billion) or 0·7% (0·7 to 0·7). Between 1990 and 2017, development assistance for health increased by 394·7% ($29·9 billion), with an estimated $37·4 billion of development assistance being disbursed for health in 2017, of which $9·1 billion (24·2%) targeted HIV/AIDS. Between 2000 and 2015, $562·6 billion (531·1 billion to 621·9 billion) was spent on HIV/AIDS worldwide. Governments financed 57·6% (52·0 to 60·8) of that total. Global HIV/AIDS spending peaked at 49·7 billion (46·2–54·7) in 2013, decreasing to $48·9 billion (45·2 billion to 54·2 billion) in 2015. That year, low-income and lower-middle-income countries represented 74·6% of all HIV/AIDS disability-adjusted life-years, but just 36·6% (34·4 to 38·7) of total HIV/AIDS spending. In 2015, $9·3 billion (8·5 billion to 10·4 billion) or 19·0% (17·6 to 20·6) of HIV/AIDS financing was spent on prevention, and $27·3 billion (24·5 billion to 31·1 billion) or 55·8% (53·3 to 57·9) was dedicated to care and treatment. Interpretation: From 1995 to 2015, total health spending increased worldwide, with the fastest per capita growth in middle-income countries. While these national disparities are relatively well known, low-income countries spent less per person on health and HIV/AIDS than did high-income and middle-income countries. Furthermore, declines in development assistance for health continue, including for HIV/AIDS. Additional cuts to development assistance could hasten this decline, and risk slowing progress towards global and national goals. Funding: The Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license