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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 Publisher Pubmed



Micah AE1 ; Cogswell IE1 ; Cunningham B1 ; Ezoe S3 ; Harle AC1 ; Maddison ER1 ; Mccracken D1 ; Nomura S3, 4 ; Simpson KE1 ; Stutzman HN1 ; Tsakalos G1 ; Wallace LE1 ; Zhao Y5 ; Zende RR1 Show All Authors
Authors
  1. Micah AE1
  2. Cogswell IE1
  3. Cunningham B1
  4. Ezoe S3
  5. Harle AC1
  6. Maddison ER1
  7. Mccracken D1
  8. Nomura S3, 4
  9. Simpson KE1
  10. Stutzman HN1
  11. Tsakalos G1
  12. Wallace LE1
  13. Zhao Y5
  14. Zende RR1
  15. Abbafati C8
  16. Abdelmasseh M9
  17. Abedi A10
  18. Abegaz KH12, 13
  19. Abhilash ES14
  20. Abolhassani H15, 16
  21. Abrigo MRM26
  22. Adhikari TB27, 28
  23. Afzal S29, 30
  24. Ahinkorah BO31
  25. Ahmadi S32
  26. Ahmed H36
  27. Ahmed MB37, 38
  28. Ahmed Rashid T39
  29. Ajami M33, 40
  30. Aji B41
  31. Akalu Y42
  32. Akunna CJ45, 46
  33. Al Hamad H47, 48
  34. Alam K49
  35. Alanezi FM54
  36. Alanzi TM50
  37. Alemayehu Y55
  38. Alhassan RK56
  39. Alinia C59
  40. Aljunid SM60, 61
  41. Almustanyir SA62, 63
  42. Alvisguzman N64, 66
  43. Alviszakzuk NJ65, 67
  44. Amini S69
  45. Aminirarani M71
  46. Amu H57
  47. Ancuceanu R72
  48. Andrei CL73
  49. Andrei T76
  50. Angell B78, 79
  51. Anjomshoa M17
  52. Antonio CAT80, 81
  53. Antony CM1
  54. Aqeel M82
  55. Arabloo J83
  56. Arabzozani M89
  57. Aripov T90, 91
  58. Arrigo A92
  59. Ashraf T93
  60. Atnafu DD96
  61. Ausloos M76, 97
  62. Avilaburgos L98
  63. Awan AT100, 101
  64. Ayano G102
  65. Ayanore MA58
  66. Azari S83
  67. Azhar GS1, 103
  68. Babalola TK104, 105
  69. Bahrami MA107
  70. Baig AA111
  71. Banach M113, 114
  72. Barati N115
  73. Barnighausen TW116, 118
  74. Barrow A121, 122
  75. Basu S119, 123
  76. Baune BT127, 128
  77. Bayati M108
  78. Benzian H129
  79. Berman AE131
  80. Bhagavathula AS132, 133
  81. Bhardwaj N134
  82. Bhardwaj P135, 136
  83. Bhaskar S139, 140
  84. Bibi S141
  85. Bijani A142
  86. Bodolica V143
  87. Bragazzi NL144
  88. Braithwaite D145, 146
  89. Breitborde NJK147, 148
  90. Breusov AV150
  91. Briko NI151
  92. Busse R152
  93. Cahuanahurtado L153
  94. Callander EJ154
  95. Camera LA155, 156
  96. Castanedaorjuela CA68, 157
  97. Catalalopez F158, 159
  98. Charan J137
  99. Chatterjee S160
  100. Chattu SK161
  101. Chattu VK162, 163
  102. Chen S116
  103. Cicero AFG164
  104. Dadras O166, 167
  105. Dahlawi SMA51
  106. Dai X1
  107. Dalal K168, 169
  108. Dandona L1, 170, 171
  109. Dandona R1, 2, 170
  110. Davitoiu DV74, 172
  111. De Neve JW116
  112. Denovagutierrez E99
  113. Dhamnetiya D174
  114. Dharmaratne SD1, 2, 175
  115. Doshmangir L176
  116. Dube J179
  117. Ehsanichimeh E18
  118. El Sayed Zaki M180
  119. El Tantawi M181
  120. Eskandarieh S19
  121. Farzadfar F20
  122. Ferede TY182
  123. Fischer F184
  124. Foigt NA185
  125. Freitas A186, 189
  126. Friedman SD130
  127. Fukumoto T190
  128. Fullman N1
  129. Gaal PA191, 193
  130. Gad MM194, 197
  131. Garciagordillo MA198
  132. Garg T199
  133. Ghafourifard M177
  134. Ghashghaee A83, 84
  135. Gholamian A200, 201
  136. Gholamrezanezhad A11
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  138. Gilani SA94, 203
  139. Glavan IR76
  140. Glushkova EV151
  141. Goharinezhad S85
  142. Golechha M204
  143. Goli S206, 207
  144. Guha A149, 208
  145. Gupta VB211
  146. Gupta VK212
  147. Haakenstad A1, 213
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  149. Hailu A215
  150. Hamidi S218
  151. Hanif A95
  152. Harapan H219
  153. Hartono RK220
  154. Hasaballah AI221
  155. Hassan S216, 217
  156. Hassanein MH195
  157. Hayat K222, 223
  158. Hegazy MI224
  159. Heidari G225
  160. Hendrie D102
  161. Herediapi I98
  162. Herteliu C76, 226
  163. Hezam K227, 228
  164. Holla R229
  165. Hossain SJ235
  166. Hosseinzadeh M83
  167. Hostiuc S75, 236
  168. Huda TM235, 237
  169. Hwang BF240
  170. Iavicoli I241
  171. Idrisov B242, 243
  172. Ilesanmi OS244, 246
  173. Irvani SSN248
  174. Islam SMS238, 249
  175. Ismail NE251
  176. Isola G252
  177. Jahani MA142
  178. Jahanmehr N34, 35
  179. Jakovljevic M253, 254
  180. Janodia MD230
  181. Javaheri T255
  182. Jayapal SK257
  183. Jayawardena R258, 260
  184. Jazayeri SB261
  185. Jha RP262, 263
  186. Jonas JB117, 264
  187. Joo T191
  188. Joukar F265, 266
  189. Jurisson M267
  190. Kaambwa B268, 269
  191. Kalhor R271, 272
  192. Kanchan T138
  193. Kandel H239, 273
  194. Karami Matin B274
  195. Karimi SE178
  196. Kassahun G183
  197. Kayode GA278, 279
  198. Kazemi Karyani A274
  199. Keikavoosiarani L280
  200. Khader YS281
  201. Khajuria H282
  202. Khalilov R283, 284
  203. Khammarnia M285
  204. Khan J286
  205. Khubchandani J289
  206. Kianipour N275
  207. Kim GR290
  208. Kim YJ292
  209. Kisa A293, 294
  210. Kisa S295
  211. Kohler S116
  212. Kosen S296
  213. Koteeswaran R297
  214. Koulmane Laxminarayana SL298
  215. Koyanagi A299, 300
  216. Krishan K301
  217. Kumar GA170
  218. Kusuma D124, 302
  219. Lamnisos D303
  220. Lansingh VC304, 305
  221. Larsson AO306, 307
  222. Lasrado S308
  223. Le LKD250
  224. Lee SWH309, 310
  225. Lee YY311, 312
  226. Lim SS1, 2
  227. Lobo SW313, 314
  228. Lozano R1, 2
  229. Magdy Abd El Razek H315
  230. Magdy Abd El Razek M316
  231. Mahdavi MM317
  232. Majeed A125
  233. Makki A318
  234. Maleki A21, 319
  235. Malekzadeh R22, 109
  236. Manda AL74, 321
  237. Mansourghanaei F265, 266
  238. Mansournia MA23
  239. Marrugo Arnedo CA66, 322
  240. Martinezvalle A323, 324
  241. Masoumi SZ325
  242. Maude RJ6, 326
  243. Mckee M327
  244. Medinasolis CE329
  245. Menezes RG52
  246. Meretoja A330, 332
  247. Meretoja TJ331, 333
  248. Mesregah MK10, 334
  249. Mestrovic T335, 336
  250. Milevska Kostova N337, 338
  251. Miller TR102, 339
  252. Mini GK340, 341
  253. Mirica A76
  254. Mirrakhimov EM342, 343
  255. Mohajer B20
  256. Mohamed TA344
  257. Mohammadi M345
  258. Mohammadianhafshejani A346
  259. Mohammed S116, 347
  260. Moitra M1
  261. Mokdad AH1, 2
  262. Molokhia M348
  263. Moni MA349
  264. Moradi Y320
  265. Morze J350
  266. Mousavi SM351
  267. Mpundukaambwa C270
  268. Muriithi MK354
  269. Muthupandian S356, 358
  270. Nagarajan AJ359, 360
  271. Naimzada MD361
  272. Nangia V363
  273. Naqvi AA53, 364
  274. Narayana AI231
  275. Nascimento BR365, 366
  276. Naveed M367
  277. Nayak BP282
  278. Nazari J70
  279. Ndejjo R368
  280. Negoi I74, 369
  281. Neupane Kandel S370
  282. Nguyen TH371, 372
  283. Nonvignon J374
  284. Noubiap JJ375
  285. Nwatah VE376, 377
  286. Oancea B378
  287. Ojelabi FAO379
  288. Olagunju AT106, 380
  289. Olakunde BO381
  290. Olgiati S382
  291. Olusanya JO383
  292. Onwujekwe OE384
  293. Otoiu A76
  294. Otstavnov N361
  295. Otstavnov SS361
  296. Owolabi MO245, 247
  297. Padubidri JR229
  298. Palladino R125, 241
  299. Pandajonas S117
  300. Park EC290, 291
  301. Pashazadeh Kan F88
  302. Pawar S385
  303. Pazoki Toroudi H86, 87
  304. Pereira DM187
  305. Perianayagam A287
  306. Pesudovs K386
  307. Piccinelli C387
  308. Postma MJ388, 389
  309. Prada SI390, 391
  310. Rabiee M392
  311. Rabiee N393
  312. Rahim F24, 394
  313. Rahimimovaghar V25
  314. Hifz Ur Rahman M396
  315. Rahman M397
  316. Rahmani AM373, 398
  317. Ram U288
  318. Ranabhat CL399, 400
  319. Ranasinghe P259
  320. Rao CR232
  321. Rathi P229
  322. Rawaf DL126, 401
  323. Rawaf S125, 402
  324. Rawal L403
  325. Rawassizadeh R256
  326. Renzaho AMN404, 405
  327. Reshmi B233
  328. Riaz MA112
  329. Ripon RK406
  330. Saad AM196
  331. Sahraian MA19
  332. Sahu M1
  333. Salama JS407
  334. Salehi S11
  335. Samy AM408
  336. Sanabria J9, 209
  337. Sanmarchi F165
  338. Santos JV188, 409
  339. Santricmilicevic MM410, 411
  340. Sathian B47, 412
  341. Savic M413
  342. Saxena D205, 414
  343. Sayyah M395
  344. Schwendicke F415
  345. Senthilkumaran S416
  346. Sepanlou SG22, 109
  347. Seylani A417
  348. Shahabi S110
  349. Shaikh MA418
  350. Sheikh A120, 419
  351. Shetty A420
  352. Shetty PH421
  353. Shibuya K422
  354. Shrime MG423
  355. Shuja KH424
  356. Singh JA425, 426
  357. Skryabin VY427
  358. Skryabina AA429
  359. Soltani S274
  360. Soofi M276
  361. Spurlock EE1
  362. Stefan SC77
  363. Szerencses V191
  364. Szocska M192
  365. Tabaresseisdedos R430, 431
  366. Taddele BW432
  367. Tefera YG43
  368. Thavamani A210, 433
  369. Tobegai R434
  370. Topormadry R435, 436
  371. Tovanipalone MR437, 438
  372. Tran BX439
  373. Tudor Car L440
  374. Ullah A441
  375. Ullah S141
  376. Umar N328
  377. Undurraga EA442
  378. Valdez PR156, 443
  379. Vasankari TJ444
  380. Villafane JH445
  381. Violante FS164, 446
  382. Vlassov V362
  383. Vo B447
  384. Vollmer S448
  385. Vos T1, 2
  386. Vu GT449
  387. Vu LG371, 372
  388. Wamai RG355, 450
  389. Werdecker A451
  390. Woldekidan MA452
  391. Wubishet BL357, 453
  392. Xu G454
  393. Yaya S7, 455
  394. Yazdifeyzabadi V352, 353
  395. Yigit V456
  396. Yip P457, 458
  397. Yirdaw BW44
  398. Yonemoto N459, 460
  399. Younis MZ461, 462
  400. Yu C463
  401. Yunusa I118, 465
  402. Zahirian Moghadam T466
  403. Zandian H466, 467
  404. Zastrozhin MS428, 468
  405. Zastrozhina A469
  406. Zhang ZJ464
  407. Ziapour A277
  408. Zuniga YMH470, 471
  409. Hay SI1, 2
  410. Murray CJL1, 2
  411. Dieleman JL1, 2

Source: The Lancet Published:2021


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. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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